1 AUSTRALIA Patents Act 1990 ARSTASIS, INC. COMPLETE SPECIFICATION STANDARD PATENT Title: Access and closure device and method The following statement is a full description of this invention including the best method of performing it known to us: - 1 TITLE OF THE INVENTION 2 3 ACCESS AND CLOSURE DEVICE AND METHOD 4 5 TECHNICAL FIELD 6 [0001] The present invention relates to the field of accessing a biological lumen and 7 closing the access port thereby created. 8 9 BACKGROUND ART 10 [00021 A number of diagnostic and interventional vascular procedures are now 11 performed translumenally, where a catheter is introduced to the vascular system at a 12 convenient access location - such as the femoral, brachial, or subclavian arteries - and 13 guided through the vascular system to a target location to perform therapy or 14 diagnosis. When vascular access is no longer required, the catheter and other vascular 15 access devices must be removed from the vascular entrance and bleeding at the 16 puncture site must be stopped. 17 [0003] One common approach for providing hemostasis is to apply external force 18 near and upstream from the puncture site, typically by manual compression. This 19 method is time-consuming, frequently requiring one-half hour or more of 20 compression before hemostasis. This procedure is uncomfortable for the patient and 21 frequently requires administering analgesics. Excessive pressure can also present the 22 risk of total occlusion of the blood vessel, resulting in ischemia and/or thrombosis. 23 [0004] After hemostasis is achieved by manual compression, the patient is required to 24 remain recumbent for six to eighteen hours under observation to assure continued 25 hemostasis. During this time bleeding from the vascular access wound can restart, 26 potentially resulting in major complications. These complications may require blood 27 transfusion and/or surgical intervention. 28 [0005] Bioabsorbable fasteners have also been used to stop bleeding. Generally, these 29 approaches rely on the placement of a thrombogenic and bioabsorbable material, such 30 as collagen, at the superficial arterial wall over the puncture site. This method 31 generally presents difficulty locating the interface of the overlying tissue and the 32 adventitial surface of the blood vessel. Implanting the fastener too far from the 33 desired location can result in failure to provide hemostasis. If, however, the fastener 1A 1 intrudes into the vascular lumen, thrombus can form on the fastener. Thrombus can 2 embolize downstream and/or block normal blood flow at the thrombus site. 3 Implanted fasteners can also cause infection and auto-immune reactions/rejections of 4 the implant. 5 [0006] Suturing methods are also used to provide hemostasis after vascular access. 6 The suture-applying device is introduced through the tissue tract with a distal end of 7 the device located at the vascular puncture. Needles in the device draw suture 8 through the blood vessel wall on opposite sides of the punctures, and the suture is 9 secured directly over the adventitial surface of the blood vessel wall to close the 10 vascular access wound. 11 [0007] To be successful, suturing methods need to be performed with a precise 12 control. The needles need to be properly directed through the blood vessel wall so 13 that the suture is well anchored in tissue to provide for tight closure. Suturing 14 methods also require additional steps for the surgeon. 15 [0008] Due to the deficiencies of the above methods and devices, a need exists for a 16 more reliable vascular closure method and device. There also exists a need for a 17 vascular closure device and method that does not implant a foreign substance and is 18 self-sealing. There also exists a need for a vascular closure device and method 19 requiring no or few extra steps to close the vascular site. 20 21 DISCLOSURE OF INVENTION 22 [0009] A device for accessing a biological lumen is disclosed. The biological lumen 23 has a lumen wall having a longitudinal lumen wall axis. The device has an elongated 24 member that has a longitudinal member axis. The member is configured to access the 25 lumen at a first angle. The first angle is defined by the longitudinal lumen wall axis 26 and the longitudinal member axis. The first angle is less than about 19 degrees. 27 [00101 The first angle can be less than about 15 degrees. The first angle can be less 28 than about 10 degrees. The device can also have an anchor. The anchor can be 29 configured to hold the elongated member at a fixed angle with respect to the 30 longitudinal lumen wall axis. 31 [0011] The device can also have a retainer. The retainer can be configured to hold the 32 elongated member at a fixed angle with respect to the longitudinal lumen axis. 2 1 [00121 Another device for accessing a biological lumen is disclosed. The biological 2 lumen has a lumen wall and a longitudinal lumen wall axis. The device has a first 3 elongated member and a second elongated member. The first elongated member has a 4 first elongated member axis. The second elongated member has a second elongated 5 member axis. The second elongated member is configured so that the second 6 elongated member axis is parallel to the longitudinal lumen wall axis. 7 [00131 The second elongated member can have a retainer. The retainer can have an 8 inflatable member. The retainer can have a resilient member. The second elongated 9 member can extend substantially adjacent to the lumen wall. 10 [0014] Also disclosed is a device for closing an opening on a biological lumen wall. 11 The device has a longitudinal axis, a first force-applying member, a second force 12 applying member, and a resilient member. The resilient member provides to the first 13 and the second force-applying members a force that is radially outward with respect 14 to the longitudinal axis. 15 [00151 A method of accessing a blood vessel through a blood vessel wall is also 16 disclosed. The blood vessel wall has a longitudinal wall axis. The method includes 17 entering the vessel at an angle of less than about 19 degrees with respect to the 18 longitudinal wall axis. The method also includes inserting a lumenal tool into the 19 vessel. 20 [0016] Also disclosed is a method for accessing a biological lumen. The biological 21 lumen has a lumen wall and a longitudinal lumen wall axis. The method includes 22 inserting in the biological lumen a second elongated member. The second elongated 23 member has a second elongated member axis. The method also includes aligning the 24 second elongated member so that the second elongated member axis is substantially 25 parallel to the longitudinal lumen wall axis. Further, the method includes inserting in 26 the biological lumen a first elongated member comprising a first elongated member 27 axis. 28 [0017] Additionally disclosed is a method of closing a vascular opening. The 29 vascular opening has an inside surface and a longitudinal axis. The method includes 30 inserting a device in the opening and applying a force to the inside surface. The force 31 is directed in at least one radially outward direction from the longitudinal axis. 3 1 [0018] The method can include maintaining the force. The applying a force can 2 include the device applying at least a part of the force. The applying of a force can 3 include the device applying all of the force. 