US20100185234A1 - Closure devices, systems, and methods - Google Patents

Closure devices, systems, and methods Download PDF

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Publication number
US20100185234A1
US20100185234A1 US12688065 US68806510A US2010185234A1 US 20100185234 A1 US20100185234 A1 US 20100185234A1 US 12688065 US12688065 US 12688065 US 68806510 A US68806510 A US 68806510A US 2010185234 A1 US2010185234 A1 US 2010185234A1
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Prior art keywords
member
disposed
closure device
elongate
elongate member
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
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US12688065
Inventor
Aaron M. Fortson
Wouter E. Roorda
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Abbott Vascular Inc
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Abbott Vascular Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A61B2017/00646Type of implements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A61B2017/00646Type of implements
    • A61B2017/00654Type of implements entirely comprised between the two sides of the opening

Abstract

The present disclosure includes vessel closure devices, systems, and methods. A closure device configured to close an opening in a body lumen may include an elongate member having a distal end and a proximal end. An anchor member may be disposed on the elongate member proximate the distal end of the elongate member. A cap member may also be disposed on the elongate member a distance from the distal end of the elongate member. The anchor member and the cap member cooperate to close the opening in the body lumen.

Description

    CROSS-REFERENCE TO RELATED APPLICATIONS
  • This U.S. patent application claims the benefit of and priority to U.S. Provisional Patent Application having Ser. No. 61/145,468, filed on Jan. 16, 2009, the disclosure of which is incorporated herein by reference in its entirety.
  • BACKGROUND
  • 1. Technical Field
  • The present disclosure relates generally to medical devices, systems, and methods. In particular, the present disclosure relates to vessel closure devices, systems, and methods.
  • 2. Technology
  • Catheterization and interventional procedures, such as angioplasty or stenting, generally are performed by inserting a hollow needle through a patient's skin and tissue into the patient's vascular system. A guidewire may be advanced through the needle and into the patient's blood vessel accessed by the needle. The needle is then removed, enabling an introducer sheath to be advanced over the guidewire into the vessel, e.g., in conjunction with or subsequent to a dilator.
  • A catheter or other device may then be advanced through a lumen of the introducer sheath and over the guidewire into a position for performing a medical procedure. Thus, the introducer sheath may facilitate introducing various devices into the vessel, while minimizing trauma to the vessel wall and/or minimizing blood loss during a procedure.
  • Upon completing the procedure, the devices and introducer sheath are removed, leaving a puncture site in the vessel wall. Traditionally, external pressure is applied to the puncture site until clotting and wound sealing occur; however, the patient must remain bedridden for a substantial period after clotting to ensure closure of the wound. This procedure, however, may be time consuming and expensive, requiring as much as an hour of a physician's or nurse's time. It is also uncomfortable for the patient and requires that the patient remain immobilized in the operating room, catheter lab, or holding area. In addition, a risk of hematoma exists from bleeding before hemostasis occurs.
  • BRIEF SUMMARY
  • The present disclosure includes vessel closure devices, systems, and methods. In particular, the devices, systems, and methods of the present disclosure may allow a medical service provider to efficiently and quickly close an opening in a body lumen in a cost effective manner. In addition, the devices, systems, and methods of the present disclosure may allow for the closing of smaller body lumen openings using fewer parts than prior devices and systems.
  • According to one embodiment of the present disclosure, a closure device configured to close an opening in a body lumen may include an elongate member having a distal end and a proximal end. In addition, an anchor member may be disposed on the elongate member proximate the distal end of the elongate member. A cap member may also be disposed on the elongate member a distance from the distal end of the elongate member.
  • These and other advantages and features of the present disclosure will become more fully apparent from the following description and appended claims, or may be learned by the practice of the invention as set forth hereinafter.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • To further clarify the advantages and features of the present disclosure, a more particular description of the disclosure will be rendered by reference to example embodiments thereof which are illustrated in the appended drawings. It is appreciated that these drawings depict only example embodiments of the disclosure and are therefore not to be considered limiting of its scope. The example embodiments will be described and explained with additional specificity and detail through the use of the accompanying drawings in which:
  • FIG. 1 illustrates an example closure device for closing an opening in a body lumen or other tissue;
  • FIG. 2 illustrates an another example closure device for closing an opening in a body lumen or other tissue;
  • FIG. 3A illustrates an example closure system for closing an opening in a body lumen or other tissue;
  • FIG. 3B illustrates an additional example closure system;
  • FIG. 3C illustrates a further example closure system; and
  • FIGS. 4-11 illustrate an example method of closing a lumen opening.
