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 through tissue, comprising:
an elongate first section extending from a proximal end to a distal end, and a cross-section sized for delivery into a puncture through tissue; and
a second section fused to and extending from the distal end of the first section, the second section comprising PEG-precursors comprising PEG-ester and PEG-amine precursors in an equivalent ratio of active group sites of PEG-ester/PEG-amine of at least about one-to-one (1:1), at least some of the precursors remaining in an unreactive state until exposed to an aqueous physiological environment, whereupon the precursors undergo in-situ cross-linking with one another to provide adhesion to tissue adjacent the puncture.
2. The sealant of claim 1 , wherein the equivalent ratio of active group sites of PEG-ester/PEG-amine is between about 65/35 and 55/45.
3. The sealant of claim 1 , wherein the equivalent ratio of active group sites of PEG-ester/PEG-amine is about 60/40.
4. The sealant of claim 1 , wherein the PEG-amine precursors of the second section comprise both a free amine form of PEG-amine precursors and a salt form of PEG-amine precursors.
5. The sealant of claim 4 , wherein an equivalent ratio of active group sites of PEG-ester precursors/salt form of PEG-amine precursors/free amine form of PEG-amine precursors is between about 50/42/8 and 50/48/2.
6. The sealant of claim 4 , wherein an equivalent ratio of active group sites of PEG-ester precursors/salt form of PEG-amine precursors/free amine form of PEG-amine precursors is between about 60/32/8 and 60/38/2.
7. The sealant of claim 4 , wherein an equivalent ratio of active group sites of PEG-ester precursors/salt form of PEG-amine precursors/free amine form of PEG-amine precursors is between about 50/45/5 and 70/25/5.
8. The sealant of claim 4 , wherein an equivalent ratio of active group sites of PEG-ester precursors/salt form of PEG-amine precursors/free amine form of PEG-amine precursors is about 60/35/5.
9. The sealant of claim 4 , wherein the second section is provided such that the free amine form of PEG-amine precursors are at least partially cross-linked with the PEG-ester precursors, and the salt form of PEG-amine precursors remain in the unreactive state until exposed to an aqueous physiological environment, whereupon the salt form of PEG-amine precursors undergo in-situ cross-linking with the PEG-ester precursors to provide adhesion to tissue adjacent the puncture.
10. The sealant of claim 1 , wherein the precursors of the second section permeate into the distal end of the first section to create a transition zone between the first and second sections.
11. The sealant of claim 1 , wherein the second section comprises a solid mass of the non-cross-linked precursors.
12. The sealant of claim 1 , wherein the solid mass comprises a substantially uniform solid plug of the non-cross-linked precursors.
13. The sealant of claim 1 , wherein the first section is formed from a freeze-dried hydrogel that expands when exposed to physiological fluid within the puncture.
14. The sealant of claim 1 , wherein the first section comprises a sheet rolled into a tubular shape, thereby defining a lumen extending between the proximal and distal ends, and wherein the second section comprises a passage there through aligned with the lumen.
15. The sealant of claim 1 , wherein the first section has a length between the proximal and distal ends between about one and twenty millimeters (1-20 mm), and the second section has a length extending from the distal end that is substantially shorter than the length of the first section.
16. The sealant of claim 1 , wherein the first and second sections have a substantially uniform outer diameter cross-section along their lengths between about one and eight millimeters (1-8 mm).
17. A sealant for sealing a puncture through tissue, comprising:
an elongate first section extending from a proximal end to a distal end, and a cross-section sized for delivery into a puncture through tissue, the first section formed from a freeze-dried hydrogel that expands when exposed to physiological fluid within a puncture; and
a second section fused to and extending from the distal end of the first section, the second section comprising PEG-precursors comprising PEG-ester and PEG-amine precursors, the PEG-amine precursors including both a free amine form of PEG-amine precursors that are at least partially cross-linked with the PEG-ester precursors and a salt form of PEG-amine precursors that remain in an unreactive state until exposed to an aqueous physiological environment, whereupon the salt form of PEG-amine precursors undergo in-situ cross-linking with the PEG-ester precursors to provide adhesion to tissue adjacent the puncture.
18. The sealant of claim 17 , wherein an equivalent ratio of active group sites of the PEG-ester precursors to the PEG-amine precursors is at least about one-to-one (1:1).
19. The sealant of claim 17 , wherein an equivalent ratio of active group sites of PEG-ester precursors/salt form of PEG-amine precursors/free amine form of PEG-amine precursors is between about 50/45/5 and 70/25/5.
20. A sealant for sealing a puncture through tissue, comprising:
an elongate first section extending from a proximal end to a distal end, and a cross-section sized for delivery into a puncture through tissue, the first section consisting essentially of a freeze-dried hydrogel that expands when exposed to physiological fluid within a puncture; and
a second section fused to and extending from the distal end of the first section, the second section formed from a solid mass of PEG-precursors consisting essentially of PEG-ester and PEG-amine precursors in an equivalent ratio of active group sites of PEG-ester/PEG-amine of at least about one-to-one (1:1), at least some of the precursors remaining in an unreactive state until exposed to an aqueous physiological environment, whereupon the precursors undergo in-situ cross-linking with one another to provide adhesion to tissue adjacent the puncture.
21. The sealant of claim 20 , wherein the PEG-amine precursors of the second section comprises both a free amine form of PEG-amine precursors and a salt form of PEG-amine precursors.
