Apparatus for sealing a puncture in a blood vessel wall - Patent application

Abstract

To provide an apparatus and a method for sealing a vessel puncture passing from a tissue into a vessel.SOLUTION: An apparatus for sealing a vessel puncture includes: a positioning assembly 714 including a positioning element 746 positioned at a distal portion of the positioning assembly and a sealant 2 disposed at a distal portion of the positioning assembly; a support member 730 axially advanceable along the positioning assembly; expansion mechanisms 766, 768 configured to advance the support member in the distal direction to expand the sealant; and a retraction mechanism 764 configured to retract the positioning element from the sealant in a base end direction independently of the expansion mechanisms.SELECTED DRAWING: Figure 16C

Description

[Technical field]

[0001] The present invention relates generally to devices and methods for sealing a puncture in the body, and more particularly to devices and methods for sealing a vascular puncture that penetrates through tissue into a blood vessel, as well as devices and methods for delivering a plug, sealant and / or other material to a percutaneous puncture extending from a patient's skin to a blood vessel or other body lumen to seal the puncture. [Background technology]

[0002] Devices and methods are known for percutaneously accessing a patient's vasculature, for example, to perform an intravascular procedure, and for sealing the resulting puncture after the procedure is completed. For example, a hollow needle can be inserted through the patient's skin and overlying tissue into the vessel. A guidewire is passed through the lumen of the needle and into the vessel, after which the needle is removed. An introducer sheath is then advanced over the guidewire into the vessel, and, for example, one or more dilators can be advanced simultaneously with the introducer sheath or one or more dilators can be advanced subsequent to insertion through the introducer sheath.

[0003] A catheter or other device can be advanced within the introducer sheath over the guidewire to the site where the medical procedure will be performed. In this manner, the introducer sheath can facilitate accessing and / or introducing various devices into the blood vessel while reducing trauma to the vessel wall and / or reducing blood loss. When the procedure is completed, the device and introducer sheath are removed, leaving a puncture extending between the skin and the vessel wall.

[0004] To seal the puncture, external pressure can be applied to the overlying tissue manually and / or using a sandbag until hemostasis occurs. This procedure, however, can be time consuming and costly for medical professionals. It is also uncomfortable for the patient and requires the patient to remain immobile in the operating room, catheter lab, or holding room. Furthermore, there is a risk of hematoma due to blood loss before hemostasis occurs.

[0005] Various devices and methods for sealing vascular punctures resulting from such procedures have been proposed, for example, in US Patent Nos. 7,316,704, 7,331,979, 7,335,220, and 7,806,856, and US Patent Publication Nos. 2007 / 0231366, 2008 / 0082122, 2009 / 0088793, 2009 / 0254110, 2010 / 0168789, 2010 / 0274280, and 2010 / 0280546, the entire disclosures of which are incorporated herein by reference.

[0006] For example, the MATRIX™ product is a mixture of two synthetic polyethylene glycol ("PEG") polymer powders mixed with a suitable buffer and injected into the femoral vessel at the arteriotomy site, as described, for example, in U.S. Patent No. 5,399,663. The MYNX® Vascular Closure Device is another system for sealing a vascular puncture and is described in one or more of the patents referenced above, such as U.S. Patent No. 5,399,663. [Prior art documents] [Patent documents]

[0007] [Patent Document 1] U.S. Patent No. 7,316,704 [Patent Document 2] U.S. Pat. No. 7,331,979 [Patent Document 3] U.S. Patent No. 7,335,220 [Patent Document 4] U.S. Patent No. 7,806,856 [Patent Document 5] US Patent Application Publication No. 2007 / 0231366 [Patent Document 6] US Patent Application Publication No. 2008 / 0082122 [Patent Document 7] US Patent Application Publication No. 2009 / 0088793 [Patent Document 8] US Patent Application Publication No. 2009 / 0254110 [Patent Document 9] US Patent Application Publication No. 2010 / 0168789 [Patent Document 10] US Patent Application Publication No. 2010 / 0274280 [Patent Document 11] US Patent Application Publication No. 2010 / 0280546 Summary of the Invention [Problem to be solved by the invention]

[0008] Therefore, devices and methods for sealing punctures through tissue would be useful.

[0009] The present invention is directed to devices and methods for sealing a body puncture. More specifically, the present invention is directed to devices and methods for producing temporary or permanent hemostasis in a vascular puncture leading to a blood vessel and / or for delivering sealant and / or other material into a percutaneous puncture through a patient's skin leading to a blood vessel or other body lumen. [Means for solving the problem]

[0010] In an exemplary embodiment, the invention provides an apparatus for sealing a puncture through tissue, the apparatus comprising an introducer sheath having a proximal end with a hub, a distal end, and a lumen extending between the proximal and distal ends. In general, the apparatus comprises a positioning member having a proximal end, a distal end, and an expandable positioning element at the distal end, a sealant carried on the distal end of the positioning element adjacent to the positioning element, a support member having a proximal end and a distal end, the distal end of the support member being located at the distal end of the positioning member adjacent to the sealant, and a sealant sleeve slidably disposed over the distal end of the support member and covering the sealant. The sleeve has a portion that abuts against the introducer sheath when the distal end of the positioning member is introduced into the introducer sheath, preventing the entire sleeve from entering the lumen of the introducer sheath, so that when the positioning member is advanced into the introducer sheath, the sealing material and support member are exposed within the lumen of the introducer sheath, and by further advancing the positioning member, it acts against the support member, directing the sealing material toward the distal end within the lumen of the introducer sheath.

[0011] In another embodiment, the invention provides a system for sealing a puncture through tissue, the system comprising: an introducer sheath having a proximal end with a hub, a distal end, and a lumen extending between the proximal and distal ends; and a positioning member having an expandable positioning element at the proximal, distal and distal ends, the distal end of the positioning member sized for introduction into the hub and lumen of the sheath with the positioning element in a contracted state. A sealant is carried on the distal end of the positioning element adjacent to the positioning element, and a support member having a proximal and distal end is carried on the positioning member, the distal end of the support member being disposed on the distal end of the positioning member adjacent to the sealant. A sealant sleeve is slidably disposed over the distal end of the support member and covers the sealant. The sleeve has a portion that abuts against the introducer sheath when the distal end of the positioning member is introduced into the introducer sheath, preventing the entire sleeve from entering the lumen of the introducer sheath, so that when the positioning member is advanced into the introducer sheath, the sealing material and support member are exposed within the lumen of the introducer sheath, and by further advancing the positioning member, it acts against the support member, directing the sealing material toward the distal end within the lumen of the introducer sheath.

[0012] In yet another embodiment of the present invention, a method of sealing a puncture through tissue into a body lumen is provided, comprising: disposing an introducer sheath within the puncture; providing an elongate positioning member having proximal and distal ends and a sealant and a sleeve at least partially surrounding the distal end of the support member, the sleeve and sealant being disposed adjacent a positioning element at the distal end of the positioning member; advancing the distal end of the positioning member into the hub and lumen of the introducer sheath until the sleeve contacts the sheath hub; advancing the positioning member further into the sheath lumen until the positioning element is disposed beyond the distal end of the introducer sheath into the body lumen, thereby sliding the sleeve over the support member and exposing the sealant within the sheath lumen and advancing the distal end of the support member within the lumen of the introducer sheath to guide the sealant out of the lumen of the introducer sheath toward the distal end of the sheath; and retracting the introducer sheath, exposing the sealant within the puncture.

[0013] In one embodiment, the invention provides an apparatus for sealing a puncture comprising an elongate positioning member having a proximal end with an expandable positioning element at a distal end thereof, and a cartridge advanceable along the positioning member from a proximal position to a distal position, the cartridge including a tubular member, a sealant disposed within the lumen of the tubular member, e.g., adjacent a distal end of the tubular member, a support member disposed within the lumen of the tubular member adjacent the sealant, and a housing at the proximal end of the tubular member.

[0014] A deployment mechanism is provided within the housing and coupled to the tubular member and the support member, the deployment mechanism having, for example, one or more rack and pinion elements coupled to the proximal ends of the tubular member and the support member. The housing includes an actuator coupled to the deployment mechanism, and when the actuator is actuated, the tubular member is guided proximally and / or the support member is guided distally in a predetermined sequence. For example, when the actuator is actuated, the one or more rack and pinions sequentially a) withdraw the tubular member against the sealant to expose the sealant from the lumen of the tubular member within the puncture, and b) advance the support member to compress the sealant within the puncture. The timing of retraction and advancement can be set based on the configuration of the deployment mechanism, for example, delaying advancement of the support member until the sealant is almost exposed from the tubular member.

[0015] In another embodiment, the present invention provides a system for sealing a puncture in tissue, the system generally comprising an introducer sheath, a positioning member, and a cartridge. The introducer sheath has a proximal end providing a hub, a distal end sized for introduction into the puncture, and a lumen extending between the proximal and distal ends. The positioning member includes an elongate member having a proximal end and an expandable positioning element at the distal end of the elongate member. The cartridge is advanceable from a proximal position to a distal position along the positioning member and includes a tubular member including a sealant and a support member disposed within the lumen of the tubular member. A locking mechanism is provided on the cartridge to engage the hub of the introducer sheath when the tubular member is advanced to the distal position and into the introducer sheath, e.g., thereby coupling subsequent proximal movement of the tubular member and the introducer sheath to one another.

