Vascular closure devices and methods of use
A closure device system for sealing a percutaneous puncture in a vessel wall can include 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 include 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 method of sealing a percutaneous puncture in a body passageway of a living being, the method comprising:
inserting a guidewire into the body passageway such that the guidewire extends from outside the body passageway, through the puncture, and into the body passageway;
passing an introducer sheath over the guidewire, through the puncture, and into the body passageway;
subsequently positioning a closure device system along the guidewire in a distal direction so that the guidewire enters a guidewire lumen defined by a guidewire tube of the closure device system such that the guidewire tube is slidable along the guidewire, wherein the closure device system further includes a toggle configured to engage an interior surface of the vessel wall, and a plug, and the guidewire tube extends through an opening of the toggle and along a thickness of the toggle such that a distal end of the guidewire tube is spaced from the toggle in the distal direction; and
moving the closure device system along the guidewire in the distal direction such that the toggle and the distal end of the guidewire tube enters the body passageway through the puncture.
2. The method of claim 1 , wherein at least the plug is disposed within a delivery tube of the closure device system, the method further comprising deploying the plug from the delivery tube.
3. The method of claim 2 , further comprising releasing the toggle from a release tube and the delivery tube of the closure device system.
4. The method of claim 3 , further comprising inserting a cannula into the body passageway, passing the guidewire through the cannula a desired distance into the body passageway, and removing the cannula from the body passageway over the guidewire, leaving the guidewire in place.
5. The method of claim 3 , further comprising moving the release tube in a proximal direction via a lever and thereby releasing the toggle from the release tube.
6. The method of claim 2 , wherein the guidewire tube is coupled to the delivery tube, wherein deploying further comprises pulling the delivery tube and guidewire tube in a proximal direction that is opposite the distal direction.
7. The method of claim 6 , wherein pulling further comprises removing the guidewire tube from the toggle and the plug.
8. The method of claim 6 , wherein the pulling step comprises sliding the toggle and plug off of the guidewire tube.
9. The method of claim 1 , wherein positioning further comprises spacing the guidewire tube from the toggle by a distance of at least 1 cm.
10. The method of claim 1 , further comprising advancing a tamper along a suture coupled to the plug and the toggle so as to tamp the plug toward the toggle.
11. The method of claim 10 , further comprising moving a lock coupled to the suture and proximal to the plug against the plug to thereby compress the plug against the body passageway such that the compressed plug is held against the body passageway by the toggle and the lock.
12. The method of claim 10 , further comprising increasing tension in the suture and providing a feedback indicating that the suture is tensioned via a tension cartridge coupled to the suture.
13. The method of claim 10 , further comprising extending the suture (i) through the plug and through the toggle along a first direction, (ii) back through the toggle and through the plug along a second direction that is opposite the first direction, and terminating the suture in a knot between the tamper and the plug such that the suture forms a loop that begins and ends at the knot.
14. The method of claim 1 , wherein the closure device system slides along the guidewire while the guidewire and the introducer sheath are held stationary.
15. The method of claim 1 , further comprising positioning the closure device system at a desired position relative to the distal end of the introducer sheath and moving the release tube relative to the delivery tube, thereby exposing the toggle.
16. The method of claim 15 , further comprising withdrawing the introducer sheath from the body passageway.
17. The method of claim 1 , wherein the toggle includes 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, and an opening that extends from the wall engaging surface to the lower surface.
18. The method of claim 17 , wherein the thickness extends from the wall engaging surface to the lower surface and is perpendicular to the length.
19. The method of claim 1 , further comprising injecting a contrast agent into the puncture, such that the contrast agent indicates any fluid leakage at the puncture site.