4 [00191 Also disclosed is a method for accessing and closing a blood vessel having a 5 vessel wall. The vessel wall can have an inside surface and an outside surface. The 6 method includes forming an arteriotomy and deploying a closure augmentation device 7 in the arteriotomy. The closure augmentation device produces pressure on the inside 8 surface and the outside surface. 9 10 BRIEF DESCRIPTION OF THE DRAWINGS 11 [0020] Figure 1 is a front perspective view of an embodiment of the arteriotomy 12 device. 13 [0021] Figure 2 is a side view of the arteriotomy device of Figure 1. 14 [0022] Figure 3 is a close-up view of the arteriotomy device of Figure 1. 15 [0023] Figures 4 and 5 are close-up views of various embodiments of the anchor. 16 [0024] Figure 6 is a side perspective view of an embodiment of the arteriotomy 17 device with the introduction device deployed. 18 [0025] Figure 7 is a close-up view of an embodiment of the arteriotomy device with 19 the introduction device deployed. 20 [0026] Figures 8 and 9 are side views of various embodiments of the arteriotomy 21 device with the introduction devices deployed. 22 [0027] Figure 10 is a bottom perspective view of an embodiment of the arteriotomy 23 device. 24 [0028] Figure 11 is a side view of an embodiment of the arteriotomy device with the 25 lumenal retainer deployed. 26 [00291 Figure 12 is a bottom perspective view of an embodiment of the arteriotomy 27 device with the lumenal retainer deployed. 28 [0030] Figure 13 is a side perspective view of an embodiment of the arteriotomy 29 device. 30 [0031] Figure 14 is a side perspective view of an embodiment of the arteriotomy 31 device with the entry wall retainer deployed. 32 [0032] Figures 15 and 16 illustrate various embodiments of the tensioner. 33 [0033] Figures 17 and 18 illustrate various embodiments of the pressure clip. 4 1 [0034] Figures 19 and 20 illustrate various embodiments of the toggle. 2 [0035] Figure 21 illustrates a method for deploying the arteriotomy device in a cross 3 section of a lumen. 4 [0036] Figures 22 and 23 illustrate methods for deploying the retainers in a cross 5 section of a lumen. 6 [0037] Figures 24 and 25 illustrate a method for deploying the introduction device in 7 a cross-section of a lumen. 8 [0038] Figure 26 illustrates a method for deploying a guidewire in a cross-section of a 9 lumen. 10 [0039] Figures 27-30 illustrate a method for deploying the introduction device in a 11 cross-section of a lumen. 12 [0040] Figure 31 illustrates a method for deploying a guidewire in a cross-section of a 13 lumen. 14 [0041] Figure 32 illustrates a portion of an arteriotomized lumen. 15 [0042] Figure 33 illustrates section A-A of Figure 28. 16 [0043] Figures 34-36 illustrate a method for deploying a tensioner in a see-through 17 portion of lumen wall. 18 [0044] Figures 37-40 illustrate methods for deploying various embodiments of the 19 pressure clip in a cross-section of a lumen. 20 [0045] Figure 41 illustrates a method of using a suture on a portion of an 21 arteriotomized lumen. 22 [0046] Figure 42 illustrates section B-B of Figure 41 with the out-of-section suture. 23 [00471 Figure 43 illustrates a method of using pledgets on a portion of an 24 arteriotomized lumen. 25 [0048] Figure 44 illustrates section C-C of Figure 43. 26 [0049] Figure 45 illustrates an embodiment of the toggle deployment device in a first 27 configuration. 28 [0050] Figure 46 is a close-up view of Figure 45. 29 [0051] Figure 47 illustrates an embodiment of the toggle deployment device in a 30 second configuration. 31 [0052] Figure 48 is a close-up view of Figure 47. 32 [0053] Figure 49 illustrates a method of using the toggle deployment device in a 33 cross-section of a lumen. 5 1 [00541 Figure 50 illustrates Figure 49 with a portion of the toggle deployment device 2 shown in section D-D. 3 [0055] Figure 51 illustrates a method of using the toggle deployment device in a 4 cross-section of a lumen. 5 [0056] Figure 52 illustrates Figure 51 with a portion of the toggle deployment device 6 shown in section E-E. 7 [00571 Figures 53-55 illustrate a method of using the toggle deployment device in a 8 cross-section of a lumen. 9 [00581 Figure 56 is a close-up view of Figure 55. 10 [0059] Figure 57 illustrates an embodiment of a deployed toggle in a cross-section of 11 a lumen. 12 [0060] Figure 58 is a close-up view of Figure 59. 13 [0061] Figures 59-61 illustrate a method for deploying a toggle in a cross-section of a 14 lumen. 15 [0062] Figure 62 is a close-up view of Figure 61. 16 [0063] Figure 63 illustrates a method for deploying a toggle in a cross-section of a 17 lumen. 18 [0064] Figures 64-66 shown, in cross-section, a method for deploying the guidewire 19 through an arteriotomy. 20 [0065] Figures 67 and 68 illustrate a method for attaching guidewire to the anchor. 21 22 DETAILED DESCRIPTION 23 AND INDUSTRIAL APPLICABILITY 24 [0066] Figures 1 through 3 illustrate a device for accessing a biological lumen, such 25 as an arteriotomy device 2. The arteriotomy device 2 can have a delivery guide 4. 26 The delivery guide 4 can be slidably attached to an anchor 6. The anchor 6 can be 27 rigid, flexible or combinations thereof. The anchor 6 can be resilient, deformable or 28 combinations thereof. The anchor 6 can be retractable and extendable from the 29 delivery guide 4. The delivery guide 4 can have an introducer lumen 8. The 30 introducer lumen 8 can have an introducer lumen exit port 10. The introducer lumen 31 exit port 10 can be on the surface of the delivery guide 4. 32 [0067] The anchor 6 can have an anchor angle section 12. The anchor 6 can have an 33 anchor extension section 14, for example a guide eye sheath or an attachable 6 1 guidewire. The anchor extension section 14 can extend from the anchor angle section 2 12. The anchor extension section 14 can be separate from and attached to, or integral 3 with, the anchor angle section 12. 4 [0068] The anchor angle section 12 can have an anchor angle first sub-section 16, an 5 anchor bend 20 and an anchor angle second sub-section 18. The anchor angle first 6 and/or second sub-sections 16 and/or 18 can be part of the anchor bend 20. The 7 anchor bend 20 can have a sharp or gradual curve. The radius of curvature for the 8 anchor bend 20 can be from about 0.1 mm (0.004 in.) to about 2.0 mm (0.079 in.). 