[0016] In yet another embodiment, the invention provides an apparatus for sealing a puncture through tissue, the apparatus comprising an introducer sheath having a proximal end including a hub, a distal end, and a lumen extending between the proximal and distal ends. The apparatus can comprise a positioning member having a proximal end, a distal end, and an expandable positioning element at the distal end, and a cartridge advanceable along the positioning member from a proximal position adjacent the proximal end of the positioning member to a distal position. The cartridge can include a sealant, a support member having a distal end disposed adjacent the sealant, and a sealant sleeve slidably disposed over the distal end of the support member and covering the sealant.

[0017] The sleeve has a distal portion sized to enter the hub of the introducer sheath when the cartridge is advanced toward the distal position, and a proximal portion abutting the hub of the introducer sheath to prevent the entire sleeve from entering the lumen of the introducer sheath, so that when the cartridge is advanced from the proximal position to the distal position, the distal portion of the sleeve enters the lumen of the introducer sheath and is stopped by the hub of the introducer sheath and slides over the support member, exposing the sealant in the lumen of the introducer sheath, and further advancing the cartridge to the distal position acts on the support member to direct the sealant in the lumen of the introducer sheath in the distal direction.

[0018] Some aspects of the present invention are directed to an apparatus for sealing a puncture in a blood vessel wall. The apparatus can include a positioning assembly having a positioning element positioned at a distal portion of the positioning assembly and a sealant disposed at a distal portion of the positioning assembly. The apparatus can include a sheath releasably engaging the positioning assembly. The apparatus can include a support member axially advanceable within the sheath.

[0019] Some aspects of the present invention are directed to an apparatus for sealing a puncture in a blood vessel wall. The apparatus can include a positioning assembly having a sealant disposed at a distal portion of the positioning assembly. The apparatus can include a sheath within which the positioning assembly is axially advanceable. The apparatus can include a handle having an outer handle portion configured for movement relative to the inner housing portion. The outer handle portion can be releasably connectable to the sheath and / or the inner housing portion can be releasably connectable to the positioning assembly.

[0020] Any of the features of the device, methods, or processes described herein may be included in any of the embodiments. For example, the positioning assembly may include a sealant sleeve configured to receive the sealant. The sheath may include a hub portion configured to receive the sealant sleeve. The inner diameter of the sheath may be smaller than the outer diameter of the sealant sleeve. The sealant may include a first sealant portion distal to a second sealant portion. The first sealant portion may be different from the second sealant portion.

[0021] In some embodiments, the device can include a positioning element movable between an unexpanded state and an expanded state. The positioning element can be positioned adjacent to and / or at a distal end portion of the positioning assembly.

[0022] In some embodiments, the handle can have a first actuator configured to decouple movement between the outer handle portion and the inner housing portion. The handle can have a second actuator configured to advance the support member within the sheath. For example, the handle can have a rack and pinion. The pinion can be linked to the second actuator and configured to move the rack. In some embodiments, the handle can have a third actuator configured to retract the positioning element through the seal. The third actuator can be slidable relative to the inner housing portion.

[0023] Some aspects of the present invention are directed to a method of sealing a puncture in a blood vessel wall. The method may include advancing a sheath over a guidewire. The method may include withdrawing the guidewire. The method may include advancing a positioning assembly within the sheath such that a positioning element enters the blood vessel. The positioning assembly may carry a sealant disposed at a distal portion thereof. The method may include retracting the sheath to expose the sealant outside the blood vessel. In some aspects, advancing the positioning assembly may include transferring sealant from a sealant sleeve to the sheath.

[0024] Any of the features, methods, or processes of the device described herein may be included in any of the embodiments. For example, the method may include expanding a positioning element within a vessel. The method may include retracting the positioning element proximally to seat the positioning element against a vessel wall. The method may include releasably engaging a positioning assembly and a sheath. The method may include releasing the positioning assembly from the sheath. The method may include advancing a support member to tamp the sealant. The method may include releasing the positioning assembly from the support member. The positioning element may be retracted through the sealant to leave the sealant in place. The method may include advancing a dilator within the sheath.

[0025] Other aspects and features of the present invention will become apparent from the following description taken in conjunction with the accompanying drawings.

[0026] The exemplary devices illustrated in the drawings are not drawn to scale and various aspects and features of the depicted embodiments may be exaggerated. [Brief description of the drawings]