  • DETAILED DESCRIPTION
  • The present disclosure includes devices, systems, and methods for closing an opening in a body lumen or other tissue. In particular, an example closure system may allow for at least one of reduced production costs, ease of use, and more effective hemostasis. In addition, embodiments of the closure system disclosed herein may allow for the closure of smaller openings in body lumens or other tissue.
  • In one embodiment, the closure system may include a closure device. The closure device may include an elongate member, such as a suture or shaft, an anchor member (or foot), and a cap member. The closure device may be disposed within or deployed by the closure system. The closure system may include an outer member, an inner member, an intermediate member, or combinations thereof configured to deploy a closure device from the closure system.
  • Reference is now made to FIG. 1, which illustrates an example closure device 100. The closure device 100 may include a plurality of closure members 110 coupled to an elongate member 120. In particular, the plurality of closure members 110 may include an anchor member 110 a and/or a cap member 110 b. In one embodiment, the anchor member 110 a may be disposed near a distal end of the elongate member 120. In a further embodiment, the cap member 110 b may be proximate the anchor member 110 a and/or spaced a distance away from the distal end of the elongate member 120.
  • The anchor member 110 a may be configured to be deployed through an opening in a body lumen in order to secure the closure device 100 from a point distal to the lumen opening. For example, the anchor member 110 a may be configured to move from a compressed, folded, or compacted first position having a dimension smaller than a lumen opening to a deployed, unfolded, or expanded second position having a dimension larger than the lumen opening. As a result, the anchor member 110 a may pass through the lumen opening while in the first position and thereafter may move to the second position and provide an anchor against the distal side of the lumen wall proximate the lumen opening.
  • The elongate member 120 may extend proximally from the deployed anchor member 110 a and/or may be tensioned to secure the anchor member 110 a proximate the lumen opening and/or against a distal surface of a lumen wall once deployed. In a further embodiment, the elongate member 120 may pass through the cap member 110 b, which may be deployed at a position proximal of the lumen wall. Once deployed, the cap member 110 b may be moved in a distal direction and/or may engage the proximal surface of the lumen wall. As a result, the anchor member 110 a and/or cap member 110 b may at least partially close the lumen opening.
  • The closure device 100 including, but not limited to, the anchor member 110 a and/or cap member 110 b, may include one or more biocompatible, bioabsorbable, bioresorbable, other materials, or combinations thereof. Examples of such materials may include a suitable hydrogel, hydrophilic polymer, biodegradable polymers, bioabsorbable polymers and bioneutral polymers. Examples of such polymers may include poly(alpha-hydroxy esters), polylactic acids, polylactides, poly-L-lactide, poly-DL-lactide, poly-L-lactide-co-DL-lactide, polyglycolic acids, polyglycolide, polylactic-co-glycolic acids, polyglycolide-co-lactide, polyglycolide-co-DL-lactide, polyglycolide-co-L-lactide, polyanhydrides, polyanhydride-co-imides, polyesters, polyorthoesters, polycaprolactones, polyesters, polyanydrides, polyphosphazenes, polyester amides, polyester urethanes, polycarbonates, polytrimethylene carbonates, polyglycolide-co-trimethylene carbonates, poly(PBA-carbonates), polyfumarates, polypropylene fumarate, poly(p-dioxanone), polyhydroxyalkanoates, polyamino acids, poly-L-tyrosines, poly(beta-hydroxybutyrate), polyhydroxybutyrate-hydroxyvaleric acids, combinations thereof, and/or the like.
  • In one embodiment, the closure device 100, including, but not limited to, the anchor member 110 a and/or cap member 110 b, may be coated with an active pharmaceutical ingredient with or without a polymeric carrier. The active pharmaceutical ingredient can be any drug. In one embodiment, the pharmaceutical ingredient may increase tissue growth.
  • The polymeric coating and drug may be configured to cooperate so as to form a diffusion pathway (e.g., lipophilic, hydrophilic, and/or amphipathic) with tissue when at least a portion of the closure device 100 engages tissue. This may facilitate diffusion into the tissue instead of into a body fluid passing over the closure device 100.