9 [0069] The anchor angle first sub-section 16 can have an anchor angle first sub 10 section diameter 22 from about 0.38 mm (0.015 in.) to about 1.0 mm (0.039 in.), for 11 example about 0.71 mm (0.028 in.). The anchor angle second sub-section 18 can 12 have an anchor angle second sub-section diameter 24 from about 0.38 mm (0.015 in.) 13 to about 1.0 mm (0.039 in.), for example about 0.71 mm (0.028 in.). 14 [0070] The anchor angle first sub-section 16 can have a delivery longitudinal axis 26. 15 The anchor angle second sub-section 18 can have an anchor longitudinal axis 28. The 16 intersection of the delivery longitudinal axis 26 and the anchor longitudinal axis 28 17 can be an anchoring angle 30. The anchoring angle 30 can be from about 200 to about 18 900, more narrowly from about 300 to about 600, for example about 45*. 19 [0071] Any or all elements of the arteriotomy device 2 or other devices or 20 apparatuses described herein can be made from, for example, a single or multiple 21 stainless steel alloys, nickel titanium alloys (e.g., Nitinol), cobalt-chrome alloys (e.g., 22 ELGILOY@ from Elgin Specialty Metals, Elgin, IL; CONICHROME@ from 23 Carpenter Metals Corp., Wyomissing, PA), molybdenum alloys (e.g., molybdenum 24 TZM alloy, for example as disclosed in International Pub. No. WO 03/082363 A2, 25 published 9 October 2003, which is herein incorporated by reference in its entirety), 26 tungsten-rhenium alloys, for example, as disclosed in International Pub. No. WO 27 03/082363, polymers such as polyester (e.g., DACRON@ from E. I. Du Pont de 28 Nemours and Company, Wilmington, DE), polypropylene, polytetrafluoroethylene 29 (PTFE), expanded PTFE (ePTFE), polyether ether ketone (PEEK), nylon, polyether 30 block co-polyamide polymers (e.g., PEBAX@ from ATOFINA, Paris, France), 31 aliphatic polyether polyurethanes (e.g., TECOFLEX@ from Thermedics Polymer 32 Products, Wilmington, MA), polyvinyl chloride (PVC), polyurethane, thermoplastic, 33 fluorinated ethylene propylene (FEP), absorbable or resorbable polymers such as 7 1 polyglycolic acid (PGA), polylactic acid (PLA), polydioxanone, and pseudo 2 polyamino tyrosine-based acids, extruded collagen, silicone, zinc, echogenic, 3 radioactive, radiopaque materials or combinations thereof. Examples of radiopaque 4 materials are barium sulfate, zinc oxide, titanium, stainless steel, nickel-titanium 5 alloys, tantalum and gold. 6 [0072] Any or all elements of the arteriotomy device 2, including supplemental 7 closure devices, such as tensioners, clips, toggles, sutures, or other devices or 8 apparatuses described herein can be or have a matrix for cell ingrowth or used with a 9 fabric, for example a covering (not shown) that acts as a matrix for cell ingrowth. The 10 matrix and/or fabric can be, for example, polyester (e.g., DACRON@ from E. . du 11 Pont de Nemours and Company, Wilmington, DE), polypropylene, PTFE, ePTFE, 12 nylon, extruded collagen, silicone or combinations thereof. 13 [00731 The elements of the arteriotomy device 2 and/or the fabric can be filled and/or 14 coated with an agent delivery matrix known to one having ordinary skill in the art 15 and/or a therapeutic and/or diagnostic agent. The agents within these matrices can 16 include radioactive materials; radiopaque materials; cytogenic agents; cytotoxic 17 agents; cytostatic agents; thrombogenic agents, for example polyurethane, cellulose 18 acetate polymer mixed with bismuth trioxide, and ethylene vinyl alcohol; lubricious, 19 hydrophilic materials; phosphor cholene; anti-inflammatory agents, for example non 20 steroidal anti-inflammatories (NSAIDs) such as cyclooxygenase-1 (COX-1) inhibitors 21 (e.g., acetylsalicylic acid, for example ASPIRIN® from Bayer AG, Leverkusen, 22 Germany; ibuprofen, for example ADVIL@ from Wyeth, Collegeville, PA; 23 indomethacin; mefenamic acid), COX-2 inhibitors (e.g., VIOXX@ from Merck & 24 Co., Inc., Whitehouse Station, NJ; CELEBREX@ from Pharmacia Corp., Peapack, 25 NJ; COX-1 inhibitors); immunosuppressive agents, for example Sirolimus 26 (RAPAMUNE@, from Wyeth, , Collegeville, PA), or matrix metalloproteinase 27 (MMvlP) inhibitors (e.g., tetracycline and tetracycline derivatives) that act early within 28 the pathways of an inflammatory response. Examples of other agents are provided in 29 Walton et al, Inhibition of Prostoglandin E 2 Synthesis in Abdominal Aortic 30 Aneurysms, Circulation, July 6, 1999, 48-54; Tambiah et al, Provocation of 31 Experimental Aortic Inflammation Mediators and Chlamydia Pneumoniae, Brit. J. 32 Surgery 88 (7), 935-940; Franklin et al, Uptake of Tetracycline by Aortic Aneurysm 33 Wall and Its Effect on Inflammation and Proteolysis, Brit. J. Surgery 86 (6), 771-775; 8 1 Xu et al, Spl Increases Expression of Cyclooxygenase-2 in Hypoxic Vascular 2 Endothelium, J. Biological Chemistry 275 (32) 24583-24589; and Pyo et al, Targeted 3 Gene Disruption of Matrix Metalloproteinase-9 (Gelatinase B) Suppresses 4 Development of Experimental Abdominal Aortic Aneurysms, J. Clinical Investigation 5 105 (11), 1641-1649 which are all incorporated by reference in their entireties. 6 [0074] Figure 4 illustrates that the anchor angle section 12 and the anchor extension 7 section 14 can have a flexible elongated element. The flexible elongated element can 8 be resilient and/or deformable. The flexible elongated element can have an integral, 9 or multiple separate and fixedly attached, wound wire 32. The anchor angle section 10 12 can be in a sheath 34. Figure 5 illustrates that the anchor angle section 12 can have 11 a wire coating 36, for example a lubricious coating and/or a coating made from 12 urethane. 13 [0075] Figures 6 and 7 illustrate that the arteriotomy device 2 can have an 14 introduction device 38. The introduction device 38 can be slidably attached to the 15 introducer lumen 8. The introduction device 38 can have a hollow needle (as shown 16 in Figure 6). The introduction device 38 can have a solid needle (as shown in Figure 17 7). The introduction device 38 can have a guidewire. 18 [0076] The introduction device 38 can have an introduction longitudinal axis 40. The 19 intersection of the introduction longitudinal axis 40 and the anchor longitudinal axis 20 28 can be an introduction angle 42. The introduction angle 42 can be less than or 21 equal to about 190, more narrowly less than or equal to about 15*, yet more narrowly 22 from about 50 to about 100, for example about 010. 23 [0077] The introduction device 38 can have an introduction device diameter 44. The 24 introduction device diameter 44 can be from about 0.25 mm (0.0 10 in.) to about 1.0 25 mm (0.039 in.), for example about 0.56 mm (0.022 in.). 26 [0078] Figures 8 and 9 illustrate that the arteriotomy device 2 can be configured so 27 that the introduction device 38 can be deployed from the anchor 6. The anchor 6 can 28 have an introduction device port 46. The introduction device 38 can be a hollow 29 needle (as shown in Figure 8). When fully deployed, the introduction device 38 can 30 contact the introducer lumen exit port 10. The introduction device 38 can be a 31 channel between the introducer lumen 8 and the anchor 6. The anchor 6 can have a 32 port (not shown) configured to communicate with the biological lumen and the 9 1 introduction device 38. The introduction device 38 can be a solid needle (as shown in 2 Figure 9). 