[0027] [Figure 1A] 1 is a side view of an exemplary embodiment of a device having a positioning member and a cartridge movable on the positioning member that contains a sealant to deliver the sealant to a puncture in tissue. [Figure 1B] FIG. 1B is an exploded perspective view of the device of FIG. 1A. [Figure 2A] FIG. 2 is a side view of the device of FIGS. 1A and 1B showing the seal and support member (shown in phantom) within the outer tubular member of the cartridge. [Figure 2B] FIG. 3 is a cross-sectional view showing an exemplary embodiment of a housing provided at the base end of the cartridge shown in FIGS. 1A to 2A, illustrating a deployment mechanism that deploys a sealing material from the cartridge within the housing. [Diagram 3] FIG. 2 is a cross-sectional view of another embodiment of a deployment mechanism that may be provided in a cartridge housing such as that shown in FIGS. 1A-2A, the deployment mechanism including a slider actuator and a series of teeth on a pinion. [Figure 3A] FIG. 13 is a cross-sectional view of yet another embodiment of a deployment mechanism having a support member indirectly coupled to the deployment mechanism. [Figure 4] FIG. 13 is a cross-sectional view of yet another embodiment of a deployment mechanism having a push button. [Figure 4A] FIG. 5 is a detailed view of an actuator-pinion configuration that can be provided in the deployment mechanism of FIG. 4. [Diagram 5] 13 is a cross-sectional view of yet another embodiment of a deployment mechanism having a lever actuator. FIG. [Figure 6] 13 is a partial cross-sectional view of another embodiment of a positioning member having an automatic retraction assembly that automatically retracts the positioning member when actuated. [Figure 7A] FIG. 13 is a side view of another embodiment of a positioning member having a retraction lock to limit movement of the positioning member relative to the cartridge (for clarity, only a first rack of cartridges is shown). [Figure 7B]FIG. 13 is a side view of another embodiment of a positioning member having a retraction lock to limit movement of the positioning member relative to the cartridge (for clarity, only a first rack of cartridges is shown). [Figure 7C] FIG. 13 is a side view of another embodiment of a positioning member having a retraction lock to limit movement of the positioning member relative to the cartridge (for clarity, only a first rack of cartridges is shown). [Figure 8A] 13 is a partial cross-sectional view of another embodiment of an apparatus having a cartridge for holding a positioning member and a sealant, the apparatus having an automatic retraction mechanism for retracting the positioning member relative to the cartridge. FIG. [Figure 8B] 13 is a partial cross-sectional view of another embodiment of an apparatus having a cartridge for holding a positioning member and a sealant, the apparatus having an automatic retraction mechanism for retracting the positioning member relative to the cartridge. FIG. [Figure 8C] 13 is a partial cross-sectional view of another embodiment of an apparatus having a cartridge for holding a positioning member and a sealant, the apparatus having an automatic retraction mechanism for retracting the positioning member relative to the cartridge. FIG. [Figure 9A] Detail view showing the contracted positioning element retracting into the cartridge from the exposed encapsulant. FIG. [Figure 9B] Detail view showing the contracted positioning element retracting into the cartridge from the exposed encapsulant. FIG. [Figure 10A] FIG. 2C is a cross-sectional view of a patient's body illustrating a method of sealing a puncture site using the device of FIGS. 1A-2B. [Figure 10B] FIG. 2C is a cross-sectional view of a patient's body illustrating a method of sealing a puncture site using the device of FIGS. 1A-2B. [Figure 10C] FIG. 2C is a cross-sectional view of a patient's body illustrating a method of sealing a puncture site using the device of FIGS. 1A-2B. [Figure 10D] FIG. 2C is a cross-sectional view of a patient's body illustrating a method of sealing a puncture site using the device of FIGS. 1A-2B. [Figure 10E] FIG. 2C is a cross-sectional view of a patient's body illustrating a method of sealing a puncture site using the device of FIGS. 1A-2B. [Figure 10F]FIG. 2C is a cross-sectional view of a patient's body illustrating a method of sealing a puncture site using the device of FIGS. 1A-2B. [Figure 10G] FIG. 2C is a cross-sectional view of a patient's body illustrating a method of sealing a puncture site using the device of FIGS. 1A-2B. [Figure 11] 11 is a cross-sectional view of a patient's body illustrating another embodiment of a cartridge having a contractible end region for delivering a sealant into a puncture. [Figure 12] A side view of another embodiment of a device having a positioning member and a cartridge movable on the positioning member for sealing a puncture in tissue, the device having a sealant and a sealant sleeve slidable on a support member. [Figure 12A] FIG. 13 is a detailed cross-sectional view of the distal end of the cartridge of FIG. 12. [Figure 13A] 13A-13C are diagrams illustrating steps in a method of sealing a puncture using the device of FIG. 12. [Figure 13B] 13A-13C are cross-sectional views showing steps in a method of sealing a puncture using the device of FIG. 12. [Figure 13C] 13 is a cross-sectional view of a patient's body illustrating a method of sealing a puncture using the device of FIG. 12. [Figure 14] 13A-13C are partial cross-sectional views of an exemplary embodiment of a sheath catch that may be provided on an apparatus for delivering a sealing material. [Figure 15A] FIG. 13 is a partial cross-sectional view of another embodiment of a sheath that may be provided on a device having a bleed back port. [Figure 15B] FIG. 13 is a partial cross-sectional view of another embodiment of a sheath that may be provided on a device having a bleed back port. [Figure 16A] 13 is a side perspective view of another embodiment of a device for delivering sealant to a puncture in tissue. FIG. [Figure 16B] 13 is a side perspective view of another embodiment of a device for delivering sealant to a puncture in tissue. FIG. [Figure 16C] FIG. 16C is a side view of the device of FIGS. 16A and 16B with a portion of the outer housing removed to show the internal components of the device. [Figure 16D] FIG. 16C is a perspective view of an introducer sheath and dilator assembly that can be used in conjunction with the device of FIGS. 16A-16C. [Figure 17A] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Figure 17B] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Figure 17C] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Figure 17D] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Figure 17E] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Figure 17F] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Figure 18A] FIG. 4 is an explanatory diagram showing a mechanism for controlling fluid flow through an expansion line. [Figure 18A-1] FIG. 13 is an explanatory diagram showing a mechanism for controlling the flow of fluid through the expansion line. [Figure 18B] FIG. 1 is an illustration of a mechanism for controlling fluid flow through an expansion line. [Figure 18B-1] FIG. 13 is an explanatory diagram showing a mechanism for controlling the flow of fluid through the expansion line. [Figure 19A] FIG. 11 is an illustration showing another mechanism for controlling fluid flow through the expansion line. [Figure 19A-1] FIG. 11 is an illustration showing another mechanism for controlling fluid flow through the expansion line. [Figure 19B] FIG. 11 is an illustration showing another mechanism for controlling fluid flow through the expansion line. [Figure 19B-1] FIG. 11 is an illustration showing another mechanism for controlling fluid flow through the expansion line. [Figure 19C] FIG. 11 is an illustration showing yet another mechanism for controlling fluid flow through the expansion line. [Figure 19D] FIG. 11 is an illustration showing yet another mechanism for controlling fluid flow through the expansion line. [Figure 19E] FIG. 11 is an illustration showing yet another mechanism for controlling fluid flow through the expansion line. [Figure 19F] FIG. 11 is an illustration showing yet another mechanism for controlling fluid flow through the expansion line. [Figure 20A] FIG. 13 is an illustration showing yet another mechanism for controlling fluid flow through the expansion line. [Figure 20A-1] FIG. 13 is an illustration showing yet another mechanism for controlling fluid flow through the expansion line. [Figure 20B] FIG. 13 is an illustration showing yet another mechanism for controlling fluid flow through the expansion line. [Figure 20B-1] FIG. 13 is an illustration showing yet another mechanism for controlling fluid flow through the expansion line. [Figure 21A] FIG. 13 is an explanatory diagram showing a mechanism for controlling movement of the outer housing relative to the inner housing. [Figure 21B] FIG. 13 is an explanatory diagram showing a mechanism for controlling movement of the outer housing relative to the inner housing. [Figure 22A] 13 is an illustration showing another mechanism for controlling movement of the outer housing relative to the inner housing. FIG. [Figure 22B] 13 is an illustration showing another mechanism for controlling movement of the outer housing relative to the inner housing. FIG. [Figure 23A] 13 is an illustration showing yet another mechanism for controlling movement of the outer housing relative to the inner housing. FIG. [Figure 23B] 13 is an illustration showing yet another mechanism for controlling movement of the outer housing relative to the inner housing. FIG. [Figure 24A] 11 is an explanatory diagram showing a lock mechanism that prevents the support member from moving. FIG. [Figure 24B] 11 is an explanatory diagram showing a lock mechanism that prevents the support member from moving. FIG. [Figure 24C] 11 is an explanatory diagram showing a lock mechanism that prevents the support member from moving. FIG. [Figure 25A] FIG. 11 is an explanatory diagram showing a mechanism for advancing a support member. [Figure 25B]FIG. 11 is an explanatory diagram showing a mechanism for advancing a support member. [Figure 26A] 13 is an explanatory diagram showing another mechanism for advancing the support member. FIG. [Figure 26B] 13 is an explanatory diagram showing another mechanism for advancing the support member. FIG. [Figure 27A] FIG. 13 is an illustration of a retract lock that limits movement of the positioning assembly. [Figure 27B] FIG. 13 is an illustration of a retract lock that limits movement of the positioning assembly. [Figure 28A] 13A-13C are diagrams illustrating another method of delivering sealant to an arteriotomy site. [Figure 28B] 13A-13C are diagrams illustrating another method of delivering sealant to an arteriotomy site. [Figure 28C] 13A-13C are diagrams illustrating another method of delivering sealant to an arteriotomy site. [Figure 28D] 13A-13C are diagrams illustrating another method of delivering sealant to an arteriotomy site. [Figure 28E] 13A-13C are diagrams illustrating another method of delivering sealant to an arteriotomy site. [Figure 28F] 13A-13C are diagrams illustrating another method of delivering sealant to an arteriotomy site. [Figure 29A] FIG. 13 is an illustration showing a device for delivering sealant to an arteriotomy site having an expansion indicator. [Figure 29B] FIG. 13 is an illustration showing a device for delivering sealant to an arteriotomy site having an expansion indicator. [Figure 30A] 1A-1C are illustrations of an embodiment of a dilator configured to engage a sheath. [Figure 30B] 1A-1C are illustrations of an embodiment of a dilator configured to engage a sheath. [Figure 30C] 1A-1C are illustrations of an embodiment of a dilator configured to engage a sheath. [Figure 30D] 1A-1C are illustrations of an embodiment of a dilator configured to engage a sheath. [Figure 31A] 13A-13C are illustrations depicting another embodiment of a dilator configured to engage a sheath. [Figure 31B]13A-13C are illustrations depicting another embodiment of a dilator configured to engage a sheath. [Figure 31C] 13A-13C are illustrations depicting another embodiment of a dilator configured to engage a sheath. [Figure 32A] FIG. 13 is an illustration of a positioning assembly and a mechanism for engaging a sheath. [Figure 32B] FIG. 13 is an illustration of a positioning assembly and a mechanism for engaging a sheath. [Figure 32B-1] FIG. 13 is an illustration of a positioning assembly and a mechanism for engaging a sheath. [Figure 32C] FIG. 13 is an illustration of a positioning assembly and a mechanism for engaging a sheath. [Figure 32C-1] FIG. 13 is an illustration of a positioning assembly and a mechanism for engaging a sheath. [Fig. 32D] FIG. 13 is an illustration of a positioning assembly and a mechanism for engaging a sheath. [Fig. 32D-1] FIG. 13 is an illustration of a positioning assembly and a mechanism for engaging a sheath. [Diagram 33] 13 is an illustration of another mechanism for engaging the positioning assembly and sheath. [Figure 34A] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Figure 34B] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Figure 34C] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Fig. 34D] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Figure 34E] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Fig. 34F] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Figure 34G] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Fig. 34H] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. [Fig. 34I] 1A-1C are diagrams illustrating steps in a method for delivering a sealant to an arteriotomy site. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0028] 1A-2B show an exemplary embodiment of an apparatus 10 having a positioning member 14 and a cartridge or shuttle 16 carried on the positioning member 14 for delivering a sealant 2 in a cartridge to a puncture (not shown). The cartridge 16 can have an elongate tubular member 20 carrying the sealant 2 therein, a support tube or support member 30 adjacent the sealant 2 within the tubular member 20, and a handle or housing 23, which can be coupled to and / or carried by the tubular member 20 and / or the support member 30.

[0029] 1A-2A, the cartridge 16 is initially disposed in a proximal position, e.g., where the sealant is proximally spaced from the expandable positioning element 46 of the positioning member 14. The entire cartridge 16 may be advanced from the proximal position to a distal position, e.g., as shown in FIGS. 10A-10C, with the sealant 2 being advanced into the puncture and / or toward the positioning element 46. In some embodiments, the relative lengths of the positioning member 14 and cartridge 16 are such that the sealant 2 is disposed adjacent the positioning element 46 when the entire cartridge 16 is in an initial position, i.e., a position where the sealant is not advanced from the proximal position to the distal position, as shown in, e.g., device 210 shown in FIGS. 8A-8C and / or device 710 shown in FIGS. 16A, 16B, and described elsewhere herein.

[0030] 2B, the cartridge 16 can include a deployment mechanism 60 coupled to the tubular member 20 and the support member 30 within the housing 23. As described below, the deployment mechanism 60 can be configured to axially orient the tubular member 20 and / or the support member 30 relative to the housing 23 and relative to the sealant 2 and / or the positioning member 14, for example, to deploy and / or compress the sealant 2.

[0031] Optionally, device 10 (or any of the other embodiments described herein) is part of a system that also includes a sheath 80 (not shown, see FIGS. 10A-10F), e.g., for delivery, access, treatment, introduction, or other purposes. The introduction sheath 80 can be a conventional sheath 80 as shown in FIGS. 10A-10F, or a custom sheath such as sheath 780 shown in FIG. 16C, e.g., including bleed-back and / or sheath-locking features as described below. Optionally, device 10 and / or the system can include one or more other components, such as one or more other components, such as needles, guidewires, other instruments for puncture, a source of inflation media, and / or additional sources of sealing compound (not shown), to form a kit for a medical procedure.

