Vascular closure devices and methods of use
A closure device system for sealing a percutaneous puncture in a vessel wall can comprise a toggle configured to engage an interior surface of the vessel wall, a plug configured to engage an exterior surface of the vessel wall, and a suture that extends through the plug and through the toggle along at least a first direction so as to couple the toggle to the plug. The system can further comprise a tube that extends through the plug and through the toggle along the first direction such that a distal end of the tube is disposed distally to the toggle. The tube can define a guidewire lumen that extends therethrough along the first direction. And the guidewire lumen can be configured to receive a guidewire that protrudes from the vessel wall such that the plug, toggle, and tube are slidable along the guidewire toward the vessel wall.
1. A closure device system for sealing a percutaneous puncture in a vessel wall, the closure device system comprising:
a toggle configured to engage an interior surface of the vessel wall, the toggle having a first end, a second end, a length that extends from the first end to the second, a lower surface, a wall engaging surface opposite the lower surface, a thickness that extends from the wall engaging surface to the lower surface, and an opening that extends from the wall engaging surface to the lower surface, wherein the thickness is perpendicular to the length;
a plug configured to engage an exterior surface of the vessel wall;
a suture that extends through the plug and through the toggle along at least a first direction so as to couple the toggle to the plug such that the plug is proximal to the toggle along the first direction; and
a tube having a proximal end, a distal end opposite the proximal end along the first direction, and a guidewire lumen that extends therethrough along the first direction, the tube extending through the plug and through the opening of the toggle along the thickness such that the distal end of the tube is disposed distal to the lower surface of the toggle along the first direction,
wherein the guidewire lumen is configured to receive a guidewire that protrudes from the vessel wall such that the plug, toggle, and tube are slidable along the guidewire toward the vessel wall.
2. The closure device system of claim 1 , further comprising a tamper that is proximal to the plug, the tamper defining a suture lumen that extends therethrough along the first direction and a tamper guidewire lumen that extends therethrough along the first direction, wherein the tube extends through the tamper guidewire lumen and the suture extends through the suture lumen, such that the plug, toggle, tube, and tamper are slidable along the guidewire.
3. The closure device system of claim 2 , wherein the suture extends (i) through the plug and through the toggle along the first direction, (ii) back through the toggle and through the plug along a second direction that is opposite the first direction, and (iii) terminates in a knot between the tamper and the plug such that the suture forms a loop that begins and ends at the knot.
4. The closure device system of claim 3 , wherein (i) the portion of the suture that extends through the plug along the first direction is a first portion of suture and the portion of suture that extends through the plug along the second direction is a second portion of suture, and (ii) the tube extends through the plug and the toggle between the first and second portions of suture.
5. The closure device system of claim 4 , further comprising a lock coupled to the suture proximal to the plug, wherein the tamper is configured to contact and move the lock against the plug to thereby compress the plug against the vessel wall such that the compressed plug is held against the vessel wall by the toggle and the lock.
6. The closure device system of claim 5 , wherein the knot is disposed between the lock and the plug.
7. The closure device system of claim 1 , wherein the tube is configured to be pulled proximally along the guidewire relative to the toggle and the plug.
8. The closure device system of claim 1 , wherein (i) the toggle defines a notch at its periphery, and (ii) the tube extends through the notch.
9. The closure device system of claim 1 , wherein the distal end of the tube is spaced from the toggle by a distance of at least 1 cm.
10. A closure device system for sealing a percutaneous puncture in a vessel wall, the closure device system comprising:
a closure device configured to seal the puncture, the closure device having a toggle configured to engage an interior surface of the vessel wall, a plug configured to engage an exterior surface of the vessel wall; and a suture that extends through the plug and through the toggle along at least a distal direction so as to couple the toggle to the plug such that the plug is proximal to the toggle; and
a deployment device including:
a) a tension cartridge coupled to the suture;
b) a delivery tube configured to hold the closure device in a pre-deployment state, the delivery tube having a rearward end and a forward end spaced from the rearward end along the distal direction, and
c) a guidewire tube within the delivery tube, the guidewire tube having a proximal end, a distal end spaced from the proximal end along the distal direction, and a guidewire lumen that extends from the proximal end to the distal end, the guidewire tube positioned in the delivery tube and extending through the plug, the toggle, and the tensioning cartridge, along the distal direction such that the distal end of the guidewire tube extends outward from the forward end of the delivery tube in the distal direction, wherein the guidewire tube is moveable relative to the closure device as the closure device is deployed from the delivery tube, wherein the lumen is configured to receive a guidewire that protrudes from the vessel wall such that the closure device and deployment device are together slidable along the guidewire toward the vessel wall.
11. The closure device system of claim 10 , further comprising a tamper that is proximal to the plug, the tamper defining a suture lumen that extends therethrough along the first direction and a tamper guidewire lumen that extends therethrough along the first direction, wherein the guidewire tube extends through the tamper guidewire lumen and the suture extends through the suture lumen, such that the plug, toggle, guidewire tube, and tamper are slidable along the guidewire.
12. The closure device system of claim 11 , wherein the deployment device is configured to be pulled proximally along the guidewire relative to the closure device.
13. The closure device of claim 11 , wherein when the deployment device is pulled proximally the tension cartridge increases the tension in the suture and subsequently provides a feedback indicating that the suture is tensioned.
14. The closure device system of claim 11 , wherein the distal end of the guidewire tube is spaced from the toggle by a distance of at least 1 cm.
15. A closure device system for sealing a percutaneous puncture in a vessel wall, the closure device comprising:
a toggle configured to engage an interior surface of the vessel wall, the toggle having a thickness, a first opening, and a second opening separate from the first opening;
a plug configured to engage an exterior surface of the vessel wall, the plug having a first plug opening and a second plug opening separate from the first plug opening;
a suture that extends through the first plug opening of the plug and through the first opening of the toggle to couple the toggle to the plug such that the plug is disposed relative to the toggle in a proximal direction; and
a tube having a proximal end, a distal end opposite the proximal end in a distal direction that is opposite to the proximal direction, and a guidewire lumen that extends therethrough along the first direction, the tube extending through the second plug opening of the plug and through the second opening of the toggle along the first direction such that the distal end of the tube is disposed distal to the toggle along the first direction, the guidewire lumen being configured to receive a guidewire such that the plug, the toggle, and the tube are slidable along the guidewire, wherein the tube is movable relative to the toggle so that the distal end of the tube is removable from the second opening of the toggle in the proximal direction.
16. The closure device system of claim 15 , further comprising a tamper that is proximal to the plug, the tamper defining a suture lumen that extends therethrough along the first direction and a tamper guidewire lumen that extends therethrough along the first direction, wherein the tube extends through the tamper guidewire lumen and the suture extends through the suture lumen, such that the plug, toggle, tube, and tamper are slidable along the guidewire.
17. The closure device system of claim 16 , wherein the suture extends (i) through the plug and through the toggle along the first direction, (ii) back through the toggle and through the plug along a second direction that is opposite the first direction, and (iii) terminates in a knot between the tamper and the plug such that the suture forms a loop that begins and ends at the knot.
18. The closure device system of claim 17 , wherein (i) the portion of the suture that extends through the plug along the first direction is a first portion of suture and the portion of suture that extends through the plug along the second direction is a second portion of suture, and (ii) the tube extends through the plug and the toggle between the first and second portions of suture.