3 [0079] Figure 10 illustrates that a lumenal retainer 48 can have a first retracted 4 configuration. The lumenal retainer 48 can be seated in a lumenal retainer port 50. 5 The lumenal retainer port 50 can be in the anchor 6. The lumenal retainer 48 can be a 6 wire, scaffold or stent - for example made from a deformable or resilient material, 7 such as a shape memory alloy - an inflatable balloon, or combinations thereof. 8 Intralumenal inflatable balloons, such as those inflated with saline solution or carbon 9 dioxide, are known to those having ordinary skill in the art. The lumenal retainer 48 10 can extend into the delivery guide 4. 11 [0080] Figures 11 and 12 illustrate that the lumenal retainer 48 can have a second 12 deployed configuration. Figure 11 shows that the lumenal retainer 48 can be a wire or 13 balloon. Figure 12 shows that the lumenal retainer 48 can be a wire. In the deployed 14 configuration, the lumenal retainer 48 can deploy away from the lumenal retainer 15 port. The lumenal retainer 48 can have a lumenal retainer deployed diameter 52. The 16 lumenal retainer deployed diameter 52 can be from about 2.54 mm (0.100 in.) to 17 about 10.2 mm (0.400 in.), for example about 6.35 mm (0.250 in.). 18 [00811 Figure 13 illustrates that the arteriotomy device 2 can have an entry wall 19 retainer port 54. The entry wall retainer port 54 can be at or near the anchor bend 20. 20 The entry wall retainer port 54 can be at or near the anchor angle first sub-section 16. 21 The entry wall retainer port 54 can be in fluid communication with a sensor or port 22 (not shown) on or near the delivery guide 4 of the arteriotomy device 2. 23 [0082] Figure 14 illustrates that an entry wall retainer 56 can be deployed through the 24 entry wall retainer port 54. The entry wall retainer 56 can have a first retracted 25 configuration (as shown in Figure 13). The entry wall retainer 56 can have a second 26 deployed configuration (as shown in Figure 14). 27 [00831 Figures 15 through 20 illustrate various supplemental closure devices. The 28 supplemental closure devices can be completely or partially bioabsorbable, 29 bioresorbable, bioadsorbable or combinations thereof. The supplemental closure 30 devices can be made from homografts, heterografts or combinations thereof. The 31 supplemental closure devices can be made from autografts, allografts or combinations 32 thereof. 10 1 [00841 Figure 15 illustrates a tensioner 58. The tensioner 58 can be resilient, 2 deformable, or combinations thereof. The tensioner 58 can have a tensioner 3 longitudinal axis 60. The tensioner 58 can have a resilient element, such as a spring, 4 for example a tensioner head 62. The tensioner head 62 can have a tensioner first 5 shoulder 64. The tensioner head 62 can have a tensioner second shoulder 66. The 6 tensioner first and second shoulders 64 and 66 can rotatably attached to a separate or 7 integral tensioner first leg 68 and a separate or integral tensioner second leg 70, 8 respectively. The tensioner first and second legs 68 and 70 can attach to tensioner 9 first and second feet 72 and 74, respectively. 10 [0085] The tensioner legs 68 and 70 can have tensioner leg diameters 76. The 11 tensioner leg diameters 76 can be from about 0.1 mm (0.005 in.) to about 0.76 mm 12 (0.030 in.), for example about 0.38 mm (0.015 in.). The tensioner first and second 13 legs 68 and 70 can have a tensioner inter-leg outer diameter 78. The tensioner inter 14 leg outer diameter 78 can be from about 1.3 mm (0.050 in.) to about 5.08 mm (0.200 15 in.), for example about 4.06 mm (0.160 in.). The tensioner shoulders 64 and/or 66 16 and/or the tensioner feet 72 and/or 74 can extend to a greater radius from the tensioner 17 longitudinal axis 60 than their respective tensioner inter-leg radius. 18 [00861 Figure 16 illustrates a tensioner first strut 80 that can attach to the tensioner 19 first leg 68 and the tensioner second leg 70. The tensioner first leg 68 can be resilient, 20 deformable or combinations thereof. A tensioner second strut 82 can attach to the 21 tensioner first leg 68 and the tensioner second leg 70. The tensioner second leg 70 22 can be resilient and/or deformable. The tensioner 58 can have no tensioner head 62. 23 The tensioner 58 can have more than two tensioner struts 80 and 82. 24 [0087] Figure 17 illustrates a pressure clip 84. The pressure clip 84 can be resilient. 25 The pressure clip 84 can be deformable. The pressure clip 84 can have a pressure clip 26 longitudinal axis 86. The pressure clip 84 can have a pressure clip head 88. The 27 pressure clip head 88 can be rotatably attached to a separate or integral pressure clip 28 first leg 90. The pressure clip head 88 can be rotatably attached to a separate or 29 integral pressure clip second leg 92. The pressure clip can have a pressure clip first 30 end 94 and a pressure clip second end 96. The pressure clip first leg 90 can terminate 31 in the pressure clip first end 94. The pressure clip second leg 92 can terminate in the 32 pressure clip second end 96. The pressure clip first leg 90 and/or the pressure clip 33 second leg 92 can be biased toward the pressure clip longitudinal axis 86. 11 1 [0088] Figure 18 illustrates the pressure clip 84 that can have a pressure clip sheath 2 98 slidably attached to the pressure clip second leg 92. The pressure clip first and/or 3 second ends 94 and/or 96 can be pressure dissipaters, such as flat and/or curved 4 portions, for example circular loops. The pressure clip first and/or second ends 94 5 and/or 96 can be resilient and/or deformable. The pressure clip first leg 90 can be 6 rotatably attached to the pressure clip second leg 92. The pressure clip first leg 90 can 7 be attached to the pressure clip second leg 92 via a rotatable, and/or deformable, 8 and/or flexural joint in the pressure clip head 88. 9 [0089] Figure 19 illustrates a toggle 100. The toggle 100 can have a toggle first end 10 102. The toggle 100 can have a toggle second end 104. The toggle first and/or 11 second ends 102 and/or 104 can be bars, dowels, rods, beams, or combinations 12 thereof. The toggle 100 can have a filament 106. The filament 106 can be fixedly 13 attached at a filament first end 107 to the toggle first end 102. The filament 106 can 14 be fixedly attached at a filament second end 109 to the toggle second end 104. The 15 filament 106 can be resilient or deformable. The filament 106 can be substantially 16 flexible. 