Apparatus and methods for sealing a vascular puncture
A sealant is provided for sealing a puncture through tissue that includes an elongate first section including a proximal end, 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 first section may be formed from a freeze-dried hydrogel that expands when exposed to physiological fluid within a puncture. The second section may be formed from a solid mass of non-freeze-dried, non-crosslinked hydrogel precursors, the precursors remaining in an unreactive state until exposed to an aqueous physiological, whereupon the precursors undergo in-situ crosslinking with one another to provide an adhesive layer bonded to the first section. Apparatus and methods for delivering the sealant into a puncture through tissue are also provided.
1. A sealant for sealing a puncture through tissue, comprising:
an elongate first section including a proximal end, 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 the puncture; and
a second section fused to and extending from the distal end of the first section, the second section formed from non-freeze-dried, non-crosslinked hydrogel precursors, the precursors remaining in an unreactive state until exposed to an aqueous physiological environment, whereupon the precursors undergo in-situ crosslinking with one another to provide an adhesive layer bonded to the first section.
2. The sealant of claim 1 , wherein the second section comprises a pH adjusted agent.
3. The sealant of claim 2 , wherein the pH adjusting agent comprises a salt mixed substantially uniformly with the precursors.
4. The sealant of claim 2 , wherein the pH adjusting agent comprises a plurality of salt particles impregnated into the precursors.
5. 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.
6. The sealant of claim 1 , wherein the second section comprises a solid mass of the non-crosslinked precursors.
7. The sealant of claim 6 , wherein the solid mass comprises a substantially uniform solid plug of the non-crosslinked precursors.
8. The sealant of claim 6 , wherein the solid mass comprises a sintered mass of precursor powders.
9. The sealant of claim 1 , wherein the second section includes one or more reinforcement elements.
10. The sealant of claim 9 , wherein the one or more reinforcement elements comprise a plurality of particles mixed with the precursors.
11. The sealant of claim 9 , wherein the one or more reinforcement elements comprise a mesh embedded within or surrounding the precursors.
12. The sealant of claim 1 , wherein the second section comprises one or more diluents mixed with the precursors to enhance one or more mechanical properties of the second section.
13. The sealant of claim 1 , wherein the hydrogel of the first section comprises a sterilized pharmaceutically acceptable covalently crosslinked hydrogel polymerized from at least one synthetic hydrophilic polyethylene glycol macromer, and having a substantially less than equilibrium level of hydration for undergoing a volumetric expansion of at least about 50% after swelling with the physiological fluid.
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 therethrough 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 15 , wherein the length of the second section is between about half and five millimeters (0.5-5.0 mm).
17. The sealant of claim 1 , wherein the first and second sections have a substantially uniform outer cross-section along their lengths between about one and eight millimeters (1-8 mm).
18. The sealant of claim 1 , wherein the first section is formed entirely from the freeze-dried hydrogel.
19. The sealant of claim 1 , wherein the first section consist essentially of the freeze-dried hydrogel.
20. The sealant of claim 1 , wherein the second section is formed entirely from the non-freeze-dried, non-crosslinked hydrogel precursors.
21. The sealant of claim 1 , wherein the second section consist essentially of the non-freeze-dried, non-crosslinked hydrogel precursors.
22. The sealant of claim 1 , wherein the freeze-dried hydrogel is porous, and wherein the non-crosslinked hydrogel precursors are non-porous.
23. The sealant of claim 1 , wherein the first section is porous, and wherein the second section is non-porous.
24. A sealant for sealing a puncture through tissue, comprising:
an elongate first section including a proximal end, 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 the puncture; and
a second section fused to and extending from the distal end of the first section, the second section consisting essentially of a solid mass of non-freeze-dried, non-crosslinked hydrogel precursors, the precursors remaining in an unreactive state until exposed to an aqueous physiological environment, whereupon the precursors undergo in-situ crosslinking to provide an adhesive layer to bond the first section relative to adjacent tissue.