[0032] Generally, as best seen in FIG. 2A, the tubular member 20 can have a proximal end 22 that projects and / or couples into the housing 23 and / or deployment mechanism 60, a distal end 24 sized for introduction into an introducer sheath and / or puncture (not shown), and a lumen 26 extending between the proximal end 22 and the distal end 24. The tubular member 20 can be generally rigid, semi-rigid, or flexible, for example, to allow the tubular member 20 to be advanced through an introducer sheath or other portion into a tissue puncture. The distal end 24 can terminate in a tapered, rounded, or blunt distal tip. Optionally, as with other embodiments described below, the distal end 24 can terminate in a retractable, splittable, or collapsible distal tip (not shown).

[0033] 2A and 2B, the support member 30 can be an elongate tubular body sized to be slidably received within the lumen 26 of the tubular member 20. The support member 30 has a proximal end 32 that penetrates and / or couples to the housing 23 and / or deployment mechanism 60, and a distal end 34 that is disposed proximal to the distal end 24 of the tubular member and / or adjacent to the sealant 2, for example, to contact the sealant 2 when the tubular member 20 is retracted during use and / or to facilitate maintaining the sealant 2 within the puncture, as described below. The support member 30 also has a lumen (not shown) extending between the proximal end 32 and the distal end 34, for allowing the positioning member 14 to be slidably received within the lumen.

[0034] The support member 30 may be generally rigid, semi-rigid, and / or generally flexible, e.g., having sufficient column strength to allow the tubular member 20 to move in a proximal direction relative to the sealant 2 without buckling of the support member 30 relative to the sealant 2, and / or to allow the distal end 34 of the support member 30 to be advanced to compress the sealant 2 within the puncture by pushing on the proximal end 32 with the deployment mechanism 60 as described below.

[0035] 2A in phantom, the sealant 2 can be disposed within the lumen 26 of the tubular member 20 near the distal end 24, e.g., immediately adjacent to and / or surrounded by the distal tip. The lumen 26 can be sized to allow the tubular member 20 and the sealant 2 to slide relative to one another, e.g., to allow the tubular member 20 to retract proximally relative to the sealant 2 and / or support member 30, as described below. In an exemplary embodiment, the sealant 2 can have a first main proximal section 2a formed from a lyophilized hydrogel and a second distal tip section 2b formed from multiple precursors that are not lyophilized and / or crosslinked, and the second tip section 2b (not shown in FIG. 2A, but see FIG. 11) can be formed as a solid mass or plug fused or attached to the first section and extending distally from the first section, as disclosed in U.S. Patent Application Publication No. 2014 / 0249575 (U.S. Patent Application No. 13 / 354,278, filed January 19, 2012), which is incorporated herein by reference in its entirety.

[0036] The sealant 2 can comprise one or more materials that are biocompatible, bioabsorbable and / or swellable, such as a lyophilized hydrogel. The sealant 2 can have a solid or hollow cylindrical shape, a rolled sheet shape, a disk shape, or other shapes or cross sections, such as oval, triangular, square, conical, discoid, polygonal, etc. For example, the sealant 2 can be formed from a solid material with a lumen (not shown) that extends between the proximal and distal ends of the sealant. The lumen can be created by rolling, wrapping a sheet material around a mandrel, or by molding, or by drilling or removing material from a preformed solid material, etc. The lumen can be sized to allow a positioning member 14 or other instrument (not shown) to slide or pass through the sealing material 2, as disclosed in U.S. Patent Application Publication No. 2014 / 0249575 (U.S. Patent Application No. 13 / 354,278, filed January 19, 2012), which publication is incorporated herein by reference in its entirety.

[0037] In some embodiments, the sealant 2 can be formed from a biocompatible and / or bioabsorbable hydrogel, such as polyethylene glycol ("PEG"). For example, the hydrogel can include a lyophilized PEG polymer that includes hydrolytically degradable chemical groups, e.g., a polymer network that can absorb bodily fluids and expand when exposed to an aqueous environment. The amount of expansion or swelling (before and after hydration) can be large, e.g., 2 to 10 times (2X to 10X) the lyophilized size based on volume. Additionally or alternatively, the sealant 2 can include one or more biological thrombogenic materials, such as collagen, fibrin, carboxymethylcellulose, oxidized cellulose, alginate, gelatin, or other protein-based materials, and / or synthetic materials, such as polyglycolic acid (PGA), polylactide (PLA), polyvinyl alcohol, and the like.

[0038] Optionally, the sealant 2 includes one or more therapeutic and / or medicinal agents, for example, to promote healing, prevent infection and / or other medical disruptive events, etc. Such agents can be embedded within the sealant and / or applied as one or more coatings or layers. Additionally or alternatively, the sealant 2 can be substantially homogenous or include one or more different materials in one or more locations. For example, in some embodiments, the sealant 2 includes a carrier or core, and first and second hydrogel precursors can be disposed against the carrier or core in an unreacted state, and the first and second hydrogel precursors can form an adhesive coating when the sealant 2 is exposed to a water-containing environment.

[0039] 2B, the housing 23 includes an actuator 62 coupled to a deployment mechanism 60 to selectively guide the tubular member 20 and / or the support member 30, for example, to expose and / or compress the sealant 2. In an exemplary embodiment, the deployment mechanism 60 includes one or more coupled rack and pinion elements to retract and / or advance the tubular member 20 and the support member 30 into a desired configuration in a predetermined sequence.

[0040] 2B, the deployment mechanism 60 includes a first rack 64 coupled to the proximal end 22 of the tubular member 20, a second rack 66 coupled to the proximal end 32 of the support member 30, and a pinion 68 coupled between the first rack 64 and the second rack 66. In an exemplary embodiment, the proximal ends 22, 32 can be attached to the racks 64, 66, for example, by providing stems (not shown) on the racks 64, 66 and receiving the stems within the proximal ends 22, 32, or by bonding, fusing, or ultrasonically welding the proximal ends 22, 33 to the stems or directly to the racks 64, 66.

[0041] The pinion 68 may be fixed against translational movement relative to the housing 23, e.g., so as to be free to rotate about an axis fixed to the housing 23 without appreciable translational movement along or across the longitudinal axis 11 of the device 10. The racks 64, 66 may be slidably mounted within the housing 23 along guides 70, 72, e.g., tracks, rails, slots, etc., allowing the racks 64, 66 to slide within the housing generally parallel to the longitudinal axis 11. Movement of the racks 64, 66 may be limited by the movement of the racks and / or actuator 62 and / or interaction with the pinion 68, e.g., so as to limit the distance that the tubular member 20 and support member 30 may travel.

[0042] Generally, the racks 64, 66 and the pinion 68 have cooperating teeth that interact with one another such that movement of one element produces a desired movement of the other element. For example, as shown, the pinion 68 has a series of substantially uniformly sized and spaced apart teeth 69 around its circumference, and the racks 64, 66 have similar teeth 65, 67 extending substantially continuously along their lengths. In some embodiments, the deployment mechanism can include multiple pinions (not shown) coupled to the racks 64, 66, which can be of different diameters or different tooth configurations, for example, to provide different rates of translational movement of the first and second racks 64, 66, as desired.

[0043] 2B, the actuator 62 may be a slider button directly coupled to the first rack 64. The actuator 62 slides within a slot in the housing 23, which may guide the actuator 62 from a first or distal position, as shown, to a second or proximal position (not shown). Optionally, the slot or the housing 23 may include a pocket or other locking feature (not shown) to allow the actuator 62 (and thus the deployment mechanism 60, the tubular member 20, and / or the support member 30) to be releasably secured in one or more desired positions, e.g., a distal position and a proximal position.

[0044] When actuator 62 is actuated, deployment mechanism 60 can guide first rack 64 proximally, thus retracting tubular member 20 proximally. Due to cooperating teeth 65, 67, 69, movement of first rack 64 can rotate pinion 68, which in turn can advance second rack 66 distally, thus advancing support member 30 distally. In this manner, deployment mechanism 60 shown in FIG. 2B can substantially simultaneously retract tubular member 20 proximally and advance support member 30 distally to deploy sealant 2, as described further below. In this configuration, the relative movement of tubular member 20 and support member 30 is one-to-one, i.e., tubular member 20 can be retracted an equal distance as support member 30 is advanced.

[0045] The teeth can be provided in a discontinuous and / or non-uniform configuration as desired, for example to provide a desired delay in the movement between the tubular member 20 and the support member 30, and / or to provide different rates of retreat and advance movement. For example, Figure 3 illustrates an alternative embodiment in which the racks 64a, 66a and / or pinion 68a have teeth 65a, 67a, 69a that are not continuous. For example, the pinion 68a can be provided with teeth 69a that extend only partially around its outer surface, or with multiple sets of teeth 69a (only one shown in the figures for simplicity) that are spaced apart from one another around the circumference of the pinion 68a.

[0046] In the exemplary embodiment, the racks 64a, 66a have sets of substantially continuous teeth 65a, 67a such that the teeth 65a of the first rack 64a engage a first set of corresponding teeth 69a of the pinion 68a when the actuator 62a is initially positioned in a distal position. In this position, the teeth 67a on the second rack 66a do not engage any teeth on the pinion 68a. Thus, when the actuator 62a is initially actuated, the first rack 64a moves immediately, thereby immediately retracting the tubular member 20. As the actuator 62a and the first rack 64a move, the pinion 68a rotates, eventually allowing a second set of teeth 69a (not shown) on the pinion 68a to engage the teeth 67a of the second rack 66a. Further movement of the actuator 62a moves the second rack 66a, thereby advancing the support member 30 in a distal direction.