22. A method for making a sealant for sealing a puncture through tissue, comprising:
forming an elongate first section extending from a proximal end to a distal end, and a cross-section sized for delivery into a puncture through tissue;
melting PEG-amine and PEG-ester powders into a liquid mixture comprising non-cross-linked PEG precursors, wherein an equivalent ratio of active group sites of the PEG-ester precursors to the PEG-amine precursors is at least about one-to-one (1:1); and
fusing a solid mass of the mixed PEG precursors onto the distal end, at least some of the PEG precursors remaining in an unreactive state until exposed to an aqueous physiological, whereupon the precursors undergo in-situ cross-linking with one another to provide an adhesive layer bonded to the first section.
23. The method of claim 22 , wherein the equivalent ratio of active group sites of the PEG-ester precursors to the PEG-amine precursors is between about 65/35 and 55/45.
24. The method of claim 22 , wherein the PEG-amine powders in the mixture comprises both a free amine form of PEG-amine precursors and a salt form of PEG-amine precursors in the mixture.
25. The method of claim 24 , wherein an equivalent ratio of active group sites of PEG-ester precursors/salt form of PEG-amine precursors/free amine form of PEG-amine precursors in the mixture is between about 50/45/5 and 70/25/5.
26. The method of claim 24 , further comprising at least partially cross-linking the free amine form of PEG-amine precursors the PEG-ester precursors, while the salt form of PEG-amine precursors remain in the unreactive state until exposed to an aqueous physiological environment, whereupon the salt form of PEG-amine precursors undergo in-situ cross-linking with the PEG-ester precursors to provide adhesion to tissue adjacent the puncture.
27. The method of claim 22 , wherein the first section is formed from a freeze-dried hydrogel that expands when exposed to physiological fluid within a puncture.
28. The method of claim 22 , wherein fusing a solid mass of the mixed PEG hydrogel precursors onto the distal end comprises:
using a vacuum generator to apply the liquid mixture of non-cross-linked PEG precursors onto the distal end, and
allowing the liquid mixture to cool and solidify into the solid mass fused to the distal end.
29. 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
sealant comprising an elongate first section extending from a proximal end to a distal end and a cross-section sized for delivery into the puncture, and a second section fused to and extending from the distal end of the first section, the sealant disposed within the lumen such that the second section is disposed closer to the distal opening than the first section, the second section comprising PEG-precursors comprising PEG-ester and PEG-amine precursors in an equivalent ratio of active group sites of PEG-ester/PEG-amine of at least about one-to-one (1:1), at least some of the precursors remaining in an unreactive state until exposed to an aqueous physiological environment, whereupon the precursors undergo in-situ cross-linking with one another to provide adhesion to tissue adjacent the puncture.
30. The apparatus of claim 29 , further comprising an advancer member disposed within the lumen of the tubular member for deploying the sealant from the lumen out the distal opening when the tubular member is retracted from a puncture relative to the advancer member.
31. The apparatus of claim 29 , wherein the sealant comprises a lumen extending through the first and second sections, the apparatus further comprising an elongate positioning member, the positioning member having an expandable element on a distal end thereof, the positioning member sized for passing through the lumen of the tubular member and the lumen of the plug.
32. A method for sealing a puncture extending through tissue of a patient, comprising:
providing sealant comprising an elongate first section extending from a proximal end to a distal end and a cross section sized for delivery into the puncture, and a second section fused to and extending from the distal end of the first section, the sealant disposed within the lumen such that the second section is disposed closer to the distal opening than the first section, the second section comprising PEG-precursors comprising PEG-ester and PEG-amine precursors in an equivalent ratio of active group sites of PEG-ester/PEG-amine of at least about one-to-one (1:1), at least some of the PEG precursors in an unreactive state until exposed to an aqueous physiological environment;
introducing the sealant into a puncture through tissue with the second section entering the puncture before the first section; and
exposing the sealant to the aqueous physiological environment within the puncture, whereupon the at least some of the PEG precursors of the second section undergo in-situ cross-linking with one another to provide adhesion to tissue adjacent the puncture.
33. The method of claim 32 , wherein the first section is formed from a freeze-dried hydrogel, and wherein, when the sealant is exposed to fluid within the puncture, the freeze-dried hydrogel expands to fill space within the puncture to provide hemostasis.
34. The method of claim 32 , wherein excess PEG-ester precursors in the second section react with amine groups of tissue adjacent to the puncture to improve adhesion of the sealant within the puncture.
35. The method of claim 32 , wherein the PEG-amine precursors of the second section comprise both a free amine form of PEG-amine precursors and a salt form of PEG-amine precursors, the free amine form of PEG-amine precursors at least partially cross-linked with the PEG-ester precursors before the sealant is introduced into the puncture, and wherein the salt form of PEG-amine precursors remain in the unreactive state until the sealant is exposed to fluid within the puncture.
36. The sealant of claim 1 , wherein:
the PEG-precursors comprising PEG-ester and PEG-amine precursors in a ratio of PEG-ester/PEG-amine in the range from 1:9 and 9:1.
37. The sealant of claim 21 , wherein an equivalent ratio of active group sites of PEG- ester precursors/salt form of PEG-amine precursors/free amine form of PEG-amine precursors is between about 50/45/5 and 70/25/5.