17 [0090] Figure 20 illustrates the toggle 100 that can have the filament 106 that can be 18 slidably attached to the toggle second end 104 at a hole 108. The filament 106 can 19 frictionally fit the hole 108. The filament 106 can have no pawls 110 (not shown in 20 Figure 20). The filament 106 can interference fit the hole 108. The filament 106 can 21 have one or more pawls 110. The hole 108 can have one or more notches 112. The 22 notches 112 can be internal to the hole 108. The notches 112 and the pawls 110 can 23 be configured to allow the toggle second end 104 to slide toward the toggle first end 24 102. The notches 112 and the pawls 110 can be configured to provide an interference 25 fit when the toggle second end 104 is attempted to be moved away from the toggle 26 first end 102. 27 28 METHOD OF MANUFACTURE 29 [0091] The elements of the arteriotomy device 2, including the supplemental closure 30 devices, can be directly attached by, for example, melting, screwing, gluing, welding 31 or use of an interference fit or pressure fit such as crimping, snapping, or combining 32 methods thereof. The elements can be integrated, for example, molding, die cutting, 33 laser cutting, electrical discharge machining (EDM) or stamping from a single piece 12 1 or material. Any other methods can be used as known to those having ordinary skill 2 in the art. 3 [0092] Integrated parts can be made from pre-formed resilient materials, for example 4 resilient alloys (e.g., Nitinol, ELGILOY@) that are preformed and biased into the 5 post-deployment shape and then compressed into the deployment shape as known to 6 those having ordinary skill in the art. 7 [0093] Any elements of the arteriotomy device 2, including the supplemental closure 8 devices, or the arteriotomy device 2, including the supplemental closure devices, as a 9 whole after assembly, can be coated by dip-coating, brush-coating or spray-coating 10 methods known to one having ordinary skill in the art. For example, these methods 11 can be used to coat the wound wire 32 with the wire coating 36 can be spray coated, 12 dip-coated or brushed onto the wire 32. 13 [0094] One example of a method used to coat a medical device for vascular use is 14 provided in U.S. Patent No. 6,358,556 by Ding et al. and hereby incorporated by 15 reference in its entirety. Time release coating methods known to one having ordinary 16 skill in the art can also be used to delay the release of an agent in the coating, for 17 example the coatings on the supplemental closure devices. 18 [00951 The supplemental closure devices can be covered with a fabric, for example 19 polyester (e.g., DACRON@ from E. I. du Pont de Nemours and Company, 20 Wilmington, DE), polypropylene, PTFE, ePTFE, nylon, extruded collagen, silicone or 21 combinations thereof. Methods of covering an implantable device with fabric are 22 known to those having ordinary skill in the art. 23 24 METHOD OF USE 25 [0096] Figure 21 illustrates a method of inserting the anchor 6 into a biological lumen 26 114, for example a blood vessel, such as a femoral artery. The biological lumen 114 27 can have a lumen wall 116 and a lumen wall surface 118. The anchor 6 can be 28 inserted into the biological lumen 114 using a Seldinger technique, modified 29 Seldinger technique, or other method known to one having ordinary skill in the art. 30 The anchor 6 can create a first arteriotomy 120. The anchor 6 can be inserted into the 31 lumen 114 so that the anchor angle second sub-section 18 can be substantially parallel 32 with the lumen wall surface 118. The anchor 6 can be inserted into the lumen 114 so 13 1 that the anchor angle second sub-section 18 can be substantially in contact with the 2 lumen wall surface 118. 3 [0097] Figure 22 illustrates a method of deploying, as shown by arrow, the lumenal 4 retainer 48 from the first retracted configuration to the second deployed configuration. 5 The lumenal retainer 48 can be deployed by extending a wire, scaffold or stent, or by 6 inflating a balloon. When the lumenal retainer 48 is deployed, the anchor angle 7 second sub-section 18 can be made substantially parallel with the lumen wall surface 8 118. When the lumenal retainer 48 is deployed, the anchor angle second sub-section 9 18 can be made to be substantially in contact with the lumen wall surface 118. 10 [0098] Figure 23 illustrates a method of deploying, as shown by arrow 122, the entry 11 wall retainer 56 from the first retracted configuration to the second deployed 12 configuration. When the lumenal retainer is in the second deployed configuration, the 13 lumenal retainer 48 can be substantially parallel with the lumen wall surface 118. 14 When the lumenal retainer is in the second deployed configuration, the lumenal 15 retainer 48 can be substantially in contact with the lumen wall surface 118. 16 [00991 A proximal force, as shown by arrow 124, can be applied to the anchor 6, for 17 example by being applied to the delivery guide 4. When the proximal force is 18 applied, the anchor angle second sub-section 18 can be made substantially parallel 19 with the lumen wall surface 118. When the proximal force is applied, the anchor 20 angle second sub-section 18 can be made to be substantially in contact with the lumen 21 wall surface 118. 22 [01001 Figures 24 and 25 illustrate a method for deploying the introduction device 38. 23 The introduction device 38 can egress from the introducer lumen 8 and the introducer 24 lumen exit port 10. As shown in Figure 24, the introduction device 38 can be pushed, 25 as shown by arrow, into and through the lumen wall 116. The introduction device 38 26 can form a second arteriotomy 128. As shown in Figure 25, the introduction device 27 38 can be pushed, as shown by arrow, adjacent to or through the anchor 6. The 28 anchor 6 can be configured to have ports suitable to allow the introduction device 38 29 to pass through the anchor 6. A tip of the introduction device 38 can enter the lumen 30 114. 31 [0101] The introduction device 38 can pass through an introduction run 132 and an 32 introduction rise 134. The introduction run 132 can be the component of the length of 33 the introduction device 38 in the lumen wall 116 that is parallel to the lumen wall 116. 14 1 The introduction run 132 can be the component of the length parallel to the lumen 2 wall 116 between the opening of the second arteriotomy 128 on the outside of the 3 lumen wall 116 and the opening of the second arteriotomy 128 on the inside lumen 4 wall surface 118. The introduction run 132 can be from about 0.10 cm (0.010 in.) to 5 about 3.810 cm (1.500 in.), for example about 0.64 cm (0.25 in.). 6 [0102] The introduction rise 134 can be the component of the length of the 7 introduction device 38 in the lumen wall 116 that is perpendicular to the lumen wall 8 116. The introduction rise 134 can be the component of the length perpendicular to 9 the lumen wall 116 between the opening of the second arteriotomy 128 on the outside 10 of the lumen wall 116 and the opening of the second arteriotomy 128 on the inside 11 lumen wall surface 118. The introduction rise 134 can be from about 0.51 mm (0.020 12 in.) to about 5.08 mm (0.200 in.), for example about 1.0 mm (0.040 in.). An 13 introduction slope can be the ratio of the introduction rise 134 to the introduction run 14 132. The introduction slope can be from about 1/2 to about 1/4o or less, for example 15 about 1/6, also for example about 1/3. The introduction slope can be, for examples, 16 equal to or less than about 1/2 or 1/3, more narrowly equal to or less than about 1/3 or 17 1/4, yet more narrowly equal to or less than about 1/5 or 1/6, even still more narrowly 18 than about equal to or less than about 1/10. 