  • The closure device 100 or any portion thereof may be loaded with and deliver beneficial agents or drugs, such as therapeutic agents, pharmaceuticals and radiation therapies. Accordingly, the closure device 100 and/or coating material may contain a drug or beneficial agent to improve the use of the closure device 100. Such drugs or beneficial agents may include antithrombotics, anticoagulants, antiplatelet agents, thrombolytics, antiproliferatives, anti-inflammatories, hemostatic agents, agents that inhibit hyperplasia, inhibitors of smooth muscle proliferation, antibiotics, growth factor inhibitors, or cell adhesion inhibitors, as well as antineoplastics, antimitotics, antifibrins, antioxidants, agents that promote endothelial cell recovery, antiallergic substances, radiopaque agents, viral vectors having beneficial genes, genes, siRNA, antisense compounds, oligionucleotides, cell permeation enhancers, and combinations thereof. Another example of a suitable beneficial agent is described in U.S. Pat. No. 6,015,815 and U.S. Pat. No. 6,329,386 entitled “Tetrazole-containing rapamycin analogs with shortened half-lives”, the entireties of which are herein incorporated by reference.
  • The anchor member 110 a and/or cap member 110 b may include any shape configured to facilitate obstruction of a lumen opening. In one embodiment, the anchor member 110 a and/or cap member 110 b may have a disc-like shape. For example, the anchor member 110 a and/or cap member 110 b may include a generally flat piece of material that may be circular or oval in shape. The anchor member 110 a and/or cap member 110 b may incorporate other shapes and/or configurations. For example, the anchor member 110 a and/or cap member 110 b may have an elliptical and/or polygonal shape. In a further embodiment, the closure members 110 may be rectangular in shape along the length thereof with rounded and/or triangular ends or corners.
  • In one implementation, the thickness of the anchor member 110 a and/or cap member 110 b may be continuous throughout the anchor member 110 a and/or cap member 110 b. In further implementations, however, the thickness of the anchor member 110 a and/or cap member 110 b may vary as desired for a particular application. For example, the thickness of the anchor member 110 a and/or cap member 110 b may be greater near the center than along the outer edge of the anchor member 110 a and/or cap member 110 b. In a yet further example, the thickness of the anchor member 110 a and/or cap member 110 b may be greater along a first axis extending through the center of the anchor member 110 a and/or cap member 110 b and progressively thinner extending away from the first axis. As a result, the anchor member 110 a and/or cap member 110 b may allow bending about the first axis but may resist bending about an axis perpendicular to or different from the first axis. In yet further implementations, the thickness of the anchor member 110 a and/or cap member 110 b may vary as desired to achieve a particular strength, rigidity, flexibility, and/or other mechanical property.
  • In one implementation, the anchor member 110 a and cap member 110 b may have the same shape, size, coating, and/or other characteristics, and/or combinations thereof. In a further embodiment, the shape, size, coating, and/or other characteristics of the anchor member 110 a may be different than those of the cap member 110 b.
  • As mentioned, the closure device 100 may include an elongate member 120. In one embodiment, the anchor member 110 a may be coupled to a distal end of the elongate member 120 and/or the cap member 110 b may be disposed on the elongate member 120 at a position along the length of the elongate member 120. The elongate member 120 may include one or more bioabsorbable materials and/or beneficial agents, such as any bioabsorbable material and/or beneficial agents disclosed herein. In a further embodiment, the elongate member 120 may include a bioabsorbable metal, alloy, polymer, plastic, composite, other materials, or combinations thereof. The elongate member 120 may include a single limb, such as disclosed in FIG. 1, or may include a plurality of limbs, such as disclosed in FIG. 2. In one example embodiment, the elongate member 120 may include a suture or a plurality of sutures. In a further embodiment, the elongate member 120 may include an elongate shaft or a plurality of elongate shafts. In a yet further embodiment, at least a portion of the elongate member 120 may be generally tubular or hollow.
  • The closure device 100 may be configured to resist proximal movement of the cap member 110 b and/or distal movement of the anchor member 110 a after deployment. For example, in one embodiment, a knot may be disposed on the elongate member 120 proximal of the cap member 110 b to secure the cap member 110 b and/or anchor member 110 a in place. In a further embodiment, a cleat, such as a bioabsorbable plastic cleat, may be positioned to secure the cap member 110 b and/or anchor member 110 a in place. For example, the cleat may be positioned along the elongate member 120 proximal of and/or abutting the cap member 110 b. The cleat may maintain sufficient tension in the elongate member 120 to maintain the cap member 110 b and anchor member 110 a securely in a deployed position, such as in apposition with the lumen wall and/or lumen opening therebetween. In particular, the anchor member 110 a and cap member 110 b may sandwich the lumen wall surrounding a lumen opening to achieve closure of the lumen opening.