25. The sealant of claim 24 , 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.
26. The sealant of claim 24 , wherein the second section comprises a substantially uniform solid plug of precursors fused to the distal end of the first section.
27. A sealant for sealing a puncture through tissue, comprising:
an elongate first section including a proximal end, 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 the puncture; and
a second section fused to and extending from the distal end of the first section, the second section consisting essentially of a solid mass of non-freeze-dried, non-crosslinked hydrogel precursors and one or more reinforcement elements, the precursors remaining in an unreactive state until exposed to an aqueous physiological environment, whereupon the precursors undergo in-situ crosslinking to provide an adhesive layer to bond the first section relative to adjacent tissue.
28. The sealant of claim 27 , wherein the one or more reinforcement elements comprise a plurality of particles mixed with the precursors.
29. The sealant of claim 27 , wherein the one or more reinforcement elements comprise a mesh embedded within or surrounding the precursors.
30. A sealant for sealing a puncture through tissue, comprising:
an elongate first section including a proximal end, 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 the puncture; and
a second section fused to and extending from the distal end of the first section, the second section consisting essentially of a solid mass of non-freeze-dried, non-crosslinked hydrogel precursors and one or more pH adjusting agents, the precursors remaining in an unreactive state until exposed to an aqueous physiological environment, whereupon the precursors undergo in-situ crosslinking to provide an adhesive layer to bond the first section relative to adjacent tissue.
31. The sealant of claim 30 , wherein the one or more pH adjusting agents comprise one or more salts mixed with the precursors.
32. The sealant of claim 30 , wherein the one or more pH adjusting agents comprise one or more salts coated on, embedded in, or impregnated in an outer surface of the second section.
33. A sealant for sealing a puncture through tissue, comprising:
an elongate first section including a proximal end, 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 the puncture; and
a second section fused to and extending from the distal end of the first section, the second section consisting essentially of a solid mass of non-freeze-dried, non-crosslinked hydrogel precursors and one or more of:
one or more pH adjusting agents;
one or more diluents mixed with the precursors to enhance one or more mechanical properties of the second section; and
one or more reinforcement elements,
wherein the precursors remain in an unreactive state until exposed to an aqueous physiological environment, whereupon the precursors undergo in-situ crosslinking to provide an adhesive layer to bond the first section relative to adjacent tissue.
34. The sealant of claim 33 , wherein the one or more reinforcement elements comprise a plurality of particles mixed with the precursors.
35. The sealant of claim 33 , wherein the one or more reinforcement elements comprise a mesh embedded within or surrounding the precursors.
36. The sealant of claim 33 , wherein the one or more pH adjusting agents comprise one or more salts mixed with the precursors.
37. The sealant of claim 33 , wherein the one or more pH adjusting agents comprise one or more salts embedded or impregnated in an outer surface of the second section.
38. 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;
sealant comprising an elongate first section including proximal and distal ends, and a second section fused to and extending from the distal end, the sealant disposed within the lumen of the tubular member such that the second section is disposed closer to the distal opening than the first section, the first section formed from a freeze-dried hydrogel that expands when exposed to a physiological fluid within the puncture, the second section formed from non-crosslinked hydrogel precursors, the precursors remaining in an unreactive state until exposed to an aqueous physiological environment, whereupon the precursors undergo in-situ crosslinking with one another to provide an adhesive layer bonded to the elongate first section; and
an advancer member disposed within the lumen of the tubular member for deploying the sealant from the lumen of the tubular member out the distal opening when the tubular member is retracted from the puncture relative to the advancer member.
39. The apparatus of claim 38 , wherein the sealant comprises a lumen extending through the first and second sections, the apparatus further comprising an elongate positioning member, the elongate positioning member having an expandable element on a distal end thereof, the elongate positioning member sized for passing through the lumen of the tubular member and the lumen of the sealant.
40. The apparatus of claim 38 , 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 therethrough aligned with the lumen defined by the sheet.
41. The apparatus of claim 38 , wherein the second section comprises a substantially uniform solid mass of precursors fused to the distal end of the first section.