19 [0103] The introduction rise 134 and the introduction run 132 can be components of 20 an introduction vector. The introduction run 132 can be the component of the 21 introduction vector parallel to the lumen wall 116. The introduction rise 134 can be 22 the component of the introduction vector perpendicular to the lumen wall 116. The 23 introduction vector can be a vector from an outer opening 136 to an inner opening 24 138. The outer opening 136 can be a temporary or permanent opening on the outside 25 of the lumen wall 116 formed by the introduction device 38. The inner opening 138 26 can be a temporary or permanent opening on the inside of the vessel wall. 27 [0104] Figure 26 illustrates that the introduction device 38, for example a hollow 28 needle, can act as a pathway for a lumenal tool, for example tools such as a guidewire 29 168, to be deployed, as shown by arrow, into the lumen 114. The introduction device 30 38, for example a solid needle, can be removed from the second arteriotomy 128 and 31 the lumenal tool can be deployed through, for example, the introducer lumen exit port 32 10, and the second arteriotomy 128. The introduction device 38 can be the lumenal 15 1 tool, for example a guidewire. The introduction device 38 can be further deployed 2 and used as a lumenal tool after passing through the lumen wall 116. 3 [0105] Figures 27 through 30 illustrates a method of deploying the introduction 4 device 38 that can have a pre-formed bend. As shown in Figure 27, the arteriotomy 5 device 2 can be configured to deploy the introduction device 38 at the introduction 6 angle 42 from about 0* to about 5*, for example about 00. 7 [0106] As shown in Figure 28, the introduction device 38 can be pushed, as shown by 8 arrow, through the lumen wall 116. The introduction device 38 can cleave a plane in 9 the lumen wall 116. The plane can be substantially parallel with the lumen wall 10 surface 118. The introduction device 38 can be adjacent to the adventitia in a blood 11 vessel. The introduction device 38 can be advanced along the subintimal or 12 submedial cleavage plane in a blood vessel. Once the lumen wall has been cleaved, a 13 subintimal angioplasty can be performed as known to one having ordinary skill in the 14 art. Once the lumen wall has been cleaved, a remote endarterectomy can be 15 performed as known to one having ordinary skill in the art. Bent and straight 16 introduction devices 38 can be swapped during use to selectively cleave the lumen 17 wall 116. Tools, such as guidewires, can be inserted through hollow introduction 18 devices 38 to selectively cleave the lumen wall 116. 19 [0107] As shown in Figure 29, when the bend in the introduction device 38 moves 20 into the lumen wall 116, the introduction device 38 can rotate, as shown by arrow, 21 toward the biological lumen 114. As shown in Figure 30, the bend in the introduction 22 device 38 can continue to rotate the introduction device 38 toward the biological 23 lumen 114. As described infra, the introduction device 38 can enter the lumen 114. 24 Figure 31 illustrates that the introduction device 38 that can have the bend can act as a 25 pathway for a lumenal tool, as described infra. 26 [0108] An introducer sheath can be inserted over the guidewire 168 and/or the 27 introduction device 38. The introducer sheath can be less than about 22 French (7.3 28 mm, 0.29 in. diameter) or less than the diameter of the lumen to which the introducer 29 sheath is introduced. The introducer sheath can be, for examples, about 6 French (2.3 30 mm, 0.092 in. diameter), and about 8 French (2.67 mm, 0.105 in. diameter). The 31 introducer sheath can be known to one having ordinary skill in the art, for example the 32 introducer sheath described in U.S. Patent No. 5,183,464 to Dubrul, et al. 16 1 [01091 The introducer sheath can be inserted into the second arteriotomy 128. The 2 introducer sheath can expand the second arteriotomy 128 to a workable size. The 3 introducer sheath can be inserted into the second arteriotomy 128 before and/or after 4 and/or concurrently with the supplemental closure device is deployed and/or other 5 closure method is used. 6 [0110] Figures 32 and 33 illustrate an exemplary biological lumen 114 after the 7 arteriotomy device 2 has been deployed to, and removed from, the biological lumen 8 114. The biological lumen 114 can have the first and second arteriotomies 120 and 9 128. The biological lumen 114 can have a second arteriotomy 128. The biological 10 lumen 114 can have a first web 140 on one side of the arteriotomy (shown for the 11 second arteriotomy 128), and a second web 142 on the opposite side of the 12 arteriotomy 120 or 128. The natural pressure, shown by arrows, from the first and 13 second webs 140 and 142 can self-seal the arteriotomy 120 or 128. 14 [0111] One or more supplemental closure devices can be deployed to the first and/or 15 second arteriotomies 120 and/or 128. The supplemental closure devices can provide a 16 force or restraint to aid hemostasis. The supplemental closure devices can be 17 permanently or temporarily deployed. The supplemental closure devices can 18 biodissolve after hemostasis is achieved and/or after the relevant arteriotomy 120 or 19 128 is substantially or completely healed. The force from the supplemental closure 20 device can be maintained from about 15 minutes to about 24 hours or more, for 21 example about 120 minutes. 22 [0112] Figure 34 illustrates a tensioner 58 in a compressed configuration. 23 Compressive forces, shown by arrows, can compress the tensioner first and second 24 legs 68 and 70. In a compressed configuration, the tensioner inter-leg outer diameter 25 78 can be from about 0.51 mm (0.020 in.) to about 2.54 mm (0.100 in.), for example 26 about 1.5 mm (0.060 in.). 27 [0113] Figures 35 and 36 illustrate a method of deploying the tensioner 58. As shown 28 in Figure 35, the tensioner 58 can be in a compressed configuration. The tensioner 58 29 can be exposed to the compressive forces, as shown by arrows 144. The compressive 30 forces can be applied by a retractable sheath, clamps, other methods known to one 31 having ordinary skill in the art, or combinations thereof. A deployment force, shown 32 by arrow 146, can deploy the tensioner 58 into the arteriotomy 120 or 128. 