[0047] By providing one or more areas of the pinion 68a that are devoid of teeth 69a, the advancement of the support member 30 can be delayed a desired time or distance after the start of retraction of the tubular member 20. For example, this delay can allow the sealant 2 to be partially or fully exposed from the distal end 24 of the tubular member 20 before the support member 30 is advanced to compress the sealant 2, thereby reducing the risk of the sealant 2 becoming compressed or jammed within the tubular member 20.

[0048] If desired, the size and / or spacing of the teeth 65a, 67a on the racks 64a, 66a can be different from one another to, for example, provide a different translation distance when the actuator 62 is actuated. For example, a second pinion (not shown) can be coupled between the pinion 68a and the second rack 66a, the second pinion being of a different diameter and / or having a tooth configuration corresponding to the teeth 67a of the second rack 66a, such that when the actuator 62 is actuated, the tubular member 20 is advanced a greater or lesser distance than it is retracted.

[0049] In some embodiments, the advancement of the support member 30 can be delayed by indirectly connecting the proximal end of the support member 30 to the second rack 66. For example, as shown in FIG. 3A, the second rack 66a' can include a stem or other extension 79a' that extends partially into the proximal end 32 of the support member 30, e.g., to support the proximal end 32 against significant lateral movement. The stem 79a' can be sized to slideably fit within the support member 30 and can accommodate a positioning member (not shown) that extends therethrough. Alternatively, another support (not shown) can be provided within the housing 23a' to support the proximal end 32 of the support member 30 for axial movement without lateral movement. In this manner, in an initial position, the proximal end 32 of the support member 30 can be spaced distally from the second rack 66a'.

[0050] The racks 64a, 66a' and the pinion 68a have substantially continuous corresponding teeth (not shown) similar to the embodiment of FIG. 2B, and when the actuator 62a is operated, both racks 64a, 66a' can move instantly due to the pinion 68a. Because the proximal end 22 of the tubular member 20 is directly connected to the first rack 64a, the first rack 64a can immediately start to move the tubular member 20 back. The second rack 66a' also immediately starts to move forward, but the support member 30 does not start to move until the second rack 66a' contacts or engages the proximal end 32 of the support member 30. Thus, the movement of the support member 30 can be delayed until the tubular member 20 moves back, for example, by an offset distance from the second rack 66a' of the proximal end 32 of the support member 30.

[0051] Although slider buttons for the actuators 62, 62a are shown in Figures 2B and 3, other actuators can be provided on the housing 23, 23a'. For example, referring to Figure 4, another embodiment of the housing 23b is shown, which includes a deployment mechanism 60b having one or more pinions (only one pinion 68b is shown) and a first rack 64b and a second rack 66b connected to the tubular member 20 and the support member 30, similar to the embodiment of Figure 3. Unlike the embodiment of Figure 3, the actuator 62b is a push button actuator that is depressed at least partially within the housing 23b to operate the deployment mechanism 60b. As best seen in Figure 4A, the actuator 62b includes a shaft 74b that slides relative to the housing 23b, for example along a track, slot, or other guide (not shown).

[0052] The actuator 62b can be guided from a first or outer position, as shown, to a second or inner position (not shown) and further into the housing 23b. The pinion 68b has an axle 76b, and the shaft 74b and axle 76b have corresponding teeth 75b, 77b that interact to rotate the pinion 68b when the actuator 62b is operated. The relative sizes of the outer diameter of the teeth 77b on the axle 76b and the outer diameter of the teeth 69b on the pinion 68b can be set to provide a desired gain, e.g., so that a relatively small displacement of the actuator 62b results in a larger displacement of the tubular member 20 and / or the support member 30 (or vice versa).

[0053] For example, similar to the embodiment described above, the first rack 64b may be coupled to the pinion 68b such that when the actuator 62b is initially actuated, the first rack 64b (and the tubular member 20) immediately retracts. The second rack 66b may not be coupled to the pinion 68b until a predetermined delay has been reached, causing the advancement of the support member 30 to occur a desired time or distance after the tubular member 20 has retracted. Alternatively, other delays or configurations may be provided in the deployment mechanism 60b as desired, such as to delay the retraction of the tubular member 20 for a predetermined time and / or advance the support member 30 before retraction of the tubular member 20 begins, for example, by providing a discontinuous area of ​​teeth 69b on the pinion 68b that do not engage teeth 65b on the first rack 64b until the actuator 62b is partially depressed.

[0054] 5, an exemplary embodiment of a housing 23c is shown that includes a deployment mechanism 60c having a pinion 68c and a first rack 64c and a second rack 66c coupled to the proximal ends 22, 32 of the tubular member 20 and the support member 30, similar to the embodiments described above. The actuator 62c can include a lever that rotates or is guided from a first or distal position to a second or proximal position (not shown). The actuator 62c can include a shaft 74c coupled to the pinion 68c such that rotation of the actuator 62c can rotate the pinion 68c. In some aspects, one or more additional pinions can be coupled between the pinion 68c and the racks 64c, 66c, for example, to provide a mechanical gain and / or an amplified translation of the racks 64c, 66c based on the distance the lever 62c translates.

[0055] Similar to the embodiment described above, the first rack 64c can be coupled to the pinion 68c such that the first rack 64c is immediately retracted when the actuator 62c is initially actuated. The second rack 66c can be not coupled to the pinion 68c until after a delay such that the support member 30 is advanced with a delay following the retraction of the tubular member 20. Other delays or configurations can be provided in the deployment mechanism 60c as desired, similar to the other embodiments described herein.

[0056] Optionally, any of the deployment mechanisms 60-60c may include features that limit the movement of the actuators 62-62c and / or racks 64-64c, 66-66c. For example, and referring to the embodiment of FIG. 2B (by way of example only), the first rack 64 and / or track 70 may include one or more ratchets or other one-way features (not shown) that allow the first rack 64 to move freely proximally from a distal position to a proximal position, but prevent it from moving distally. A similar feature may be coupled to the actuator 62 and / or pinion 68 to allow the actuator 62 and / or pinion 68 to move in only one direction, e.g., to retract the tubular member 20, but not to subsequently advance it distally. In this manner, after the tubular member 20 has been retracted to at least partially expose the sealant 2, the tubular member 20 can be prevented from advancing distally back onto the sealant 2, which would otherwise clog or damage the sealant 2. Additionally or alternatively, one or more locking features (not shown) can be provided on the positioning member 14 to limit movement of the tubular member 20 and / or the support member 30, for example, as described below.

[0057] Optionally, any of the embodiments described herein may include other desirable functional features on the housing 23. For example, as shown in FIG. 2B, a guide member 78 may be provided and sized to slidably receive the positioning member 14 therethrough. The guide member 78 may be aligned with the second rack 66 and / or the proximal end 32 of the support member 30 and receive the positioning member 14 such that the cartridge 10 slides over the positioning member 14, as described elsewhere herein. Additionally or alternatively, a spring mechanism 78a may be provided around the guide member 78 and / or coupled between the deployment mechanism 60 and the positioning member 14. For example, a compression spring 78a may be provided between a stop on the first rack 64 and a hub 48 on the positioning member 14 to facilitate handling and / or automatically retract the positioning member 14 during a procedure, as described elsewhere herein.

[0058] Additionally or alternatively, the housing 23 may include a sheath catch assembly within the shroud 23a, as in other embodiments described herein. Optionally, the housing 23 may include one or more detents or other features (not shown) for coupling the cartridge 16 to the positioning member 14, and may releasably couple the housing 23 to the hub 48 (see FIGS. 1A-2A), as described below and in the incorporated references. Additionally or alternatively, the housing 23 may include a trigger lock (not shown) that couples to the deployment mechanism 60 and prevents movement of the actuator 62 and / or the deployment mechanism 60 until the lock is released, as described below.

[0059] 1A-2A, positioning member 14 generally includes an elongate member 40 having a proximal end 42, a distal end 44, and an occlusion or positioning element 46 at distal end 44. Positioning element 46 may be an expandable member, such as a balloon, a wire mesh structure, an expandable frame, or the like, and may be sized for advancement within an introducer when in a contracted state, for example, as described in the incorporated herein by reference patents. Positioning element 46 may be selectively expanded using a source of inflation media, such as, for example, a syringe, pull wire, and / or other actuator (not shown) operable from proximal end 42 of positioning member 14.

[0060] For example, as shown, the positioning element is a balloon 46 and the positioning member 14 has a tubular body 40 extending between a proximal end 42 and a distal end 44 and having a lumen (not shown) in communication with the interior of the balloon 46. In some embodiments, the positioning member 14 has a source of inflation media, such as a syringe 148, which may be in communication with the interior of the hub 48 by an inflation line 48c or coupled to the hub 48 at the proximal end 42 of the positioning member 14. Optionally, the positioning member 14 has an internal pull wire (not shown) that allows the balloon 46 to shorten during inflation and lengthen during deflation. Exemplary embodiments of positioning member 14 having a balloon that may be used are described in U.S. Patent Application Publication Nos. 2004 / 0249342, 2004 / 0267308, 2006 / 0253072, and 2008 / 0009794, the entire disclosures of which are incorporated herein by reference.