  • In a further embodiment, the closure device 100 may include a mechanism to lock and/or secure the anchor member 110 a and cap member 110 b in place. In one example embodiment, the elongate member 120 may have a uniform thickness along its length and/or pass through an aperture in the cap member 110 b configured to produce sufficient frictional force between the cap member 110 b and elongate member 120 to resist relative movement between the elongate member 120 and cap member 110 b. In particular, this configuration may allow the cap member 110 b to be deployed by sliding the cap member 110 b in a distal direction along the elongate member 120 to secure the cap member 110 b and anchor member 110 a in place. Once deployed, the frictional force between the elongate member 120 and the cap member 110 b may prevent and/or resist further movement by the cap member 110 b and/or anchor member 110 a.
  • In a further embodiment, the closure device 100 may include a barbed and/or ratchet design to secure the cap member 110 b and anchor member 110 a in the deployed configuration. For example, the elongate member 120 may include a plurality of projections 125 disposed along the length thereof. The projections 125 may include barbs, teeth, ridges, and/or other similar projections. The projections 125 may be configured to allow the cap member 110 b to move in a distal direction but may resist/prevent movement by the cap member 110 b in a proximal direction. For example, the projections 125 may be angled and/or extend in a distal direction to allow the cap member 110 b to pass over the projections 125 in a distal direction but to prevent the cap member 110 b from then passing back over the projections 125 in a proximal direction. Accordingly, once the anchor member 110 a is deployed and/or secured against the distal surface of the lumen wall, the cap member 110 b may be advanced along the elongate member 120 over the projections 125. The cap member 110 b may be secured against the proximal surface of the lumen wall and/or held in place by one or more of the projections 125 of the elongate member 120.
  • In yet a further embodiment, the locking mechanism (i.e., knot, cleat, projections, etc.) may be independent of the cap member 110 b. In particular, decoupling the locking mechanism from the cap member 110 b may allow for the independent optimization of the locking mechanism and/or the cap member 110 b. For example, the closure device 100 may further include a sliding collet that may be advanced along the elongate member 120 and/or lock the cap member 110 b in place once deployed. The collet may incorporate one or more locking features that may be otherwise incorporated in the cap member 110 b as explained in more detail herein.
  • In a further embodiment, the cap member 110 b may be secured in place using a hollow elongate member 120 and a plug configured to be inserted into the elongate member 120. Once the anchor is deployed, the cap member 110 b may be moved along the hollow elongate member 120 into apposition with the anchor member 110 a, thereby applying pressure to opposite sides of the lumen wall near the lumen opening. A plug may be driven into the hollow elongate member 120 to expand the elongate member 120 proximal of the cap member 110 b. As a result, the expanded portion of the hollow elongate member 120 may secure the cap member 110 b in place by limiting movement by the cap member 110 b in a proximal direction.
  • Reference is now made to FIG. 2 which illustrates another example closure device. The example closure device 200 of this configuration may be functionally similar to the example closure device 100 previously described above and shown in FIG. 1 in most respects. Certain features will not be described in relation to this configuration where those components may function in the manner as described above and are hereby incorporated into this additional configuration described below. Like structures and/or components may be given like reference numerals.
  • In one embodiment, the closure device 200 may include a plurality of closure members 210 coupled to a plurality of elongate members 220 a, 220 b. The plurality of closure members 210 may include an anchor member 210 a and/or a cap member 210 b. In particular, the anchor member 210 a may be coupled to the distal ends of the elongate members 220 a, 220 b and/or the cap member 210 b may be disposed on the elongate members 220 a, 220 b proximal of the anchor member 210 a.
  • In one embodiment, the elongate members 220 a, 220 b may include plurality of sutures extending together along at least a portion of the length of the closure device 300. In a further example, the elongate members 220 a, 220 b may include shafts and/or sutures. The elongate members 220 a, 220 b may be coupled together and/or to the anchor member 210 a at their distal ends. For example, the elongate members 220 a, 220 b may be coupled together and/or coupled to the anchor member 210 a using a distal knot 230 a. In particular, the distal knot 230 a may be a heat formed knot. In a yet further embodiment, the elongate members 220 a, 220 b may form a proximal knot 230 b at a position proximal of the cap member 210 b. The proximal knot 230 b may be configured to be advanced in a distal direction and/or secure the cap member 210 b in apposition to the anchor member 210 a on opposite sides of a lumen wall. The elongate members 220 a, 220 b may be flexible and include surgical silk or thread, which may be bioabsorbable. Alternatively, the elongate member 120 (in FIG. 1) may be relatively stiff.
