U.S. patent application number 11/316775 was filed with the patent office on 2007-03-15 for vascular closure methods and apparatuses.
Invention is credited to Randy R. Sibbitt, Wilmer L. JR. Sibbitt.
Application Number | 20070060895 11/316775 |
Document ID | / |
Family ID | 37772371 |
Filed Date | 2007-03-15 |
United States Patent
Application |
20070060895 |
Kind Code |
A1 |
Sibbitt; Wilmer L. JR. ; et
al. |
March 15, 2007 |
Vascular closure methods and apparatuses
Abstract
A vascular closure device comprised of a sheath-delivered
expandable, umbrella-like device with structural radial members
with terminal and non-terminal hooks that engage the vessel wall.
Unlike other vascular closure umbrella-type devices that effect
closure by opening of the umbrella to cover an opening, the present
invention effects closure of the aperture with closure of the
umbrella. The closure can be maintained by a retainer lock that
slides down the members, causing contraction, bringing the members
into a compressed configuration (e.g., a parallel orientation of
linear members) and the wound edges together, permitting immediate
vascular closure and healing of the blood vessel. The device can be
delivered and recovered by an intravascular sheath.
Inventors: |
Sibbitt; Wilmer L. JR.;
(Albuquerque, NM) ; Sibbitt; Randy R.; (Helena,
MT) |
Correspondence
Address: |
V. Gerald Grafe, esq.
P.O. Box 2689
Corrales
NM
87048
US
|
Family ID: |
37772371 |
Appl. No.: |
11/316775 |
Filed: |
December 23, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60711279 |
Aug 24, 2005 |
|
|
|
Current U.S.
Class: |
604/215 |
Current CPC
Class: |
A61B 2017/00663
20130101; A61B 17/083 20130101; A61B 17/0057 20130101; A61B
2017/00668 20130101; A61B 17/10 20130101; A61B 17/0643 20130101;
A61B 2017/0641 20130101 |
Class at
Publication: |
604/215 |
International
Class: |
A61M 5/178 20060101
A61M005/178 |
Claims
1) A tissue closure device, comprising: a) A junction body; b) A
plurality of tissue engagement elements, each having first and
second ends, each mounted with the junction body near its first end
in a manner that allows the tissue engagement elements to assume
first and second configurations, and each comprising a portion
spaced from the first end adapted to engage the tissue in both the
first and second configurations, wherein: i) In the first
configuration, the second ends of the tissue engagement elements
are spaced from each other by at least a first distance; ii) In the
second configuration, the second ends of the tissue engagement
elements are spaced from each other by no more than a second
distance, where the second distance is less than the first
distance.
2) A tissue closure device, comprising a plurality of tissue
engagement elements, mounted with each other such that in a first
compressed configuration the tissue engagement elements can pass
through a tissue opening to be closed, and such that in a second
compressed configuration the tissue engagement elements bring the
edges of the opening into apposition, and such that in an expanded
configuration the tissue engagement elements span the opening,
wherein the tissue engagement elements engage the tissue in both
the compressed configuration and in the expanded configuration.
3) A device as in claim 2, wherein the tissue engagement elements
comprise hooks.
4) A device as in claim 2, wherein the tissue engagement elements
comprise wires each having a hook at a first end and slidably
mounted with a lock device at a second end, wherein the wires
assume the expanded configuration when not constrained by the lock
device and assume the compressed configuration when constrained by
the lock device.
5) A device as in claim 4, wherein the wires mount together at
their second ends with a string receiving element adapted to engage
a string such that tension on the string opposed to force on the
lock device urges the wires through the lock device substantially
along the direction of the tension on the string.
6) A tissue closure device, comprising: a) A junction element,
having a string engagement portion; b) A plurality of members,
where each member has a tissue engagement feature at a first end,
and mounted with the junction element such that the members extend
away from the junction element defining a truncated cone; c) A lock
element comprising a collar defining an interior passage, wherein
passage of the junction element through the interior passage
manipulates the members such that the area of the base of the
truncated cone defined by the members is reduced.
7) A device as in claim 6, wherein the members comprise wires each
having a hook at its first end.
8) A device as in claim 6, wherein the members comprise wires each
having a plurality of hooks at its first end.
9) A device as in claim 6, wherein the lock element comprises a
tissue engagement portion adapted to engage tissue over an area
more than three times the area of the interior passage.
10) A device as in claim 6, wherein the junction element comprises
a collar defining an interior passage suitable for passage of a
guidewire therethrough.
11) A device as in claim 6, wherein each member further comprises
one or more secondary tissue engagement features mounted with the
member not at the first end.
12) A device as in claim 6, wherein the secondary tissue engagement
members comprise projections from the member oriented toward the
first end.
13) A device as in claim 6, further comprising a covering extending
between the members.
14) A device as in claim 6, wherein the covering comprises a
therapeutic material eluted when the device is placed in
tissue.
15) A device as in claim 6, wherein the members comprise elongated
diamond shaped elements.
16) A device as in claim 6, wherein the members are connected to
each other by intermember struts.
