Apparatus and methods for sealing a vascular puncture
A sealant for sealing a puncture through tissue includes a first section, e.g., formed from freeze-dried hydrogel, and a second section extending from the distal end. The second section may be formed from PEG-precursors including PEG-ester and PEG-amine, e.g., in an equivalent ratio of active group sites of PEG-ester/PEG-amine greater than one-to-one, e.g., such that excess esters may provide faster activation upon contact with physiological fluids and enhance adhesion of the sealant within a puncture. At least some of the precursors remain in an unreactive state until exposed to an aqueous physiological environment, e.g., within a puncture, whereupon the precursors undergo in-situ cross-linking to provide adhesion to tissue adjacent the puncture. For example, the PEG-amine precursors may include the free amine form and the salt form. The free amine form at least partially cross-links with the PEG-ester and the salt form remains in the unreactive state in the sealant before introduction into the puncture.
1. A sealant for sealing a puncture extending through tissue, comprising:
an elongate first section including proximal and distal ends, wherein the first section is formed from a freeze-dried hydrogel that expands when exposed to physiological fluid within a puncture, and
a second section comprising a mass of PEG precursors fused to and extending from the distal end, wherein the mass of PEG precursors comprises PEG-ester precursors and PEG-amine precursors and/or salt forms thereof, and wherein at least some of the PEG-amine precursors are at least partially cross-linked with the PEG-ester precursors, and at least some of the PEG-amine precursors remain in an unreactive state until exposed to an aqueous physiological environment, whereupon the unreactive PEG-amine precursors undergo in-situ cross-linking with the PEG-ester precursors to provide adhesion to tissue adjacent the puncture.
2. The sealant of claim 1 , wherein the sealant is disposed within the lumen of the tubular member such that the second section of the sealant is disposed closer to the distal opening of the tubular member than the first section.
3. The sealant of claim 1 , wherein the at least some of the PEG-amine precursors that remain in an unreactive state are salt form of PEG-amine precursors.
4. The sealant of claim 3 , wherein the salt form is HCl salt, HBr salt, or HF salt.
5. The sealant of claim 1 , wherein the PEG-amine precursors are in salt form.
6. The sealant of claim 5 , wherein the salt form is HCl salt, HBr salt, or HF salt.
7. The sealant of claim 6 , wherein a ratio of active group sites of the PEG-ester precursors to the PEG-amine precursors is about 60/40.
8. The sealant of claim 1 , wherein a ratio of active group sites of the PEG-ester precursors to the PEG-amine precursors is between 1:9 and 9:1.
9. The sealant of claim 1 , wherein a ratio of active group sites of the PEG-ester precursors to the PEG-amine precursors is greater than one-to-one (1:1).
10. The sealant of claim 1 , wherein a ratio of active group sites of the PEG-ester precursors to the PEG-amine precursors is between about 65/35 and 55/45.
11. The sealant of claim 1 , further comprising a pH adjusting agent in the first section and/or section.
12. The sealant of claim 11 , wherein the pH adjusting agent is selected from sodium borate, sodium phosphate, sodium bicarbonate, and sodium borate decahydrate.
13. The sealant of claim 1 , wherein the mass of PEG precursors comprises a substantially uniform plug of PEG precursors.
14. The sealant of claim 1 , further comprising a transition zone between the first section and the second section, wherein the PEG-precursors of the second section permeate into an end of the first section to form the transition zone.
15. The sealant of claim 1 , wherein the PEG-amine precursors are in free amine form.
16. An apparatus for sealing a puncture extending through tissue, comprising:
a tubular member comprising a proximal end, a distal end sized for insertion into a puncture, a lumen extending between the proximal and distal ends, and a distal opening in communication with the lumen; and
a sealant comprising an elongate first section including proximal and distal ends, wherein the first section is formed from a freeze-dried hydrogel that expands when exposed to physiological fluid within a puncture, and a second section comprising a mass of PEG precursors fused to and extending from the distal end, wherein the mass of PEG precursors comprises PEG-ester precursors and PEG-amine precursors and/or salt forms thereof, and wherein at least some of the PEG-amine precursors are at least partially cross-linked with the PEG-ester precursors, and at least some of the PEG-amine precursors remain in an unreactive state until exposed to an aqueous physiological environment, whereupon the unreactive PEG-amine precursors undergo in-situ cross-linking with the PEG-ester precursors to provide adhesion to tissue adjacent the puncture.
17. The apparatus of claim 16 , wherein the sealant is disposed within the lumen of the tubular member such that the second section of the sealant is disposed closer to the distal opening of the tubular member than the first section.
18. The apparatus of claim 16 , wherein the first section of the sealant comprises a sheet rolled into a tubular shape, thereby defining a lumen extending along a length of the freeze-dried hydrogel, and wherein the second section comprises a passage therethrough aligned with the lumen.
19. The apparatus of claim 16 , wherein the first section of the sealant has a length between about one and twenty millimeters (1-20 mm), and the second section of the sealant has a length that is substantially shorter than the length of the first section.
20. A method for sealing a puncture extending through tissue of a patient, comprising:
providing a sealant into a puncture through tissue, the sealant comprising an elongate first section including proximal and distal ends, the first section being formed from a freeze-dried hydrogel that expands when exposed to physiological fluid within the puncture, and a second section comprising a mass of PEG precursors fused to and extending from the distal end, wherein the mass of PEG precursors comprises PEG-ester precursors and PEG-amine precursors and/or salt forms thereof, and wherein at least some of the PEG-amine precursors are at least partially cross-linked with the PEG-ester precursors, and at least some of the PEG-amine precursors remain in an unreactive state, the second section entering the puncture before the first section; and
exposing the sealant to the physiological fluid within the puncture, whereupon the unreactive PEG-amine precursors undergo in-situ cross-linking with the PEG-ester precursors to provide adhesion to tissue adjacent the puncture.