  • Reference is now made to FIG. 3A, which illustrates an example closure system 1000 for closing an opening in a body lumen or other tissue. In one embodiment, the closure system 1000 may include a closure device 300, a generally tubular outer member 1010, a generally tubular inner member 1030, and a generally tubular intermediate member 1020. The example closure device 300 included in the closure system 1000 of this configuration may be functionally similar to the example closure devices 100, 200 previously described above and shown in FIGS. 1-2 in most respects, where certain features will not be described in relation to this configuration wherein those components may function in the manner as described above and are hereby incorporated into this additional configuration described below. Like structures and/or components may be given like reference numerals.
  • In one embodiment, the closure device 300 may include an anchor member 310 a, a cap member 310 b, and an elongate member 320. The closure device 300 may be disposed at least partially within the outer member 1010 proximate a distal opening 1015 of the outer member 1010. The intermediate member 1020 may be disposed at least partially within the outer member 1010 proximal of the closure device 300. In particular, the distal end of the intermediate member 1020 may be disposed within the proximal end of the outer member 1010. The proximal end of the intermediate member 1020 may also extend out of the proximal end of the outer member 1010 for operation by a medical practitioner. The inner member 1030 may be disposed at least partially within the outer member 1010 and/or the intermediate member 1020. In a further embodiment, the closure device 300 may be disposed on or along side the inner member 1030. In particular, the anchor member 310 a and/or cap member 310 b may fold or wrap at least partially around the inner member 1030. The elongate member 320 of the closure device 300 may extend through a distal opening in the inner member 1030 and out a proximal opening in the inner member 1030 for operation by a medical practitioner.
  • The outer member 1010 may be configured to advance to a lumen opening while carrying the other components of the closure system 1000. In one embodiment, the outer member 1010 may have a generally tapered distal end to facilitate entry into a body lumen through a lumen opening. The outer member 1010 may have a distal opening 1015 through which the inner member 1030 may pass and through which the closure device 300 may be deployed. In one example embodiment, the outer member 1010 may include a non-rigid catheter.
  • In further implementations, the outer member 1010 may have any dimensions desired. For example, as shown in FIG. 3A, the outer member may have a substantially constant diameter along a majority of its length. However, in further implementations, the outer member 1010 may have a varying diameter. In a yet further implementation, the thickness of the outer member 1010 may vary along its length. For example, the thickness of the outer member may increase near the distal end. As a result, the inner diameter of the outer member may decrease near the distal end, creating a conical or funnel-like interior surface of the outer member 1010. The reduced inner diameter of the outer member 1010 may allow for a reduction of setting of the anchor member 310 a and/or cap member 310 b from age and/or sterilization. In a yet further implementation, the anchor member 310 a and/or cap member 310 b may be disposed with the outer member proximate its proximal end or within a handle portion of the closure system 1000 prior to deployment through the distal opening 1015 of the outer member 1010.
  • The intermediate member 1020 may be configured to deploy the anchor member 310 a and/or cap member 310 b of the closure device 300 through the distal opening 1015 in the outer member 1010. For example, the intermediate member 1020 may be disposed within the outer member 1010 and positioned proximal of and/or abutting the closure device 300. The intermediate member 1020 may be configured to translate in a distal direction relative to the outer member 1010 in order to push at least a portion of the closure device 300 through the distal opening 1015 of the outer member 1010 and/or to deploy the anchor member 310 a and/or cap member 310 b. For example, once a distal end of the outer member 1010 has advanced through a lumen opening into a lumen, the intermediate member 1020 may be advanced in a distal direction relative to the outer member 1010 to deploy the anchor member 310 a from the distal end of the outer member 1010 and/or into the lumen.
  • In one embodiment, the intermediate member 1020 may be configured to limit its range of movement in order to reduce instances of inadvertent deployment of the cap member 310 b within the lumen. For example, the distance that the proximal end of the intermediate member 1020 extends beyond the proximal end of the outer member 1010 may be equal to the distance necessary to deploy the anchor member 310 a. In a further embodiment, the intermediate member 1020 may be configured to limit further distal movement of the intermediate member 1020 relative to the outer member 1010 once the relative movement necessary to deploy only the anchor member 310 a has been achieved. For example, the proximal end of the intermediate member 1020 may include one or more flanges at its proximal end configured to abut the proximal end of the outer member once the relative movement necessary to deploy only the anchor member 310 a has been achieved.