17) A tissue closure device, comprising: a) A junction element,
having a string engagement portion; b) A plurality of members,
where each member has a tissue engagement feature at a first end,
and mounted with the junction element such that the members extend
away from the junction element defining a truncated cone, and
having one or more secondary tissue engagement features mounted
with the member and oriented toward the first end.
18) A device to close openings in blood vessels comprising an
expandable umbrella-like device that in the compressed state
resides in a sheath; after being expelled from the sheath assumes a
planar or conical shape; after being brought into contact with a
vessel wall engages the vessel wall; and can be collapsed to bring
the edges of the opening into apposition.
19) A method of closing an opening in tissue, comprising: a)
passing a device, as in claim 2, while in the first compressed
condition through a sheath that penetrates the proximal surface of
the tissue; b) expelling the device from the sheath into space
beyond the proximal surface of the tissue such that the device
assumes the expanded configuration; c) manipulating the device such
that the tissue engagement elements engage the tissue; d) causing
the device to assume the second compressed configuration, bringing
the edges of the opening into apposition.
20) A method as in claim 19, further comprising configuring the
device such that it will remain in the second compressed
configuration.
21) A method as in claim 19, wherein causing the device to assume
the second compressed configuration comprises applying traction to
the device.
22) A device as in claim 6, wherein the junction element defines a
lumen suitable for passage of a guidewire therethrough.
23) A device as in claim 2, wherein the tissue engagement elements
comprise a shape memory material such that the tissue engagement
elements assume the expanded configuration unless forced to another
configuration.
24) A method of as in claim 19, wherein: a) The device comprises a
string attachment portion, to which a string is attached; b)
Manipulating the device such that the tissue engagement elements
engage the tissue comprises pulling the string to encourage the
device towards the tissue; c) Causing the device to assume the
second compressed configuration comprises passing the string
through a central passageway of a locking element, passing the
locking element down the string to the device, pulling the string
such that a portion of the device engages the locking element,
which engagement causes the device to assume the second compressed
configuration.
25) A tissue closure device as in claim 2, wherein a) the tissue
engagement elements comprise elongated members, where each
elongated member defines a first portion and a second portion along
the length of the member, and are mounted with each other near the
boundaries of the first and second portions of the members; b) each
tissue engagement element is shaped such that, absent external
restraining force, the first portion and second portion of the
member form an angle less than 180 degrees to each other, and the
mounting of the tissue engagement elements is such that, when the
first portions of the members are substantially parallel to each
other, the second portions extend approximately radially outward
from the mounting, defining the expanded configuration; c) each
tissue engagement element comprises a resilient material, such that
the members can be forced to a configuration where the first
portions of the members and the second portions of the members can
be contemporaneously contained within a sheath, defining the
compressed configuration.
Description
BACKGROUND
[0001] The present invention relates to methods and apparatuses for
closing punctures and apertures in human and animal tissue and to
methods and apparatuses for inserting such an apparatus into such
tissue to perform such closure functions.
[0002] During angiography and related procedures, catheters are
inserted through an incision or puncture in the skin and underlying
tissues to access an artery or vein, typically in the groin, neck,
or subclavian areas of a patient. The catheter can be inserted
through a puncture in the blood vessel and guided to the desired
site to perform interventional procedures such as angiography,
angioplasty, plaque removal, and infusion of a therapeutic
substance. After the procedure is completed and the catheter is
removed from the patient, the access hole must be closed to prevent
massive hemorrhage. This is conventionally achieved by applying
pressure over the blood vessel manually and then by applying a
pressure bandage, compressive weight, or clamp device. With
conventional methods, the rate of post-puncture hemorrhage is high,
which causes considerable complications. This complication is
exacerbated by the concomitant use of anticoagulant medications
such as heparin or warfarin and by antiplatelet drugs, which are
commonly used to treat vascular disease.
[0003] Sutures have been used to close access puncture wounds in
blood vessels. U.S. Pat. No. 5,613,974 describes a device and
method for applying sutures to a vascular puncture.
US2004/0093027A1 describes barbed suture-like material that apposes
the puncture site. US 2005/0121042 A1 describes a device and method
for applying suture to a vascular puncture. Difficulties with these
methods include the large number of steps necessary to deploy the
needles, capture the suture, withdraw the suture, tie the knot, and
cut the suture. In addition, the hole in the blood vessel is often
widened by insertion of the instrument, and the suture remains
intravascularly on the endothelial surface, and thus can be a nidus
for thrombus or intravascular mural hyperplasia with later
spontaneous and catastrophic closure of the vessel.
[0004] Extravascular plugs have also been proposed for closure of
vascular punctures. U.S. Pat. No. 5,254,105 and U.S. Pat. No.
5,330,445 describe an extravascular plug which is slid down the
external surface of the catheter or introducer and is placed into
the puncture site in this manner. U.S. Pat. No. 5,643,318 relates
to a similar device that has its own vessel locator device.
US22022822A1 and US2004/0158287A1 describe an extravascular plug
that is delivered with a specialized system. US24215232A1 describes
an extravascular plug with an intravascular anchor set with a
sheath with a detection port. US2005/0085855A1 describes an
extravascular collagen plug, held in place with an intravascular
anchor, and a device that locks over a piece of suture. U.S. Pat.