17 1 [0114] The arteriotomy 120 or 128 can have an arteriotomy diameter 148. The 2 arteriotomy diameter 148 can be from about 0.5 mm (0.020 in.) to about 400 mm (15 3 in.), yet a narrower range from about 1.0 mm (0.040 in.) to about 10.2 mm (0.400 in.), 4 for example about 2.54 mm (0.100 in.). When in the compressed configuration, the 5 tensioner inter-leg outer diameter 78 can be smaller than the arteriotomy diameter 6 148. The tensioner first and second shoulders 64 and 66 can be wide enough to 7 interference fit with the arteriotomy 120 or 128. The tensioner first and second 8 shoulders 64 and 66 can dissipate force on the lumen wall surface 118. 9 [01151 As shown in Figure 36, the compressive forces can be removed from the 10 tensioner 58. The tensioner first and second leg 68 and 70 can expand, as shown by 11 arrows. The tensioner 58 can force the arteriotomy 120 or 128 into a substantially or 12 completely flat and/or closed and/or stretched configuration. The walls of the 13 arteriotomy 120 or 128 can come into close contact. 14 [0116] The arteriotomy 120 or 128 can have an arteriotomy width 150 and an 15 arteriotomy height 152. The arteriotomy width 150 can be about half the 16 circumference of the arteriotomy 120 or 128. The arteriotomy width 150 can be from 17 about 1.0 mm (0.040 in.) to about 10.2 mm (0.400 in.), for example about 4.06 mm 18 (0.160 in.). 19 [0117] The arteriotomy height 152 can be about the tensioner leg diameter 76. The 20 arteriotomy height 152 can be less than about 0.51 mm (0.020 in.), more narrowly, 21 less than about 0.38 mm (0.015 in.). The arteriotomy height 152 can be from about 22 0.25 mm (0.010 in.) to about 1.3 mm (0.050 in.), for example about 0.38 mm (0.015 23 in.). The arteriotomy height 152 can be small enough to enable cell growth, blood 24 clotting, acoustic sealing, heat sealing, gluing, enhanced self-sealing and 25 combinations thereof across the arteriotomy 120 or 128. 26 [0118] The tensioner first and second shoulders 64 and 66 can be wide enough to 27 interference fit with the arteriotomy 120 or 128. The tensioner first and second feet 28 72 and 74 can be wide enough to interference fit with the arteriotomy 120 or 128. 29 The tensioner first and second feet 72 and 74 can dissipate force on the lumen wall 30 surface 118. 31 [0119] The arteriotomy 120 or 128 can be plugged, and/or packed, and/or tamponed 32 before, and/or concurrent with, and/or after using any of any of the supplemental 33 closure devices infra and/or supra, the self-sealing closure method, or combinations 18 1 thereof. The plug, pack, tampon, or combinations thereof (not shown) can be made 2 from gelfoam, collagen, other implantable and biocompatible tampon materials 3 known to those having ordinary skill in the art, or combinations thereof. 4 [01201 Figures 37 through 40 illustrate deploying the pressure clip 84 to the 5 arteriotomy 120 or 128. Figure 37 illustrates extending, and/or thinning, and/or 6 straightening, and/or tensioning the pressure clip second end 96. The pressure clip 7 sheath 98 can be translated, as shown by arrow, along the pressure clip second leg 92 8 and onto the pressure clip second end 96. The pressure clip 84 can be deployed to the 9 arteriotomy after the pressure clip second end 96 is extended, and/or thinned, and/or 10 straightened, and/or tensioned. 11 [01211 As shown in Figure 38, the pressure clip second leg 92 can be rotated with 12 respect to the pressure clip head 88, so that the pressure clip second leg 92 and the 13 pressure clip head 88 are substantially aligned. The pressure clip second leg 92 can 14 be deployed, as shown by the arrow, through the first arteriotomy 120. The pressure 15 clip second leg 92 can be deployed through the lumen wall 116 (e.g., if there is no 16 existing first arteriotomy 120, if the first arteriotomy 120 is not suitably located with 17 respect to the second arteriotomy 128). 18 [01221 Figure 39 illustrates contracting, and/or widening, and/or releasing and/or 19 relaxing the pressure clip second end 96. The pressure clip sheath 98 can be 20 translated, as shown by arrow, along the pressure clip second leg 92 and off of the 21 pressure clip second end 96. The pressure clip second end 96 can be contracted, 22 and/or widened, and/or released and/or relaxed after the pressure clip 84 is deployed 23 to the arteriotomy. 24 [0123] As shown in Figure 40, after the pressure clip second leg 92 is deployed 25 through the first arteriotomy 120, the pressure clip second leg 92 can be released or 26 deformed so as to rotate with respect to the pressure clip head 88. The pressure clip 27 head 88 can seat in the first arteriotomy 120. The pressure clip first and second legs 28 90 and 92 can apply force, as shown by arrows, to the first and second webs 140 and 29 142, respectively. 30 [0124] Figures 41 and 42 illustrate a method of deploying a stitch 154 surrounding 31 and/or through the arteriotomy 120 or 128. The stitch 154 can be tightened to apply 32 additional pressure to the arteriotomy 120 or 128. The stitch 154 can have a knot 156, 33 or other tying configuration or device, for example a pledget or clamp. 19 1 [0125] Figures 43 and 44 illustrate a method of deploying the filament 106 adjacent 2 to and/or through the arteriotomy 120 or 128. The filament 106 can be attached to a 3 first pledget 158a by a first knot 156a or other tying configuration or device. The 4 filament 106 can be attached to a second pledget 158b by a second knot 156b or other 5 tying configuration or device. The first and second pledgets 158a and 158b can be 6 other pressure diffusers known to one having ordinary skill in the art, such as the 7 toggles 100 described infra and supra. 8 [0126] Figures 45 and 46 illustrate a toggle deployment device 159 that can be in a 9 first retracted configuration. The toggle deployment device 159 can have a pressure 10 check port 160. The pressure check port 160 can be in fluid communication with a 11 sensor or port on or near the handle (not shown) of the toggle deployment device 159, 12 such as an external lumen where blood flow can be observed, for example from flow 13 from the end of an external tube or port and/or through a transparent or translucent 14 window. The pressure check port 160 can facilitate deployment of the toggle 15 deployment device 159 to a location where the pressure check port 160 is introduced 16 to pressure, for example when the pressure check port 160 enters the biological lumen 17 114. The sensor or port on or near the handle of the toggle deployment device 159 18 will signal that the pressure check port 160 has been placed into the biological lumen 19 114 (e.g., by displaying a small amount of blood flow). The pressure check port 160 20 can be deployed into the biological lumen 114 and then withdrawn from the 21 biological lumen 114 to the point where the lumen wall 116 just stops the pressure in 22 the pressure check port 160. The entry wall retainer port 54 can additionally perform 23 the function as described herein for the pressure check port 160. The toggle 24 deployment device 159 can have a delivery needle port 161. 