  • The inner member 1030 may pass through the intermediate member 1020 and/or outer member 1010 and extend out the distal and/or proximal ends of the outer member 1010 and/or intermediate member 1020, respectively. In one embodiment, the distal end of the inner member 1030 may be configured to at least partially close the distal opening 1015 in the outer member 1010 in order to reduce instances of premature and/or inadvertent deployment of the closure device 300. In a further embodiment, the inner member 1030 may include an inner lumen. For example, the inner lumen of the inner member 1030 may operate as a guidewire lumen, such that the closure system 1000 may advance over a guidewire into a body lumen through an opening in the body lumen wall. As explained above, the elongate member 320 of the closure device 300 may also be at least partially disposed through the inner member 1030. In addition, the inner member 1030 may be configured to operate as and/or include a marker port and/or a flow back lumen, such as blood mark race and/or bleed back lumen, to indicate when the distal end of the closure system 1000 has entered the body lumen.
  • Reference is now made to FIG. 3B, which illustrates an additional example closure system 1000′ in accordance with an implementation of the present invention. The closure system 1000′ of this configuration may be functionally similar to the example closure system 1000 previously described above and shown in FIG. 3A in most respects, wherein certain features will not be described in relation to this configuration where those components may function in the manner as described above and are hereby incorporated into this additional configuration described below. Like structures and/or components may be given like reference numerals.
  • In particular, the closure system 1000′ may differ from the closure system 1000 of FIG. 3A by integrating the intermediate member 1020 and inner member 1030 into a single component, namely intermediate member 1020′. For example, the intermediate member 1020′ may include a proximal portion 1020 a′ and a distal portion 1020 b′. In one implementation, the proximal portion 1020 a′ may have a larger diameter than the distal portion 1020 b′. The anchor member 310 a′ and/or cap member 310 b′ of the closure device may be disposed on or proximate to the distal portion 1020 b′ of the intermediate member 1020′ within the outer member 1010′ and distal of the proximal portion 1020 a′ of the intermediate member 1020′. When the intermediate member 1020′ is advanced in a distal direction, the proximal portion 1020 a′ may assist in pushing or deploying the anchor member 310 a′ and/or cap member 310 b′ through a distal opening 1015′ in the outer member 1010′. The intermediate member 1020′ may also define a lumen through which the elongate member 320′, a guidewire, or body fluid may pass. As a result, the closure system 1000′ may have less moving parts than the closure system 1000 of FIG. 3A but may, nonetheless, operate similarly to deploy the closure device 300′ to close a body lumen opening.
  • Reference is now made to FIG. 3C, which illustrates an additional example closure system 1000″ in accordance with an implementation of the present invention. The closure system 1000″ of this configuration may be functionally similar to the example closure systems 1000, 1000′ previously described above and shown in FIGS. 3A-3B in most respects, wherein certain features will not be described in relation to this configuration where those components may function in the manner as described above and are hereby incorporated into this additional configuration described below. Like structures and/or components may be given like reference numerals.
  • As shown in FIG. 3C, in addition to or in conjunction with the closure device 300″, the closure system 1000″ may include a plug 400. The plug 400 may be configured to close an opening in a body lumen or a corresponding tissue tract. The plug 400 may be disposed within the closure system 1000″ and configured for deployment proximate the body lumen opening. In particular, the plug 400 may be disposed within the closure system 1000″ on the inner member 1030″ and distal of the intermediate member 1020″. In a further implementation, the plug 400 may be disposed on the elongate member 320″ of the closure device 300″ proximal of the anchor member 310 a″ and/or cap member 310 b″. The plug 400 may comprise any material known or used for closing a body lumen opening or tissue tract, including biodegradable materials, bioerodible materials, bioabsorbable materials, bioresorbable materials, other materials, or combinations thereof. In one implementation, the plug 400 may comprise collagen and/or polyethylene glycol.