No. 5,906,631 describes a plug made of hydrophilic material. U.S.
Pat. No. 6,126,675 describes an intravascular anchor and a
bioabsorble extravascular plug. U.S. Pat. No. 6,623,509 describes a
bioabsorbable plug. U.S. Pat. No. 6,296,657 and U.S. Pat. No.
6,743,195 describe an inflatable balloon that puts pressure on the
puncture site. U.S. Pat. No. 6,569,185 describes an injectable
vascular plug. U.S. Pat. No. 6,663,655 describes a plug that screws
in the puncture tract. US2004/0143290 A1 describes a combination of
an intraluminal balloon and injectable sealant. Disadvantages to
these methods are related to the high likelihood of thrombosis
associated with the intravascular plug or anchor, and the presence
of collagen or other bioabsorble materials which cause
inflammation, activate the clotting cascade, and increase the
likelihood of thrombosis, which, in an arterial system, is
catastrophic.
[0005] Vascular patches have also been used for repairing blood
vessels, but usually only for large areas of damage. U.S. Pat. No.
5,100,422 describes a vascular patch that is sutured to the
external surface of the damaged blood vessel. U.S. Pat. No.
5,100,422 describes a vascular patch achieved by instilled
adhesives and the device for doing such. These are generally
impractical for catheter-based methods. U.S. Pat. No. 6,248,124 and
U.S. Pat. No. 5,507,744 describe devices and methods that use
electrocautery for sealing vascular punctures. This also requires a
complicated device, and perforation and thrombosis are very real
possibilities.
[0006] Vascular clips or staples delivered through a catheter
device have also been proposed. These devices have penetrating
members that bring the edges of the tissue together. U.S. Pat. No.
6,695,867 describes a clip or staple that is delivered by a
specialized device. U.S. Pat. No. 6,749,622 describes a number of
different clips with sharpened barbs or ends that include both
intra- and extravascular portions, made of metal with memory
characteristics. U.S. Pat. No. 5,861,005 describes an arterial
staple that is delivered with a specialized device. U.S. Pat. No.
5,919,207 describes a stapling system based on long hooked wires
that appose the surfaces, with a small staple gun to close the
lesion. U.S. Pat. No. 6,022,372 describes a similar staple gun.
U.S. Pat. No. 6,296,657, U.S. Pat. No. 6,663,655, and U.S. Pat. No.
6,749,621 describe a clip that is external to the vessel, but clips
the two sides of the puncture together, and a device for achieving
such. U.S. Pat. No. 5,782,861 and U.S. Pat. No. 5,964,782 describe
clip devices composed of two or more prongs or hooks that,
depending on the direction of the prongs, can clip together the
puncture site from the intra- or extravascular position, through
the use of a collar which forces the prongs together or other
mechanisms. These clip devices are composed of thick semi-rigid
material, and can be placed only with a specialized instruments,
and because of the rigidity have great potential to injure or cut
the blood vessel. Disadvantages of these clip devices in general
include difficulty in retrieving the device if misplaced, excessive
manipulation required, the thickness of the clip material which
tends to cut or shear the blood vessel, the large forces that must
be used to curve the staples and fix the clips, the increased
possibility of tearing the blood vessel, and the general lack of
control of the forces being applied to the blood vessel.
[0007] Accordingly, there is a need for methods and apparatuses
that are suitable for closure of vascular punctures or other
openings, and that do not suffer from the drawbacks of conventional
approaches.
SUMMARY OF THE INVENTION
[0008] The present invention provides methods and apparatuses that
are suitable for closure of vascular punctures or other openings,
and that do not suffer from the drawbacks of conventional
approaches.
[0009] The present invention comprises a tissue closure device,
comprising a plurality of tissue engagement elements, mounted with
each other such that in a first compressed configuration the tissue
engagement elements can pass through a tissue opening to be closed,
and such that in a second compressed configuration the tissue
engagement elements bring the edges of the opening into apposition,
and such that in an expanded configuration the tissue engagement
elements span the opening, wherein the tissue engagement elements
engage the tissue in the compressed configuration and in the
expanded configuration.
[0010] The present invention also comprises methods for closing
tissue openings, comprising passing a device while in the first
compressed condition through a sheath that penetrates the proximal
surface of the tissue; expelling the device from the sheath into
space beyond the proximal surface of the tissue such that the
device assumes the expanded configuration; c) manipulating the
device such that the tissue engagement elements engage the tissue;
d) causing the device to assume the second compressed
configuration, bringing the edges of the opening into
apposition.
[0011] The present invention can provide a catheter-delivered
umbrella-like device comprising fine, strong, flexible material
that after delivery expands in a blood vessel so that the
individual members extend beyond the catheter edges and/or puncture
dimensions. The device can be viewed as analagous in structure and
design as contemporary expandable vascular filters and closure
umbrellas, although its purpose and function is completely
different. As the catheter is withdrawn, the device is pulled
against the interior of the blood vessel and the hooks or grasping
devices on the ends of the members seize the interior of the vessel
wall. Because of the very fine and flexible nature of the members
and their multiplicity, there is minimal shear force applied to the
blood vessel. While pulling on the retaining suture to keep the
device against the blood vessel, a retaining lock is then advanced
distally starting at the proximal portion of the members, which
causes the members to first angle the device into a conical shape
and then force the individual members together in a linear parallel
direction, which because the members are engaged with the vessel
wall, brings the edges of the punctured tissue together into
apposition. The retainer lock is then locked onto the parallel
members and can keep tension on the wound externally, and can
prevent intravascular migration of the device. If there is no blood
leakage through the closure and the device is properly positioned
and stable, then the guidewire can be removed and the retaining
suture or string loop cut, resulting is complete and rapid closure,
which can then heal.