[0061] In some embodiments, the positioning element may be biased toward the expanded state, for example, compressed or contracted by an overlying sleeve or other restraint (not shown). When the restraint is removed to expose the positioning element, the expanding element may automatically expand to the expanded state. Further information regarding expandable structures on the positioning member 14 can be found in U.S. Patent Nos. 6,238,412, 6,635,068, and 6,890,343, and U.S. Patent Application Publication No. 2007 / 060950 (co-pending application Ser. No. 10 / 975,205, filed Oct. 27, 2004), which are incorporated herein by reference.

[0062] Additionally or alternatively, the positioning member 14 may include one or more additional functional features that limit or facilitate movement of the positioning member 14, e.g., relative to the cartridge 16 and / or other components of the device 10. For example, as shown in Figs. 7A-7C, the positioning member 14 may include a retraction lock 114 in the housing 23 (not shown for simplicity) to limit movement of the positioning member 14 relative to the first rack 64. The retraction lock 114 may be axially secured to the tubular body 40 of the positioning member 14 and may have an outer diameter larger than the opening 61 in the first rack 64 that would otherwise accommodate and move the positioning member 14 and / or the support member 30 (not shown) axially relative to the first rack 64. For example, the retraction lock 114 may be an annular member that is attached to the outer surface of the tubular body 40, e.g., by one or more of an interference fit, adhesive bonding, fusion, ultrasonic welding, etc.

[0063] Device 10 is provided with retraction lock 114 positioned as shown in Figure 7A, e.g., with cartridge 16 in the position shown in Figures 1A-2A. In some embodiments, the relative lengths of tubular body 40 of positioning member 14 and tubular member 20 of cartridge 16 are such that sealant 2 (not shown, but see Figure 2A) is positioned immediately adjacent to expandable member 46, i.e., such that cartridge 16 does not need to be advanced during a procedure, as described throughout this specification and in the references incorporated herein by reference.

[0064] In some embodiments, the positioning member 14 is prevented from retracting proximally relative to the cartridge 16 by the retraction lock 114 abutting the first rack 64 within the housing 23. Thus, the retraction lock 114 can prevent undesired proximal movement of the positioning member 14, for example, during preparation or handling prior to using the device 10 to seal a puncture.

[0065] As shown in Figure 7B, when the actuator 62 of the deployment mechanism 60 (not shown) is operated to retract the first rack 64 (and the tubular member 20, not shown), the retraction lock 114 may be spaced a distance 115A corresponding to the retraction from the first rack 64. Thereafter, as described elsewhere herein, when the positioning member 14 is retracted, e.g., manually or automatically, during the sealing procedure, the distance that the positioning member 14 may be retracted is limited to a distance 115B, i.e., the retraction lock 114 again abuts against the first rack 64, as shown in Figure 7C.

[0066] Additionally or alternatively, the positioning member 14 may be provided with an automatic retraction assembly 140 that can be used to automatically retract the positioning member 14 during use. For example, Figures 6A and 6B show an exemplary embodiment of an automatic retraction assembly 140 attached to or coupled to a positioning member 14' that is generally similar to other positioning members described throughout this specification and in the references incorporated herein by reference. Alternatively, the features of the automatic retraction assembly 140 may be incorporated directly into the hub 48' of the positioning member 14' (not shown).

[0067] Generally, the automatic retraction assembly 140 includes a housing 142 defining a chamber 143 within which a piston 144 is slidably disposed. The chamber 143 may be substantially sealed between the piston 144 and the hub 48', for example, by the piston 144 itself and / or other seals 144a, allowing fluid and / or pressure to be introduced or extracted from the chamber 143 in a substantially leak-tight manner. The piston 144 may be coupled to the tubular body 40' of the positioning member 14', for example adjacent the proximal end 42' of the tubular body 40', for example, by one or more of an interference fit, adhesive bonding, fusion, ultrasonic welding, etc.

[0068] Additionally, fluid / pressure line 146 communicates with chamber 143 and may be connected to inflation line 48c' which communicates with a syringe (not shown) similar to that shown in Figure 1A, which may be the same syringe used to inflate and deflate expandable member 46' of positioning member 14'. Fluid / pressure line 146 has a flow control switch 146a for selectively opening and closing fluid / pressure line 146 during use, e.g., allowing chamber 143 to communicate with the syringe only when switch 146a is open.

[0069] Prior to use, the positioning member 14' may be provided with a piston 144 in the distal position shown in Figure 6A. As shown, in this position, the proximal end 42 of the tubular body 40 is generally extended and / or straightened. To fix the piston 144 and proximal end 42 in this position, the switch 146a is opened and fluid is introduced into the chamber 143, after which the switch 146a is closed.

[0070] For example, when it is desired to retract positioning member 14' after deploying or exposing sealant 2, expandable member 46 is deflated, which can be done, for example, by closing switch 146a and extracting fluid through inflation line 48c' similar to other embodiments. After expandable member 46 is deflated, switch 146a can be opened and fluid can be extracted from chamber 143 via fluid / pressure line 146, for example, using the same syringe or a different syringe than that used to deflate expandable member 48. This extraction can cause piston 144 to slide proximally within housing 142 toward hub 48', as shown in FIG. 6B, thereby pulling expandable member 46 proximally, for example, through sealant 2 and intermediate tubular member 20 (not shown), similar to the process shown in FIGS. 9A and 9B. As piston 144 moves proximally within housing 142, it causes proximal end 42 of tubular body 40 to bunch up and / or collapse within chamber 143, as also shown in FIG. 6B.

[0071] In some embodiments, the positioning member 14 may include other automatic retraction features similar to the spring mechanism 78a shown in FIG. 2B. For example, FIGS. 8A-8C illustrate another exemplary embodiment of a device 210 having a positioning member 214 and a cartridge 216 generally similar to other embodiments described herein. As shown, the positioning member 214 includes a tubular body 240 having a hub 248 at a proximal end 242 and a balloon 246 at a distal end 244. The cartridge 216 may include a tubular member 220 having a sealant 2 and a support member 230, and a housing 233 having a deployment mechanism 260 similar to any of the other embodiments described herein. In some embodiments, the relative lengths of the tubular body 240 and the tubular member 220 are such that the distal end 224 of the tubular member 220, and thus the sealant 2, is disposed adjacent the balloon 246, thus eliminating the need to advance the cartridge 216 during use.

[0072] The positioning member 214 can have a lock that selectively prevents the positioning member 214 from moving relative to the housing 223 and / or a biasing mechanism that automatically retracts the positioning member 214. For example, the lock can be a hydraulic lock, such as an expandable balloon or membrane 261 that surrounds the distal end of the hub 248 that is located within the housing 223. The interior of the membrane 261 can be in communication with an inflation line 248c that is in communication with the interior of the balloon 246, or can be in communication with a separate inflation line (not shown) as desired. In some embodiments, the hub 248 is provided with a bellows structure (not shown) that can expand and / or retract when operated with a fluid. In some embodiments, a mechanical lock (not shown) is provided that is manually operated to lock and / or release the hub 248 from the housing 223, or the membrane 261 can be configured to engage an expandable detent or other feature between the hub 248 and the housing 223 as desired.

[0073] Initially, the membrane 261 may be deflated similarly to the balloon 246, as shown in FIG. 8A. When the balloon 246 expands, the fluid also expands the membrane 261, thus engaging the housing 223 and preventing subsequent axial movement of the positioning member 214 relative to the housing 223, as shown in FIG. 8B. When the balloon 246 is deflated, as shown in FIG. 8C, the fluid is also extracted from the interior of the membrane 261, thus disengaging the positioning member 214 from the housing 223, allowing subsequent retraction of the positioning member 214 relative to the housing 223, e.g., allowing the deflated balloon 246 to pass into the sealant 2 and / or retract into the tubular member 220, as in other embodiments described herein. In some aspects, the bellows lock may extend and / or retract to engage a detent or other feature between the hub 248 and the housing 223. In some aspects, the mechanical lock may be engaged separately before or after the balloon 246 is expanded.

[0074] The housing 223 and hub 248 can have cooperating features to automatically retract the positioning member 214 when the balloon 246 is deflated or the lock is disengaged. For example, as shown in FIGS. 8A-8C, a biasing mechanism can be provided having a spring 262 coupled between a first rack 264 of the deployment mechanism 260 (coupled to the tubular member 220) and the hub 248 of the positioning member 214. For example, the compression spring 262 can be positioned about the distal end 242 of the tubular body 240 within the housing 223 of the cartridge 216. As shown, a first end of the spring 262 can be coupled to or about a proximal extension 264a of the first rack 264 and a second end of the spring 262 can be coupled to or about a distal end of the hub 248. In the initial configuration shown in FIG. 8A, the spring 262 is in a relaxed state, or slightly compressed if desired, providing a distal bias to the first rack 264 within the housing 223 .

[0075] In use, an actuator (not shown) of the deployment mechanism 260 is operated to guide the first rack 264 proximally, thereby retracting the distal end 224 of the tubular member 220 to expose the sealant 2, and to advance the second rack 266 and the support member 230, as in other embodiments described herein, as shown in FIGURE 8B. As the first rack 264 translates proximally within the housing 223, the first end of the spring 262 is directed proximally towards the second end. However, the hydraulic lock 261 is activated to restrain the hub 248 of the positioning member 214 from moving proximally, thereby allowing the spring 262 to be compressed to a higher potential energy state, as shown in FIGURE 8B.