  • Reference is now made to FIGS. 4-11 which illustrate an example method of deploying the closure device 300 using the closure system 1000 of FIG. 3. For example, FIG. 4 illustrates that the closure system 1000 may be advanced through a tissue tract and at least partially into a body lumen through a lumen opening to be obstructed or closed. As shown, the closure system 1000 may be advanced into the lumen over a guidewire 1040. In particular, the guidewire may pass through the inner member 1030 of the closure system 1000. The inner member 1030 may include and/or operate as a fluid mark race and/or flow back lumen in order to indicate to a user that the distal end of the closure system 1000 has entered the body lumen. For example, the closure system 1000 may be advanced in an artery, until a pulsatile blood mark is indicated at the proximal end of the inner member 1030.
  • Once the closure system 1000 is in position with the distal end thereof disposed within the lumen, the inner member 1030 and/or guidewire 1040 may be retracted as illustrated in FIG. 5. In particular, the inner member 1030 may be removed by pulling on the inner member 1030 while stabilizing the remaining components of the closure system 1000. In one embodiment, removing the inner member 1030 from the closure system 1000 may facilitate deployment of the closure device 300 through the distal opening 1015 of the outer member 1010.
  • Once the inner member 1030 has been removed, the intermediate member 1020 may be advanced in a distal direction to deploy the anchor member 310 a of the closure device 300 into the lumen as illustrated in FIG. 6. In one embodiment, the anchor member 310 a, which may have been folded and/or otherwise compacted while disposed within the outer member 1010, may expand into a deployed state.
  • After the anchor member 310 a is deployed, the outer member 1010 may be refracted and/or the elongate member 320 of the closure device 300 may be tensioned for the anchor member 310 a to engage the distal surface of the lumen wall proximate the lumen opening as illustrated in FIG. 7. The outer member 1010 may continue to retract, and the resulting tension in the elongate member 320 caused by the secured anchor member 310 a may deploy the cap member 310 b from the distal opening 1015 of the outer member 1010 as illustrated in FIGS. 8-9. In a further embodiment, the intermediate member 1020 may be used to deploy the cap member 310 b.
  • Once the cap member 310 b is deployed within the tissue tract proximal of the lumen wall, it may then be advanced into apposition with the anchor member 310 a, as illustrated in FIG. 10, in order to engage the anchor member 310 a and/or cap member 310 b with opposing surfaces of the lumen wall. During this process, the position of the anchor member 310 a may be retained by maintaining tension in the elongate member 320 as the outer member 1010 is withdrawn and/or as the cap member 310 b is advanced. In a further embodiment, a knot and/or cleat 330 may be advanced along the elongate member 320 of the closure device 300 and/or secure the cap member 310 b against the anchor member 310 a with the lumen wall sandwiched at least partially therebetween, thereby further securing the closure members in place. In a further embodiment, the elongate member 320 may include a plurality of projections (i.e., 125, FIG. 1) extending from a surface thereof and configured to secure the cap member 310 b in place and prevent proximal movement of the cap member 310 b relative to the elongate member 320. Once the cap member 310 b and anchor member 310 a are secured, the elongate member 320 may be trimmed proximal of the cap member 310 b, such as by using a suture trimmer 340, and then retracted, as shown in FIG. 11. In a further embodiment, one or more additional locking mechanisms as disclosed in more detail herein may be used to secure the cap member 310 b and/or anchor member 310 a in place.
  • Once deployed, the cap member 310 b and the anchor member 310 a can close or substantially close an opening in a body lumen. The vessel or tissue adjacent the opening can be disposed at least partially between the cap member 310 b and the anchor member 310 a. As the cap member 310 b is advanced, the cap member 310 b and the anchor member 310 a can apply pressure to the tissue or vessel to hold the tissue in place and close the opening. Further, the cap member 310 b and the anchor member 310 a may be configured to also bond or become connected to the tissue to further close the opening. Also, the cap member 310 b and the anchor member 310 a may slightly deform as tension is applied to accommodate the tissue that is between the cap member 310 b and the anchor member 310 a.
  • The embodiments of the present disclosure may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the disclosure is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.

Claims (28)

  1. 1. A closure device configured to close an opening in a body lumen, the closure device comprising:
    an elongate member having a distal end and a proximal end;
    an anchor member disposed on the elongate member proximate the distal end of the elongate member; and
    a cap member disposed on the elongate member a distance from the distal end of the elongate member, wherein the anchor member and the cap member are positioned to close the opening in the body lumen.
  2. 2. The closure device of claim 1, wherein the elongate member comprises a metal or plastic shaft.
  3. 3. The closure device of claim 1, wherein the elongate member comprises a suture.