[0012] Since this device brings the puncture edges together, there
is true blood vessel healing with little endothelial disruption,
reducing the chances of thrombosis or intimal hyperplasia. The
device can be supplied in different diameters (e.g., french) to
accommodate different sizes of catheters and different sizes of
puncture holes.
[0013] The present invention can comprise a device with
umbrella-like structure, which can be viewed as analogous to the
various designs of intravascular filters and aperture seals, which
are delivered in a folded or compressed form, and then expanded to
their filter shapes. U.S. Pat. No. 4,969,891 describes a
self-expanding removable filter device that is placed with a
sheath. U.S. Pat. No. 5,634,942 and U.S. Pat. No. 5,634,942
describe a similar device but with two sets of arms which protrude
in opposite directions. U.S. Pat. No. 6,241,746 B1 is a similar
version that can be converted to a vascular stent. U.S. Pat. No.
6,361,546 is a version with a central guidewire lumen. U.S. Pat.
No. 6,428,559 describes a variable-diameter vascular filter system.
U.S. Pat. No. 6,485,501 B1 also describes a filter with a
guidewire. US 2003/0208227 describes different construction
configurations of a filter. US 2004/0087999 A1 reveals various
types of structures to retain the filter in the vessel. U.S. Pat.
No. 5,709,707 describes a typical umbrella-type closure device used
to close apertures. Each of the preceding patents and applications
are incorporated herein by reference. The present device, analogous
to many of the vascular filters and umbrella closure devices noted
above, is both expandable like an umbrella and retrievable if it
had to be retrieved because of misplacement. Unlike previous
umbrella closure devices, the present device engages the tissue in
both the expanded and compressed configurations, and functions by
bringing tissue edges into apposition rather than by providing a
patch that covers the opening. In addition, although the
embodiments shown here generally have linear members, these
members, like the structure of the intravascular filters and
umbrella-type devices, need not be strictly linear, but can assume
a number of complex geometrical shapes and structural patterns.
[0014] The present device, like some contemporary vascular filters,
can utilize an expanding material, preferably with memory
characteristics, that opens up spontaneously within the blood
vessel. The device also, like some contemporary filters, can have
tissue hooks or penetrators, in order to seize the vessel wall and
stabilize the device. However, unlike an umbrella-style vascular
filter, the device uses this opening-closing quality to seize the
edges of the puncture site, and close them, resulting in a complete
vascular closure. Although the device can be viewed as analogous to
some contemporary self-expanding and retractable vascular filters,
it is unlike them in that in certain embodiments it has a retaining
lock to force the umbrella to reassume its folded state.
DESCRIPTION OF THE FIGURES
[0015] The invention is explained by using embodiment examples and
corresponding drawings, which are incorporated into and form part
of the specification.
[0016] FIG. 1 (a,b) is a schematic depiction of a vascular closure
apposition device according to the present invention.
[0017] FIG. 2(a,b) is a schematic depiction of a vascular closure
apposition device according to the present invention.
[0018] FIG. 3(a,b) is a schematic depiction of a vascular closure
apposition device with a guidewire lumen, according to the present
invention.
[0019] FIG. 4 is a schematic depiction of a vascular closure
apposition device according to the present invention.
[0020] FIG. 5 is a schematic depiction of a vascular closure
apposition device according to the present invention.
[0021] FIG. 6(a,b,c) are schematic depictions of example
embodiments of vascular closure apposition devices according to the
present invention.
[0022] FIG. 7(a,b,c,d,e,f) is a schematic illustration of a method
of closing a vascular opening according to the present
invention.
[0023] FIG. 8(a,b,c,d) is a schematic depiction of a double-action
vascular closure apposition device according to the present
invention.
[0024] FIG. 9(a,b,c) is a schematic depiction of a double-action
vascular closure apposition device according to the present
invention.
DETAILED DESCRIPTION
[0025] The present invention provides apparatuses and methods for
closing a vascular puncture wound or any tissue aperture, for
example those resulting from the insertion of a vascular catheter
or surgical instrument, trauma or disease. The present invention
embraces both apparatus and method aspects of devices for closing a
vascular puncture, and the methods for delivering such a device.
The present device can be closed in the delivery system (catheter
or sheath) and when discharged, be open in the blood vessel. In
some embodiments, at least a portion of the device can be formed of
a memory metal or similar material, as is currently done in
vascular filters. The stress free state corresponds to the state at
which the apparatus has opened in a blood vessel, and the stressed
state in the catheter and when a retaining lock is put into
position. Example embodiments of tissue closure apposition devices
according to the present invention are shown in FIGS. 1, 2, 3, 4,
5, 6, and 8. The descriptions refer to "vessels" for convenience;
the present invention is applicable to facilitate closure of
various types of tissue openings.