25 [0127] Figures 47 and 48 illustrate the toggle deployment device 159 that can be in a 26 second delivery configuration. A delivery needle 162 can be slidably attached to the 27 toggle deployment device 159. The delivery needle 162 can egress from the delivery 28 needle port 161 when the toggle deployment device 159 is in the second delivery 29 configuration. 30 [01281 Figures 49 and 50 illustrate that the toggle deployment device 159 can be 31 deployed into the arteriotomy 120 or 128 at a location where the pressure check port 32 160 can be located in the biological lumen 114. The delivery needle port 161 can be 33 in, or adjacent to, the lumen wall 116. 20 1 [0129] Figures 51 and 52 illustrate that the toggle deployment device 159 can be 2 placed in the second delivery configuration. If the delivery needle port is in, or 3 adjacent to, the lumen wall 116 when the toggle deployment device 159 is placed in 4 the second delivery configuration, the delivery needle 162 can enter the lumen wall 5 116. For example, the delivery needle 162 can enter the second web 142. The 6 delivery needle 162 can exit the second web 142 and enter, as shown by arrows, the 7 biological lumen 114. 8 [01301 Figure 53 illustrates that a pusher 164 can be slidably attached to the delivery 9 needle 162. The delivery needle 162 can have a needle tip port 166. The toggle 100 10 can be in the delivery needle 162. The toggle 100 can be configured in the delivery 11 needle 162 such that the toggle first end 102 can be located on the needle tip port 166 12 -side of the pusher 164. 13 [0131] Figure 54 illustrates that the pusher 164 can be moved, as shown by arrow, 14 toward the needle tip port 166. The delivery needle 162 can be moved back relative 15 to the pusher 164, the pusher 164 can be moved forward relative to the delivery 16 needle 162, or combinations thereof. The pusher 164 can push the toggle first end 17 102 out of the delivery needle 162. The pusher 164 can push the toggle first end 102 18 into the biological lumen 114. 19 [0132] Figures 55 and 56 illustrate that the toggle deployment device 159 can be in a 20 first retracted configuration after deploying the toggle first end 102 into the biological 21 lumen 114. When the delivery needle 162 retracts into the toggle deployment device 22 159, the toggle second end 104 can be in the toggle deployment device 159. The 23 filament 106 can extend though -the delivery needle port 161. 24 [0133] Figures 57 and 58 illustrate that the toggle 100 can be deployed across the 25 lumen wall. When the toggle deployment device 159 is removed from the 26 arteriotomy, the toggle second end 104 can deploy on the outside of the lumen wall 27 116 from the delivery needle port 161. The toggle first end 102 can form an 28 interference fit with the lumen wall surface 118. The toggle second end 104 can form 29 an interference fit with the outside of the lumen wall 116 or the surrounding tissue, 30 such as subcutaneous tissue. The toggle second end 104 can be slidably translated 31 along the filament 106 toward the lumen wall 116, for example for the toggle 100 32 illustrated in Figure 20. The length of the filament 106 on the opposite side of toggle 21 1 second end 104 from the toggle first end 102 can be cut, snapped, torn or otherwise 2 removed. 3 [01341 Figures 59 through 63 illustrate a method for deploying the toggle 100. The 4 delivery needle 162 can egress, as shown by arrow, from a toggle deployment 5 delivery port 163. The toggle deployment delivery port 163 can be in the delivery 6 guide 4. The delivery needle 162 can be advanced toward the lumen 114. 7 [0135] Figure 60 illustrates that the delivery needle 162 can be deployed through the 8 lumen wall. When the delivery needle 162 is deployed through the lumen wall 116, 9 the delivery needle can intersect, or pass adjacent to, the second arteriotomy. 10 [0136] Figures 61 and 62 illustrate that the pusher 164 can be advanced, as shown by 11 arrow, through the delivery needle 162. The toggle first end 102 can egress from the 12 needle tip port 166. The toggle first end 102 can deploy into the lumen 114. 13 [0137] Figure 63 illustrates that the delivery needle 162 can be retracted into the 14 delivery guide 4 and/or the filament 106 can be pulled taught, both shown by arrow. 15 The toggle first end 102 can form an interference fit with the lumen wall surface 118. 16 The toggle second end 104 (not shown in Figure 63) can be slidably translated on the 17 filament 106 down to, and form an interference fit with, the outside of the lumen wall 18 116. The length of the filament 106 on the opposite side of toggle second end 104 19 from the toggle first end 102 can be cut, snapped, torn or otherwise removed. 20 [01381 Figure 64 illustrates an introducer needle 165 that can have an end inserted, as 21 shown by arrow, through the lumen wall 116 and into the lumen 114, for example by 22 using the Seldinger technique. The introducer needle 165 can be hollow and/or have 23 a longitudinal channel. Figure 65 illustrates that the guidewire 168 can be deployed, 24 shown by arrows, through the hollow and/or longitudinal channel of the introducer 25 needle 165. 26 [01391 Figure 66 illustrates that the introducer needle 165 can be removed, as shown 27 by arrow, from the lumen wall 116. The guidewire 168 can remain substantially in 28 place. After the introducer needle 165 is removed, a portion of the guidewire 168 can 29 be outside the lumen 114 and another portion of the guidewire 168 can be inside the 30 lumen 114. 31 [0140] Figure 67 illustrates a method of fixedly or slidably attaching the guidewire 32 168 to the anchor 6. A guidewire proximal end 170 can be placed in proximity to an 33 anchor distal end 172. The guidewire proximal end 170 can then be attached, as 22 1 shown by arrows, to the anchor distal end 172. The guidewire proximal end 170 can 2 be attached to the anchor distal end 172 while some or all of the guidewire 168 is in 3 the lumen 114. The guidewire proximal end 170 can be configured to snap-fit, 4 interference fit, slidably attach or combinations thereof, to the anchor 6. When the 5 guidewire 168 is attached to the anchor 6, the guidewire 168 can act as the anchor 6 extension section 14 and/or the lumenal tool. Figure 68 illustrates the guidewire 168 7 attached to the anchor 6. 8 [0141] Where applicable, the methods described supra for deploying any 9 supplemental closure device can be used for deploying any of the other supplementary 10 deployment device. It is apparent to one skilled in the art that various changes and 11 modifications can be made to this disclosure, and equivalents employed, without 12 departing from the spirit and scope of the invention. Elements shown with any 13 embodiment are exemplary for the specific embodiment and can be used on other 14 embodiments within this disclosure. 23