  4. 4. The closure device of claim 3, further comprising a second elongate member disposed substantially in parallel with the first elongate member, the second elongate member comprising a suture.
  5. 5. The closure device of claim 1, wherein the elongate member comprises a hollow shaft and the closure device further comprises a plug configured to be inserted into the hollow shaft to expand the hollow shaft.
  6. 6. The closure device of claim 1, wherein the elongate member comprises one or more projections disposed along the length thereof.
  7. 7. The closure device of claim 6, wherein the one or more projections are chosen from a group comprising teeth, barbs, and ridges.
  8. 8. The closure device of claim 6, wherein the one or more projections are configured to permit movement by the cap member in a distal direction and resist movement by the cap member in a proximal direction.
  9. 9. The closure device of claim 1, wherein the cap member is slidably disposed on the elongate member.
  10. 10. The closure device of claim 1, wherein the anchor member or cap member comprises a biodegradable material.
  11. 11. The closure device of claim 1, wherein the anchor member or cap member is disc shaped.
  12. 12. The closure device of claim 1, wherein the anchor member or cap member has a varying thickness.
  13. 13. The closure device of claim 1, wherein the elongate member comprises a bioabsorbable monofilament.
  14. 14. The closure device of claim 1, wherein the anchor member is coupled to the elongate member proximate a knot.
  15. 15. The closure device of claim 1, further comprising a cleat, collet, or knot disposed on the elongate member proximal of the cap member.
  16. 16. A closure system comprising:
    a generally tubular outer member having a distal opening and a proximal opening;
    a generally tubular intermediate member disposed at least partially within the outer member; and
    a closure device disposed at least partially within the outer member, the closure device comprising:
    an elongate member having a distal end and a proximal end, the elongate member being disposed at least partially through the intermediate member;
    an anchor member disposed on the elongate member proximate the distal end of the elongate member, the anchor member being further disposed within the outer member distal of the intermediate member; and
    a cap member disposed on the elongate member a distance from the distal end of the elongate member, the cap member being further disposed within the outer member proximal of the anchor member.
  17. 17. The closure system of claim 16, wherein the outer member comprises a non-rigid catheter.
  18. 18. The closure system of claim 16, further comprising a generally tubular inner member disposed at least partially within the outer member and/or intermediate member.
  19. 19. The closure system of claim 18, wherein the inner member comprises a guidewire lumen, fluid marker port, and/or flow back lumen.
  20. 20. The closure system of claim 18, wherein the inner member and the intermediate member are integrated together into a single component.
  21. 21. The closure system of claim 16, wherein the intermediate member comprises a pusher tube.
  22. 22. The closure system of claim 16, wherein the intermediate member is movable relative to the outer member.
  23. 23. The closure system of claim 22, wherein the distal movement of the intermediate member relative to the outer member is limited to the movement necessary deploy the anchor member from the distal opening of the outer member.
  24. 24. The closure system of claim 16, further comprising a collagen or polyethylene glycol plug configured to at least partially obstruct a tissue tract proximate a body lumen opening.
  25. 25. A method of closing an opening in a lumen wall, the method comprising:
    advancing the distal end of a closure system over a guidewire into a body lumen, the closure system comprising:
    a generally tubular outer member having a distal opening and a proximal opening;
    a generally tubular intermediate member disposed at least partially within the outer member; and
    a closure device disposed at least partially within the outer member, the closure device comprising:
    an elongate member having a distal end and a proximal end, the elongate member being disposed at least partially through the intermediate member;
    an anchor member disposed on the elongate member proximate the distal end of the elongate member, the anchor member being further disposed within the outer member distal of the intermediate member; and
    a cap member disposed on the elongate member a distance from the distal end of the elongate member, the cap member being further disposed within the outer member proximal of the anchor member.
    deploying the anchor member into the lumen;
    tensioning the elongate member to engage the anchor member with a distal surface of the lumen wall; and
    deploying the cap member and advancing the cap member in a distal direction along the elongate member to engage a proximal surface of the lumen wall.
  26. 26. The method of claim 25, further comprising positioning a knot, collet, or cleat on the elongate member proximal of the cap member.
  27. 27. The method of claim 25, further comprising retracting the outer member in a proximal direction to deploy the cap member.
  28. 28. The method of claim 25, wherein the closure system further comprises a generally tubular inner member disposed at least partially within the intermediate member.
US12688065 2009-01-16 2010-01-15 Closure devices, systems, and methods Abandoned US20100185234A1 (en)

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