[0026] FIG. 1 (a,b) is a lateral view of a vascular closure
apposition umbrella. A plurality of members 101 are disposed
substantially radially about a central junction 103. Each of the
members 101 comprise a tissue hook 102, in the figure a double
hook. The central junction 103 is adapted to engage a closed loop
of string or suture 104. The hooks 102 engage the tissue, and are
brought and maintained together by operation of a retaining lock
105. In FIG. 1b, the device is shown in a closed position, where
the central junction 103 has passed through the retaining lock
105.
[0027] The vascular closure apposition umbrella of FIG. 1(a,b)
comprises 2 or more members 101 placed in apposition to each other,
shown in the figure as disposed substantially radially. The members
101 in the figure are shown as straight wires, but can be curved or
have a wave structure or other design, for example a design to
engage a retaining lock. The members are flexible for manipulation
in tissue and delivery, yet rigid enough when extended to push the
tissue engagement structures against the vessel wall. The tissue
engagement structures 102 in this example comprise double hooks,
allowing engagement of the tissue in 102 different directions
simultaneously. The tissue engagement structures can also comprise
multiple hooks, a single hook, or straight engaging devices. The
tissue engagement structures can be sharp in order to penetrate in
one direction, but not to cut, thus, would generally not have a
cutting surface other than the point. The members join in a central
junction 103 which can be continuous with each of the members or
can be joined to the members by any suitable method. The central
junction 103 comprises an eyelet or recovery loop in which
initially a closed loop of string or suture 104 engages. The eyelet
or recovery loop can be used to recover the device into a catheter
in the event of misplacement. A retaining lock 105 can encourage
closure of the device, and can also prevent unintended
intravascular migration of the device. The retaining lock 105 is
shown in the figure as a washer-like device, but can take a number
of different shapes and can comprise a number of different
materials. For example, the retaining lock 105 can comprise
plastic, metal, or composite.
[0028] In operation, the tissue closure apposition umbrella is
closed within the catheter or sheath, corresponding to the
illustration of FIG. 1(b). Once placed within the blood vessel, the
umbrella can be opened within the blood vessel, corresponding to
the illustration of FIG. 1(a), so that the hooks on the members
engage the vessel wall. The umbrella can then be closed with the
retaining lock. As the umbrella closes with the retaining lock, the
hooks hold the edges of the puncture wound and, as they align with
each other, bring the puncture wound edges in apposition.
Undulations or excresences on the members or central junction can
engage corresponding locking surfaces on the retaining lock. More
specific locking devices such as angled dentates, peg and hole, and
male-female locking surfaces can also be suitable. A guidewire can
go between the members in this particular embodiment without a
specific lumen for the guidewire.
[0029] FIG. 2(a,b) is a lateral view of a vascular closure
apposition double umbrella. A plurality of members 201 are disposed
substantially radially about a central junction 203. Each member
comprises a tissue engagement structure 202, shown in the figure as
a hook on the end of the member. The central junction can comprise
a structure compatible with a string or suture 204 to facilitate
deployment and removal. A retaining lock 205, in the figure an
umbrella oriented opposite the umbrella formed by members 201,
closes the device. FIG. 2(b) shows the device with the umbrella
formed by members 201 closed, bringing tissue sides in apposition,
and the retaining lock 205 open, maintaining the closed position of
the umbrella and providing tissue stability on the opposite side of
the vessel wall.
[0030] The radial members 201 in FIG. 2(a,b) are shown as straight,
but can have dentates or other devices compatible with engagement
of the retaining lock. The string or suture 204 can be engaged with
the central junction 203 to urge the central junction 203 through
the retaining lock 205, encouraging the members 201 into
apposition. The retaining lock of the device of FIG. 2(a,b)
comprises another expanding umbrella, but facing the opposite
direction. In the figure, the retaining lock umbrella has straight
members with hooks on the ends. The retaining lock umbrella can
also comprise a variety of configurations, including bent or curved
members, members with various hooks or no hooks, web-like
structures, and film-like members. This retaining lock comprise
more complicated structure members, as examples like many
constructions of intravascular stents and filters. The members 201
close and bring the tissue together as in FIG. 2(b); the retaining
lock can provide for tissue stability in the extravascular tissues.
A guidewire in this embodiment can go between the members without a
specific lumen for the guidewire.
[0031] FIG. 3(a,b) is a lateral view of a vascular closure
apposition umbrella with a guidewire lumen. The device comprises
members 301 disposed substantially radially about a central
junction 303. Each arm 301 comprises a tissue engagement structure
302, in the figure shown as a double hook on the end of the arm
301. The central junction 303 comprises a columnar guidewire lumen
with a recovery loop or device for engaging a closed loop of string
or suture 304. A retaining lock 305 that closes the device. FIG.
3(b) shows the device in a closed position with the retaining lock
305 engaged.