[0076] Thereafter, when it is desired to deflate and remove the balloon 246, fluid is extracted from the inflation line 248c, thereby deflating both the balloon 246 and the membrane 261. Due to the potential energy stored in the spring 262, the hub 248 of the positioning member 214 is automatically guided proximally, thus allowing the deflated balloon 246 to pass proximally into the sealant 2 and retract into the distal end 224 of the tubular member 220, as shown in FIG. 8C. The support member 230 remains substantially stationary during this movement, thus preventing the sealant 2 from moving proximally as the balloon 246 is retracted. Optionally, as shown in FIGS. 9A and 9B, the support tube 230 can have a stop or other feature 237 that engages the second rack 266 to prevent retraction of the support member 230 as the positioning member 214 is retracted. Additionally or alternatively, the second rack 266 and / or other components of the deployment mechanism (not shown) may be provided with a brake or other functional feature that prevents proximal movement of the second rack 266, e.g., preventing undesired retraction of the support member 230.

[0077] Optionally, the biasing mechanism may include a delay feature that delays the deflation of the membrane 261 a predetermined amount of time relative to the deflation of the balloon 246, for example allowing the membrane 261 to deflate after the balloon has begun to deflate or after the balloon has fully deflated. This delay may ensure that the positioning member 214 is released after the balloon 246 is substantially deflated and that the spring 262 automatically retracts the balloon 246 back through the sealant 2. For example, in some embodiments, a restrictor feature (not shown) may be included in the hydraulic circuit that communicates from the inflation line 248c to the interior of the membrane 261. This allows fluid to be extracted more quickly from the balloon 246 when it is initially extracted via the inflation line 248c than from the membrane 261.

[0078] In some embodiments, the inflation fluid delivered into the balloon 246 and membrane 261 can be selected to facilitate a desired timing or delay in deflation. For example, different size orifices or other flow restrictions can be provided in the flow path branches from the inflation line 248c to the interior of the balloon 246 and membrane 261 to provide a fluid having a desired viscosity and to create a delay in fluid flow between the branches. The inner diameter of the flow restrictions can be selected to allow the balloon 246 to fully deflate before the membrane 261 can deflate and retract through the positioning member 214 into the sealant 2 and into the support member 230.

[0079] In an exemplary embodiment, the viscosity of the fluid may be made substantially higher than water, for example by mixing with an X-ray contrast agent, which may facilitate monitoring of the balloon 246 under fluoroscopy or other external imaging. In some embodiments, the mechanical lock may simply be disengaged at any time, for example after the balloon 246 is surely nearly deflated, allowing the positioning member 214 to be retracted and the balloon 246 to be guided from within the sealant 2 and into the support member 230, as shown in Figures 8C and 9B.

[0080] 10A-10C, the device 10 of FIGS. 1A-2B (or any of the other embodiments described herein) is used to position and deliver a sealant 2 within a puncture, for example, extravascularly, immediately above or adjacent to an arteriotomy of a blood vessel or other body lumen that communicates with the puncture, as described elsewhere herein. In the embodiment shown in FIGS. 1A-2A, the cartridge 16 (with the sealant 2 within the tubular member 20) may be initially disposed at the proximal end 42 of the positioning member 14. For example, the hub 48 of the positioning member 14 and the housing 23 of the cartridge 16 may initially couple to one another, such as by using one or more releasable detents (not shown). In some embodiments, as shown in the embodiment of Figures 8A-8C (or device 710 shown in Figures 16A-16D), the cartridge 216 can be configured such that the distal end 224 of the tubular member 220 is positioned adjacent to the balloon 246, as described, for example, in U.S. Pat. No. 7,335,220 and U.S. Patent Application Publication No. 2008 / 0082122, which are incorporated herein by reference.

[0081] 10B and 10C, cartridge 16 may be slid distally along positioning member 14, for example, by disengaging housing 23 from hub 48 and then advancing cartridge 16 until distal end 24 of tubular member 20 is disposed adjacent positioning element 46. For example, detents on housing 23 and hub 48 may simply separate from one another when housing 23 is advanced away from hub 48 with sufficient force. In some embodiments, one of housing 23 and hub 48 may have an actuator or lock that may be actuated (not shown) to separate the detents or allow cartridge 16 to be advanced relative to positioning member 14.

[0082] Optionally, cartridge 16 and / or positioning member 14 may be provided with cooperating features that limit distal movement of cartridge 16 relative to positioning member 14. For example, housing 23 of cartridge 16 may be provided with a pocket and positioning member 14 may be provided with a detent or other feature (both not shown) that is received in the pocket when cartridge 16 is advanced to a distal position.

[0083] Additionally or alternatively, one or more markers may be provided on the device 10, for example to identify when a component is in one or more desired positions or to facilitate use of the device. For example, the positioning member 14 may be provided with one or more markers 43 at predetermined locations on the elongate member 40. These markers may provide a visual indication when the cartridge 16 is being advanced to a desired distal position, for example, when the marker 43 emerges from the housing 23 as the cartridge 16 is advanced on the positioning member 14.

[0084] 10A-10G, an exemplary method of sealing a puncture 90, e.g., using the device of FIGS. 1A-2B (or any of the other embodiments described herein) to deliver sealant 2 to, e.g., effect hemostasis within the puncture 90. Generally, the puncture 90 extends from the patient's skin 92, through the tissue en route, e.g., to a body lumen 94. In an exemplary embodiment, the puncture 90 may be a percutaneous puncture that communicates with a blood vessel 94, such as the femoral artery, carotid artery, or the like.

[0085] In an exemplary method, the puncture 90 may be formed using known procedures, such as a needle, a guidewire, one or more dilators, etc. (not shown). An introducer sheath 80 may be advanced from the puncture 90 into the vessel 94, such as over a guidewire (not shown) that is passed through the puncture 90 and placed within the vessel 94. The introducer sheath 80 allows one or more instruments (not shown) to access the vessel 94, for example, to perform one or more diagnostic and / or interventional procedures via the vessel. When the via-vessel procedure is completed, such instruments are removed from the puncture 90, leaving the introducer sheath 80 extending through the puncture 90 and into the vessel 94.

[0086] 10A, the positioning member 14 can be introduced into and / or through the lumen of the introducer sheath 80, e.g., with the expandable positioning element 46 in a contracted state. The cartridge 16 along with the sealant 2 is disposed at the proximal end 42 of the positioning member 40, e.g., initially with the actuator 62 in a first distal position, as shown in FIG. 2A. Thus, the distal end 24 of the tubular member 20 is located outside of the puncture 90 when the positioning member 14 is advanced into the puncture 90.

[0087] 10A, distal end 44 of positioning member 14 can be passed through puncture 90 (via introducer sheath 80) and inserted into blood vessel 94. If the cartridge is configured such that sealant 2 is disposed immediately adjacent to the positioning element, similar to cartridge 216 of FIGS. 8A-8C, distal end 224 of tubular member 220 can also be passed through introducer sheath 80 and into blood vessel 94. Otherwise, distal end 24 of tubular member 20 can remain outside of puncture 90, as shown in FIGS. 10A and 10B.

[0088] After positioning element 46 is positioned within blood vessel 94, i.e., beyond distal end 84 of introducer sheath 80, positioning element 46 may be expanded to an enlarged state as shown. After positioning element 46 is expanded, positioning member 40 is at least partially withdrawn, causing positioning element 46 to contact wall 96 of blood vessel 94, e.g., substantially sealing blood vessel 94 from puncture 90. In the exemplary method shown in FIGS. 10A and 10B, this involves a two-step process (albeit completed in a single, substantially continuous act). First, with positioning element 46 expanded within blood vessel 94, positioning member 14 is withdrawn until positioning element 46 contacts distal end 84 of introducer sheath 80, which contact provides a first tactile feedback to the user (i.e., a tactile sensation that positioning element 46 has contacted introducer sheath 80, e.g., based on an increased feeling of weight and / or resistance to proximal movement). Positioning member 14 may then be withdrawn until positioning element 46 contacts vessel wall 96 providing resistance to further withdrawal, providing a second tactile feedback. As positioning member 14 is withdrawn, introducer sheath 80 is withdrawn proximally by positioning element 46 until distal end 84 of introducer sheath 80 is withdrawn from vessel 94 and into puncture 90, as shown in, for example, FIG.

[0089] A proximal pulling force can be applied and / or maintained on positioning member 14 to retain positioning element 46 against vessel wall 96, e.g., to seal puncture 90 from vessel 94 and / or to prevent further dislodgment of positioning member 14. Maintenance of proximal pulling force can be performed manually or with a pulling device (not shown), e.g., to provide temporary hemostasis during the next step. Exemplary pulling devices are described in U.S. Patent Application Publication No. 2004 / 0267308.

[0090] 10C, the cartridge 16 (carrying the sealant 2) may then be advanced distally over the positioning member 14 and into the puncture 90. As shown, the distal end 24 of the tubular member 20 may enter the introducer sheath 80 and be advanced toward the positioning element 46. The cartridge 16 may be advanced until a component of the cartridge 16 encounters a stop on the positioning member 14, thereby preventing further advancement of the cartridge 16 and / or spacing the sealant 2 a predetermined distance from the positioning element 46. Alternatively, the cartridge 16 may be advanced within the introducer sheath 80 until the distal end 24 contacts the expanded positioning element 46, providing tactile feedback that the cartridge 16 has been sufficiently advanced, or until the sealant 2 is positioned within the puncture 90.

