Apparatus and methods for sealing a vascular puncture
View Patent ↗Apparatus for sealing a puncture communicating with a blood vessel includes a porous carrier formed from lyophilized hydrogel or other material. The plug may include at least first and second hydrogel precursors and a pH adjusting agent carried by the porous carrier in an unreactive state prior to exposure to an aqueous physiological environment. Once exposed to bodily fluids, the carrier expands as the lyophilized material hydrates to enhance and facilitate rapid hemostasis of the puncture. When the plug is placed into the puncture, the natural wetting of the plug by bodily fluids (e.g., blood) causes the first and second precursors to react and cross-link into an adhesive or “sticky” hydrogel that aids in retaining the plug in place within the puncture.
1. A method for sealing a puncture extending through tissue to a body lumen using an apparatus comprising an elongate positioning member carrying a cartridge on a proximal end thereof, the cartridge carrying therein a plug comprising lyophilized hydrogel and a pusher member adjacent the plug, the method comprising:
introducing a distal end of the positioning member into the puncture with the cartridge adjacent the proximal end until a positioning element thereon is disposed within the body lumen;
expanding the positioning element within the body lumen;
at least partially withdrawing the positioning member from the puncture until the expanded positioning element contacts a wall of the body lumen adjacent the puncture;
advancing the cartridge over the positioning member into the puncture until the pusher member passes over a feature on the positioning member that prevents the pusher member from being retracted proximally; and
retracting the cartridge while the feature prevents the pusher member from retracting proximally to deploy the plug from the cartridge within the puncture, thereby exposing the plug to bodily fluid, whereupon the lyophilized hydrogel expands to substantially seal the puncture.
2. The method of claim 1 , wherein the lyophilized hydrogel comprises a PEG polymer containing a hydrolytically degradable chemical group.
3. The method of claim 1 , further comprising advancing the pusher member within the puncture to compress the plug within the puncture.
4. The method of claim 3 , wherein the plug is compressed within the puncture between the pusher member and the expanded positioning element.
5. The method of claim 3 , further comprising delivering a sealing compound into the puncture after delivering the plug into the puncture.
6. The method of claim 5 , wherein the sealing compound comprises liquid hydrogel precursors that flow into the puncture at least partially above or around the plug.
7. The method of claim 1 , further comprising:
collapsing the positioning element; and
withdrawing the positioning member from the puncture through the plug and pusher member, the pusher member preventing proximal migration of the plug within the puncture.
8. A method for sealing a puncture extending through tissue to a body lumen, comprising:
introducing a tubular sheath into the puncture until a distal end of the sheath extends into the body lumen;
introducing a positioning member into the puncture until a positioning element on the positioning member is disposed within the body lumen;
expanding the positioning element within the body lumen;
at least partially withdrawing the positioning member from the puncture until the expanded positioning element contacts the wall of the body lumen adjacent the puncture;
introducing a cartridge into the puncture through the sheath, the cartridge carrying a plug therein and a pusher member proximal to the plug;
at least partially withdrawing the cartridge and the sheath while maintaining the pusher member substantially stationary to expose the plug to bodily fluid within the puncture; and
withdrawing the positioning member and the pusher member from the puncture, leaving the plug within the puncture adjacent the body lumen,
wherein the cartridge is introduced into the puncture over the positioning member until the pusher member passes over a feature on the positioning member that prevents the pusher member from being retracted proximally, and wherein the feature prevents the pusher member from retracting proximally when the cartridge is at least partially withdrawn to expose the plug to bodily fluid within the puncture.
9. The method of claim 8 , further comprising delivering a sealing compound into the puncture after delivering the plug into the puncture.
10. The method of claim 9 , wherein the sealing compound comprises a liquid sealant that is delivered through the pusher member into the puncture.
11. The method of claim 9 , wherein the sealing compound comprises liquid hydrogel precursors that flow into the puncture at least partially above or around the plug.