[0032] The embodiment of FIG. 3(a,b) comprises a closure apposition
umbrella with a guidewire lumen. Inclusion of a guidewire lumen can
reduce interference of the guidewire with placement of the
umbrella, and allows the guidewire to remain in place in case the
seating of the device is not optimal and then the device must be
retrieved. The device can be delivered and placed with a guidewire
in place. The apposed tissue might close the lumen once the
guidewire is withdrawn. If desired, a soft one-way flap valve (not
shown) or other structure can be placed in the lumen to occlude any
blood flow that might occur when the wire is withdrawn.
[0033] FIG. 4 is a lateral view of a vascular closure apposition
umbrella comprising members 401 disposed substantially radially
about a central junction 403, forming an overall conical shape. The
members have tissue engagement structures 402, shown in the figure
as hooks at the ends of the members 401. The members also have
reversed barbs or feathers 406 to prevent intravascular migration
of the device and to maintain the members in a closed state by
engaging the tissue, a retaining lock, or both. In operation, the
embodiment of FIG. 4 is similar to those discussed previously.
[0034] FIG. 5 is a lateral view of a vascular closure apposition
umbrella. A plurality of members 501 are disposed substantially
radially about a central junction 503. The members have tissue
engagement structures 502, shown in the figure as a hook at the end
of the member 502. The central junction 503 can have a recovery
loop or device, and can engage a string or suture 504 for delivery,
placement, and recovery. A retaining lock 505 can engage the
members 501, the central junction 503, or both, to encourage the
device to and maintain the device in a closed position. A backing
or coating 507 can be mounted with the members as a fabric, web, or
film. The backing can carry, or be made of, a material that can
elute drug to prevent coagulation or to prevent endothelial
hyperplasia or can be hemostatic initially, and fill the puncture
track later.
[0035] FIG. 6(a,b,c) are lateral views of example embodiments of
vascular closure apposition devices according to the present
invention. In FIG. 6(a), members 601 comprise elongated diamond
shapes (rather than the straight wires depicted previously), which
shape can have advantages in manufacture and in operation. The
members 601 have tissue engagement structures 602, in the figure
shown as hooks mounted with members at various locations. In FIG.
6(b), a device having a reduced number of members 611 is shown. A
reduced number of members can provide for a simpler device, which
can have manufacturing advantages and can be suitable for certain
applications. In FIG. 6(c), members 621 comprise a non-linear
geometry, and are connected by intermember struts 628. The
non-linear geometry and intermember struts can allow specific
opening and closing trajectories, and can allow optimization of
forces when opening and closing. A wide variety of specific
geometries and structures can be suitable with the present
invention, as examples including geometries and structures
currently used in vascular filters and stents.
[0036] FIG. 7(a,b,c,d,e,f) is a schematic illustration of a method
of closing a vascular opening according to the present invention. A
blood vessel 701 is penetrated by a sheath 702 and a guidewire 703.
In FIG. 7(a), an apposition device 704, for example as described
previously, is in a closed configuration within the sheath, with
the loop of string or suture 705 engaged. In FIG. 7(b) the device
704 has been extruded from the sheath 702 and is in the expanded
configuration within the vessel 701. In FIG. 7(c), the device 704
has been positioned against the wall of the vessel 701, seating the
tissue engagement structures 706 in the tissue 701. The sheath 702
has been partially removed to facilitate seating of the device. The
lock can be preseated on the device (not shown) or can be placed on
the device after intravascular placement of the device by threading
the lock down the guidewire or suture onto a central junction of
the device after the device has been positioned in the blood
vessel, or positioned by a separate sheath). In FIG. 7(d), a
retaining lock 707 has been advanced over the members of the
apposition device, forcing them into the closed configuration, and
bringing the edges of the opening 709 together. If no bleeding
occurs, then the guidewire 703 can be removed as shown in FIG.
7(e). The loop of string or suture 705 can be cut and removed,
leaving the device 704 safely seated and locked with the opening
closed, as shown in FIG. 7(f).
[0037] Delivery of the device can be done sequentially, or can be
done with a dedicated device. For sequential delivery of the
device, the following sequence of steps are suitable: 1) the
guidewire and sheath are in place, 2) the device is pushed down the
sheath, either next to the guidewire or with the guidewire in the
lumen of the umbrella; 3) the umbrella is extruded, and then using
the thread or suture, pulled tight against the lumen of the vessel;
4) the retaining lock is pushed down the thread and/or guidewire,
and is pushed onto the umbrella while applying traction (the sheath
can be removed partially at this stage); 5) after the retaining
lock is seated, the sheath is observed for bleeding; 6) if there is
no bleeding, then the sheath and guidewire are removed. For a
dedicated device, there can be a sheath with the umbrella, a
pushing device to push the umbrella out (another sheath), a sheath
to push the retaining lock, and a thread/suture to oppose the other
sheaths and to retrieve the umbrella if it is misplaced.
[0038] FIG. 8 (a,b,c,d) is a lateral view of a double-action
vascular closure apposition device. In FIG. 8a, the unassembled
device is in the closed position. The device comprises a plurality
of umbrella members 801 disposed substantially radially about a
central junction 803. Each umbrella member 801 can comprise a
tissue hook 802, in the figure a double hook, spaced from the
junction of the member and the central junction 803. The central
junction 803 can include a central lumen for a guidewire, and is
adapted to engage a plurality of opposite facing members 804, which
opposite facing members can optionally have hooks, tissue
penetrators, or feet. The opposite facing members can comprise
memory material, and be configured such that they force a retaining
lock 805 over the open umbrella members 1 (shown open in FIG. 8c)
forcing them to close (as shown in FIG. 8d).
