Instrument and methods for surgically closing percutaneous punctures
Methods for sealing a percutaneous puncture in a wall of a body passageway are disclosed herein. The methods include inserting a deployment instrument into the puncture via a toggle along the guidewire, and actuating the deployment instrument to move the first component and the second component relative to each other such that the toggle abuts the wall of the artery proximate the puncture to seal the puncture.
1 . A method of sealing a puncture in a wall of an artery, the method comprising:
inserting a guidewire into the puncture such that the guidewire extends from outside the artery, through the puncture and into the artery;
inserting a deployment instrument into the puncture via a toggle along the guidewire, the deployment instrument having a distal end section including a first component and a second component being in actuatable relationship to one another, wherein one of the first component of the second component rigidly supports the toggle, and the toggle is at least partially received in the other of the first component or the second component; and
actuating the deployment instrument to move the first component and the second component relative to each other such that the toggle abuts the wall of the artery proximate the puncture.
2 . The method of claim 1 , further comprising actuating the deployment instrument to move the first component and the second component relative to each other, wherein the actuation relieves the rigid support of the toggle, thereby enabling the toggle to effectively move relative to the distal end section.
3 . The method of claim 1 , further comprising inserting the distal end section into an insertion sheath extending through the puncture from outside of the artery to inside of the artery while the distal end section of the deployment instrument rigidly supports the toggle.
4 . The method of claim 3 , further comprising inserting the insertion sheath into the puncture.
5 . The method of claim 3 , wherein the insertion sheath is inserted into the puncture such that the insertion sheath substantially deforms from a linear configuration.
6 . The method of claim 3 , further comprising after inserting the insertion sheath into the puncture, moving the insertion sheath and the deployment instrument relative to each other so that the toggle is exposed from the insertion sheath and in the artery.
7 . The method of claim 1 , further comprising actuating the deployment instrument to move the first component and the second component relative to each other, wherein the actuation relieves the rigid support of the toggle, thereby enabling the toggle to effectively move relative to the distal end section.
8 . The method of claim 1 , further comprising after actuating the deployment instrument, moving the deployment instrument in a distal direction so that the toggle abuts the wall of the artery proximate the puncture.
9 . The method of claim 1 , further comprising after actuating the deployment instrument, moving the deployment instrument in a distal direction so that the toggle abuts the wall of the artery proximate the puncture and so that a plug contained in the deployment instrument moves towards the toggle and towards the puncture.
10 . The method of claim 9 , wherein the plug has an aperture configured to receive the guidewire, such that the toggle and the plug are slidable along the guidewire when the toggle is inserted into the artery, and the plug is compressed against the toggle into the puncture.
11 . A method of sealing a percutaneous puncture in a wall of an artery, comprising:
inserting a deployment instrument along a guidewire through the puncture into the artery, the deployment instrument carrying a tensioner assembly and a closure device including a toggle, a plug and a continuous elongate filament configured to draw the plug towards the toggle upon the application of tension to the filament in a direction away from the toggle;
positioning a distal end of the deployment instrument such that the toggle is positioned in the artery; and
pulling the tensioner assembly away from the puncture while the filament is connected to the tensioner assembly such that a mechanically induced tension force is applied to the filament such that the tension force increases with increasing distance of the tensioner assembly away from the puncture to draw the toggle and the seal towards each other and into engagement with the wall of the artery at respectively opposite sides of the wall, wherein the plug has an aperture configured to receive the guidewire, such that the toggle and the plug are slidable along the guidewire when toggle is inserted into the artery.
12 . The method of claim 11 , wherein pulling the tensioner assembly away from the puncture while the filament is connected to the tensioner assembly results in the application of a linearly increasing mechanically induced tension force to the filament.
13 . The method of claim 11 , wherein the mechanically induced increasing tension force is produced via compression of a spring.
14 . The method of claim 11 , wherein the tensioner assembly includes a handle that is movable relative to a first location on the tensioner assembly to which the filament is connected, the method further comprising continuing to pull the tensioner assembly away from the puncture by pulling on the handle until the handle no longer moves relative to the first location on the tensioner assembly.
15 . The method of claim 11 , further comprising sliding a tamper along the filament to compress the plug into the puncture adjacent the toggle.
16 . The method of claim 11 , further comprising pulling the deployment instrument away from the puncture while the filament is connected to the tensioner assembly such that the mechanically induced tension force is applied to the filament causing the tensioner assembly to be withdrawn from an interior of the deployment instrument.
17 . A method of sealing a percutaneous puncture in a wall of an artery, comprising:
inserting a deployment instrument along a guidewire through the puncture into the artery, the deployment instrument carving a tensioner assembly and a closure device including a toggle, a plug and a continuous elongate filament configured to draw the plug towards the toggle upon the application of tension to the filament in a direction away from the toggle;
positioning a distal end of the deployment instrument such that the toggle is positioned in the artery; and
pulling the tensioner assembly way from the puncture while the filament is connected to the tensioner assembly such that a mechanically induced tension force is applied to the filament such that the tension force increases with increasing distance of the tensioner assembly away from the puncture to draw the toggle and the seal towards each other and into engagement with the wall of the artery at respectively opposite sides of the wall, wherein the toggle includes a cavity, and inserting the toggle of the closure device into the artery includes positioning the guidewire through the cavity of the toggle so that the toggle slides along the guidewire.
18 . A method of sealing a percutaneous puncture in a wall of an artery, comprising:
inserting a deployment instrument along a guidewire through the puncture into the artery, the deployment instrument carving a tensioner assembly and a closure device including a toggle, a plug and a continuous elongate filament configured to draw the plug towards the toggle upon the application of tension to the filament in a direction away from the toggle:
positioning a distal end of the deployment instrument such that the toggle is positioned in the artery; and
pulling the tensioner assembly away from the puncture while the filament is connected to the tensioner assembly such that a mechanically induced tension force is applied to the filament such that the tension force increases with increasing distance of the tensioner assembly away from the puncture to draw the toggle and the seal towards each other and into engagement with the wall of the artery at respectively opposite sides of the wall;
locking the plug and the toggle in place along the filament to seal the puncture; and
removing the guidewire from the toggle and the artery.
19 . The method of claim 18 , further comprising, prior to locking the plug and the toggle in place along the filament to seal the puncture, pulling the toggle in a proximal direction that is opposite the distal direction until the toggle contacts an inner surface of the wall of the artery.