12. The method of claim 8 , wherein the plug comprises lyophilized hydrogel, the plug expanding when exposed to bodily fluid.
13. The method of claim 8 , wherein the plug comprises a lumen therethrough, and wherein the positioning member is delivered into the puncture by directing the positioning member through the plug lumen.
14. The method of claim 8 , further comprising advancing the pusher member to compress the plug between the pusher member and the positioning element.
15. The method of claim 8 , wherein the positioning member is withdrawn from the puncture before the pusher member is withdrawn from the puncture such that pusher member prevents the plug from moving proximally while the positioning member is withdrawn.
16. The method of claim 8 , wherein at least partially withdrawing the positioning member from the puncture comprises:
withdrawing the positioning member until the expanded positioning element contacts a distal end of the tubular sheath, thereby providing a first tactile feedback; and
withdrawing the positioning member until the expanded positioning element contacts the wall of the body lumen, thereby providing another tactile feedback.
17. The method of claim 8 , wherein the cartridge is carried on a proximal end of the positioning member when the positioning member is introduced into the puncture.
18. A method for sealing a puncture extending through tissue to a body lumen using a cartridge carrying a plug therein, the method comprising:
introducing a distal end of a positioning member into the puncture until a positioning element on the distal end is disposed within the body lumen, while the cartridge and plug are disposed on a proximal end of the positioning member;
expanding the positioning element within the body lumen;
withdrawing the positioning member until the expanded positioning element contacts a wall of the body lumen adjacent the puncture;
introducing the cartridge and plug into the puncture over the positioning member; and
at least partially withdrawing the cartridge while preventing the plug from moving proximally to expose the plug within the puncture,
wherein the cartridge is introduced into the puncture over the positioning member until a pusher member passes over a feature on the positioning member that prevents the pusher member from being retracted proximally, and wherein the pusher member prevents the plug from moving proximally while the cartridge is at least partially withdrawn to expose the plug within the puncture.
19. The method of claim 18 , further comprising advancing the pusher member to compress the plug between the pusher member and the expanded positioning element.
20. The method of claim 18 , further comprising withdrawing the positioning member and the pusher member from the puncture, leaving the plug within the puncture adjacent the body lumen.
21. The method of claim 20 , wherein withdrawing the positioning member comprises:
collapsing the positioning element; and
withdrawing the positioning element through the pusher member and plug.
22. The method of claim 21 , wherein the pusher member prevents the plug from moving proximally while the positioning member is withdrawn.
23. A method for sealing a puncture extending through tissue to a body lumen, comprising:
providing a positioning member comprising a positioning element on a distal end thereof, a cartridge on the positioning member, the cartridge comprising a proximal end, a distal end disposed adjacent the positioning element, a lumen extending between the proximal and distal ends, and a plug within the cartridge lumen;
introducing the distal end of the positioning member into the puncture until the positioning element and the cartridge distal end are disposed within the body lumen;
expanding the positioning element within the body lumen;
withdrawing the positioning member until the expanded positioning element contacts a wall of the body lumen adjacent the puncture; and
at least partially withdrawing the cartridge to expose the plug within the puncture,
wherein the cartridge is introduced into the puncture over the positioning member until a pusher member passes over a feature on the positioning member that prevents the pusher member from being retracted proximally, and wherein the pusher member prevents the plug from moving proximally while the cartridge is at least partially withdrawn to expose the plug within the puncture.
24. The method of claim 23 , further comprising advancing the pusher member to compress the plug between the pusher member and the expanded positioning element.
25. The method of claim 24 , wherein the pusher member is advanced over the positioning member to compress the plug.
26. The method of claim 23 , further comprising withdrawing the positioning member and the pusher member from the puncture, leaving the plug within the puncture adjacent the body lumen.
27. The method of claim 26 , wherein withdrawing the positioning member comprises:
collapsing the positioning element; and
withdrawing the positioning element through the plug and pusher member.
28. The method of claim 27 , wherein the pusher member prevents the plug from moving proximally while the positioning member is withdrawn.