[0039] A closed loop of string or suture (not shown) can be joined
to the device by ways of a lumen or loop. FIG. 8a shows the device
preassembly. In FIG. 8b, the device is in assembled form and in a
closed position, where the central junction 3 has passed through
the retaining lock 805. In this form the double action vascular
closure apposition device can reside within a delivery catheter
before being placed in the puncture wound of a blood vessel. FIG.
8c shows the device partially expelled from the sheath (not shown),
where the umbrella members 801 have opened and engaged the vessel
wall, analogous to the embodiments previously described. In the
arrangement of FIG. 8c, the opposite facing members 804 are
retained in the sheath so that they are prevented from forcing the
lock 805 over the umbrella members 801. FIG. 8d shows the device
completely expelled from the delivery sheath, where the opposite
facing members 804 are now forcing the retaining collar or lock 805
down the umbrella members 801, causing the portions of the umbrella
members 801 with tissue engagement features (hooks in the figure)
together (i.e., closing of the umbrella). The opposite facing
members 804 are shown for ease of illustration as wire-like; they
can be configured as coiled or semi-coiled structures, strut-like,
multiple angles, spring-like, curled in an opposite direction,
single or multiple members, elbow-like, or other geometrical or
curvolinear shapes that when extended are neutral to the retaining
lock, but when expelled, force the lock over the umbrella members,
initiating closure.
[0040] Accordingly, the double action vascular closure apposition
device of FIG. 8 is first closed, then opens, and then closes
again, the second closure occurring spontaneously by contraction of
the opposite facing members against the retaining lock. After the
device has been delivered and vascular closure is complete, then
the guidewire can be removed.
[0041] FIG. 9 (a,b,c,) is a lateral view of a collarless
double-action vascular closure apposition device. FIG. 9a shows the
device in the closed position. A plurality of umbrella members 901
are disposed substantially radially about a central junction 905,
which can have a lumen for a guidewire. The central junction can
comprise a retaining ring which permits the members to flex along
their length. Each of the umbrella members 901 has a tissue
engagement feature spaced apart from the central junction 905, in
the figure a double hook 902. The central junction is adapted to
engage a plurality of opposite facing members 903, which optionally
can have hooks, tissue penetrators, or feet 904. The opposite
facing members 904 can be composed of memory material, and can be
directly joined to a corresponding umbrella member, with the memory
forces in the opposite facing members dominant over the memory
forces in the umbrella members. FIG. 9a depicts the form that the
collarless double action vascular closure apposition device would
have while within a delivery catheter before being placed in the
puncture wound of the blood vessel.
[0042] FIG. 9b shows the device partially expelled from the sheath
(not shown). The umbrella members 901 have opened and engaged the
vessel wall, analogous to embodiments described previously. The
opposite members are still in the closed form, restrained there by
the sheath. FIG. 9c shows the device completely expelled from the
delivery sheath, where the opposite facing members 903 have curled
or contracted. Since the opposite facing members are directly
joined to the umbrella members and have dominant memory
characteristics, they force the umbrella members 901 to close. The
opposite facing members are shown in figure as wire-like for ease
of illustration; they can be configured as coiled or semi-coiled
structures, strut-like, multiple angles, spring-like, curled in an
opposite direction, more than two members, elbow-like, or other
geometrical or curvolinear shapes that when extended are neutral to
the umbrella members, but when expelled, dominate over the umbrella
members, and force closure of the umbrella members, initiating
puncture wound closure.
[0043] Accordingly, the collarless double action vascular closure
apposition device is first closed, then opens, and then closes
again, with the second closure occurring spontaneously, by
contraction of the opposite facing members which have dominant
memory characteristics over the umbrella members. The central
junction can be loose enough (e.g., made of a flexible polymer) to
permit the forces from the contraction of the opposite facing
members to be exerted on the umbrella members. In some embodiments
each opposite facing member can be continuous with a corresponding
umbrella member (i.e., a first portion of a single wire comprises
an umbrella member, a second portion of the same wire comprising an
opposite facing member). For simplicity, only two opposing members
are shown in the figure; in embodiments where an umbrella member
and a opposite facing member are formed from a single wire, the
number of umbrella members can equal the number of opposite facing
members, and each opposing member-umbrella member can be an
integrated piece of memory material. After the device has been
delivered and vascular closure is complete, then the guidewire can
be removed.
[0044] In any of the embodiments described, the umbrella-like
structure, members of this structure or components of the umbrella
can be made from any number of suitable materials, including
radiopaque materials and materials coated to be made radiopaque,
including bioabsorbable polymers or compounds, non-absorbable
alloys and compounds including stainless steel, MP35, Nitinol,
Nickel-Titanium ally, Kevlar, nylon polyester acrylic, gold,
platinum, tantalum, niobium, molybdenum, rhodium, palladium silver,
hafnium, tungsten, iridium. Materials with memory would also be
preferable to allow the umbrella to spontaneously open after
placement by the sheath. These can be made in the form of wires,
fibers, filaments, small beams, and other extruded, woven, or
formed shapes. Piano wire, super elastic memory wire, chromium
allows, alloys of titanium and nickel, and other elastic memory
materials previously mentioned as well as others can be used as
well The umbrella fabric can be made from a number of suitable
materials, including flexible polymeric materials with elastomeric
properties including polyurethane, polyethylene, polyestenurethane,
polyimide, olyethreimide, polycarbonate, polysiloxane, polyvinyls,
hydroxyethylmethacrylate, related polymers, co-polymers of these or
other polymers, or drug-embedded or drug-eluting polymers to
prevent coagulation or intimal hyperplasia (such as Taxol), also
which can be made radiopaque by markers and addition of appropriate
radiopaque materials.
EXAMPLE EMBODIMENTS
[0045] The present invention can comprise a device to close
puncture wounds caused by catheter procedures and especially
angiography comprised of an expandable umbrella-like device that in
the compressed state resides in a sheath, and after being expelled
from the sheath assumes a planar or conical or other shape, engages
vessel wall by means of tissue hooks or penetrators, is collapsed,
analogous to umbrella tines, and brings the edges of the vessel
wound or puncture into apposition. The device can have a retaining
locking device that prevents the umbrella-like structure from
reopening. This locking can be achieved by mechanical means
including deformable enlargements on the members, dentates,
male-female connectors, peg and hole, or other directional
mating/locking devices on the members and retaining locking device.
This locking device can have a washer like appearance, but can also
take a number of different forms, including an inverted umbrella
device made of metal, plastic, composites, or biodegradable
material.
[0046] The device can have single or multiple hooks and penetrating
devices to engage and seize the vessel wall. Each hook can be a
single or multiple hook. The device can have members (or tines) of
the umbrella-like structure that are linear, curvilinear, spiral,
leaf-like, diamond shaped, woven, or other complex shapes, but
still function as an opening-closing structure that can accommodate
a retaining lock. The device when expanded can have a planar or
conical or reverse conical geometry, or other complex shape that
can collapse into near-linear form with traction and locking of the
retaining lock. The device can have a retrieval fitting, usually a
loop, fitted with a closed loop thread, string, or suture in order
to apply traction to the device. The device can have a lumen for a
guidewire.
[0047] The device can have members that are coated or backed with a
fabric or membrane, either completely or partially. The device can
elute therapeutic material to prevent thrombogenesis, hemorrhage,
inflammation, and intimal hyperplasia with vascular closure. The
device can be used in angiography, angioplasty, vascular puncture,
tissue biopsy, or trauma that cause a puncture wound that should be
closed. The device can comprise materials with memory, so that the
device spontaneously assumes it therapeutic shape when expelled
from the sheath. The device can comprise at least 2 or more
members; 3 or more members can be preferable in some applications.
The device can have members with angled dentates or tissue
penetrators to prevent movement or migration of the device into the
lumen of the blood vessel. These can also be used to retain the
retaining lock.
[0048] A tissue opening can be closed according to the present
invention by a) introducing a guidewire and sheath, b) penetrating
the proximal surface of the blood vessel by the sheath and the
guidewire, c) placing a device in the closed form in the sheath,
with the loop of string or suture, d) extruding the device from the
sheath and expanding while in the tissue (e.g., while inside a
blood vessel), e) pulling the device against the tissue wall (e.g.,
the blood vessel wall), seating the hooks in the tissue, f)
partially removing the sheath is to seat the device while a
retaining lock is advanced, g) advancing the retaining lock over
the members of the device while applying traction with the string,
forcing them in the closed position, h) bringing the edges of the
puncture wound together; if no bleeding occurs, i) then removing
the guidewire, j) cutting the loop of string, leaving the device
safely seated and locked with the puncture repaired.
[0049] A tissue opening can be closed according to the present
invention with sequential delivery of a device. For example, the
following steps can be taken 1) first the guidewire and sheath are
in place, 2) next the umbrella is pushed down the sheath, either
next to the guidewire or with the guidewire in the lumen of the
umbrella; 3) the umbrella is extruded, and then using the thread or
suture, pulled tight against the lumen of the vessel; 4) next the
retaining lock is pushed down the thread and/or guidewire, and is
pushed onto the umbrella while applying traction (the sheath can be
removed partially at this stage, 5) after the retaining lock is
seated, the sheath is observed for bleeding, 6) if there is no
bleeding, then the sheath and guidewire are removed.
[0050] A tissue opening can be closed according to the present
invention employing a dedicated device consisting of a sheath
containing a device, a pushing device to push the device out (e.g.,
another sheath), a sheath to push the retaining lock, and a
thread/suture to oppose the movement of the other sheaths and to
retrieve the umbrella if it is misplaced.
[0051] The particular sizes and equipment discussed above are cited
merely to illustrate particular embodiments of the invention. It is
contemplated that the use of the invention may involve components
having different sizes and characteristics. It is intended that the
scope of the invention be defined by the claims appended
hereto.
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