[0091] Optionally, cartridge 16 may include a sleeve or locking device (not shown) similar to other embodiments described herein or to those described in U.S. Patent Application Publication No. 2009 / 0088793, the disclosure of which is incorporated herein by reference in its entirety, that may couple introducer sheath 80 to tubular member 20 as cartridge 16 is advanced. In some embodiments, housing 23 of cartridge 16 may include one or more features (not shown) that engage matching features (not shown) on sheath hub 83 to couple movement of tubular member 20 and / or other components in cartridge 16 to introducer sheath 80, as in other embodiments described herein.

[0092] 8A-8C is provided with sealant 2 immediately adjacent distal end 224 of tubular member 220 and positioning element 246, cartridge 216 is not advanced but is merely introduced into sheath 80 along with positioning element 214. Thus, distal end 224 of tubular member 220 is only slightly exposed within vessel 94 before positioning element 246 is expanded and device 210 is withdrawn in its entirety to abut positioning element 246 against vessel wall 96. In some embodiments, sealant 2 can be slightly recessed within distal end 224, for example, if it is desired to reduce exposure of sealant 2 to bodily fluids, sealant 2 can be flush with distal end 24, or can protrude slightly beyond distal end 24 as shown in FIG. 11 and described elsewhere herein.

[0093] Optionally, in the embodiment of Figures 8A-8C, positioning member 214 and cartridge 216 are advanced into introducer sheath 80 until a marker (not shown) on proximal end 222 of tubular member 220 is aligned with hub 83 of introducer sheath 80, which alignment provides a visual indication that positioning element 246 has been positioned distally beyond distal end 84 of sheath 80, i.e., into vessel 94. After positioning element 246 is expanded and positioning member 214 and cartridge 216 are retracted to position positioning element 246 against vessel wall 96, sheath 80 can be retracted a desired distance to expose distal end 224 of tubular member 220 adjacent positioning element 246 within puncture 90, as desired. Optionally, tubular member 20 can be provided with another marker (not shown) that aligns with hub 83 of introducer sheath 80 when sheath 80 is fully retracted.

[0094] If desired, the cartridge 216 may be provided with a trigger lock (not shown), for example, on a distal end of the housing 223, and the sheath 80 may be retracted until the hub 83 engages the trigger lock. The trigger lock may prevent the actuator 262 of the deployment mechanism 260 from operating until the sheath 80 engages the trigger lock, thereby preventing unintended deployment of the sealant 2.

[0095] In some embodiments, when the device 210 is fully advanced into the sheath 80, the sheath 80 can be coupled to the cartridge 216, e.g., to allow movement of the sheath 80 to be coupled to movement of the tubular member 220. The introducer sheath 80 desirably has a relative length with respect to the tubular member 220 such that the distal ends 84, 224 of the sheath 80 and tubular member 220 are aligned with one another, e.g., approximately coextensive with one another. In this case, when the tubular member 220 (and thus the sheath 80) is retracted, the sealant 2 can be exposed beyond the distal end 84 of the sheath 80.

[0096] 1A-2B, and referring now to FIG. 10D, the actuator 62 may be actuated, for example, by guiding the actuator 62 to a second proximal position, thereby initiating retraction of the tubular member 20 (and introducer sheath 80, if connected thereto or not yet withdrawn) relative to the positioning member 14, sealant 2, and support member 30. For example, a delay in the deployment mechanism 60 (not shown, see e.g., FIG. 2B) may allow the support member 30 to prevent significant proximal movement of the sealant 2, retracting the tubular member 20, until the sealant 2 has been significantly exposed within the puncture 90 beyond the sheath distal end 84, as shown in FIGS. 10D and 10E. As the actuator 62 continues to be guided toward the second position, the support member 30 may begin to advance, as shown in FIGS. 10E and 10F, thereby compressing the sealant 2 against the expanded positioning element 46 and / or the arteriotomy and vessel wall 96.

[0097] When the sealant 2 is exposed within the puncture 90, it is exposed to blood and / or other bodily fluids within the puncture 90. This exposure causes the sealant 2 to absorb the bodily fluids and activate it to provide hemostasis, as described elsewhere herein. If the sealant 2 has a distal section formed from a non-crosslinked precursor, the precursor may crosslink and bond the sealant 2 to the surrounding tissue, e.g., to the outer surface of the vessel wall 96 and / or other tissue adjacent the arteriotomy, or fill or penetrate the arteriotomy, e.g., optionally extending into the interior of the blood vessel 94, enhancing the resulting seal and / or inhibiting migration of the proximal section of the sealant 2, e.g., away from the arteriotomy and vessel wall 96.

[0098] After a sufficient period of time, the positioning element 46 is retracted and the device 10 is withdrawn from the puncture 90, leaving the sealant 2 remaining within the puncture 90 and / or against the vessel wall 96, as shown in FIG 10G. Initially, the positioning member 14 may be retracted through the sealant 2 and into the support member 30, for example, as shown in FIGs. 9A and 9B. Optionally, the positioning member 14 may be retracted automatically using an automatic retraction assembly (not shown), as described elsewhere herein.

[0099] In some embodiments, an actuator, such as a single button or a pair of opposed buttons (not shown), may be provided on the positioning member 14. The buttons are located on a hub 48, which may be attached to a table or other fixed surface on which the patient rests during the procedure. When the positioning member 14 is removed from the blood vessel 96 and puncture 90, the squeeze design allows the deflated balloon 46 to be retracted through the compressed sealant 2.

[0100] 9A and 9B, support member 30 remains substantially stationary as positioning member 214 is retracted, as described elsewhere herein, thereby preventing sealant 2 from being directed proximally away from vessel wall 96 as positioning member 46 is pulled through sealant 2. If desired, support member 30 can be advanced further, for example, to compress sealant 2 within puncture 90. Support member 30 and other components of device 10 still extending into puncture 90 can be removed, leaving sealant 2 in place within the puncture and / or against vessel wall 94.

[0101] Referring now to FIG. 11, another embodiment of a device 310 for sealing a puncture in tissue is shown. Much like the embodiments described above, the device 310 includes a positioning member 314 and a cartridge 316 that is carried by the positioning member 314 to deliver a sealant 2 into the puncture (not shown). The positioning member 314 includes a tubular body 340 having a hub at a proximal end (not shown) and a balloon 346 at a distal end 344. The cartridge 316 includes a tubular member 320 that includes the sealant 2 and a support member 330 within the tubular member 320. As with the embodiment of FIGS. 8A-8C, the relative lengths of the tubular body 340 and the tubular member 320 can be such that the distal end 324 of the tubular member 320, and thus the sealant 2, is disposed immediately adjacent to the balloon 346. Thus, the entire cartridge 316 does not need to be advanced during use.

[0102] Tubular member 320 has a composite distal end 324 and includes a distal end segment 325 that is configured differently from adjacent ends. End segment 325 may have, for example, a plurality of slits or other weakened areas (not shown) extending axially, helically, or along at least a portion of end segment 325. Additionally or alternatively, end segment 325 may have a relatively thinner wall thickness than adjacent ends 324 and / or may be formed of a weakened material that may be easily split, folded, contracted, expanded, or crushed to expose internal sealant 2.

[0103] As shown, the sealant 2 can have a proximal or main section 2a and a distal or tip section 2b formed from a non-crosslinked precursor. The distal section 2b can, for example, protrude at least partially from a distal segment 325 of the tubular member 320 as shown in FIG. 11. For example, the device 310 can be provided to a user with the distal section 2b exposed, or the user can advance the support member 330 a predetermined distance, for example, using an actuator in the handle of the cartridge 316 (both not shown). If the distal section 2b protrudes at least partially from the distal segment 325, the distal section 2b can optionally be rounded or otherwise shaped, for example, to have a generally atraumatic and / or tapered shape (not shown) that facilitates introduction into an introducer sheath and / or puncture.

[0104] The device 310 can be introduced into the puncture, for example, from a previously placed introducer sheath (not shown), with the positioning element 346 contracted, and the positioning element 346 and distal segment 325 exposed beyond the introducer sheath within the puncture and / or vessel 94. The positioning element 346 can be expanded and brought against the vessel wall 96, as shown in FIG. 11, and the introducer sheath can be withdrawn when necessary to expose the distal segment 325, as in other embodiments herein.

[0105] With the distal section 2b of the sealant 2 partially exposed, bridging begins, allowing the sealant 2 to bond with the arteriotomy, vessel wall 94, and / or surrounding tissue, as in other embodiments herein. The support member 330 is then advanced to press the sealant 2 against the vessel wall 96 and / or positioning element 346, exerting an outward expansive force on the distal segment 325 of the tubular member 320 as the sealant 2 is compressed. This may cause the distal segment 325 to split, fold, contract, or collapse, exposing the sealant 2 within the puncture. The positioning element 346 is then contracted (e.g., using any of the devices and methods described herein) and the device 310 is removed from the puncture, as in other embodiments herein. The bonding of the distal section 2b to the vessel wall 96 may prevent entanglement and / or disengagement of the sealant 2 when the device 310 is removed.

[0106] In this manner, the terminal segment 325 forms a skirt or cover over the sealant 2, reducing premature exposure of the sealant 2 to bodily fluids, but can be opened to expose the sealant 2 without having to retract the tubular member 320 relative to the support member 330, the positioning element 346 and / or the vessel wall 96.

[0107] 12, another exemplary embodiment of a device 410 for sealing a puncture in tissue is shown. Much like the above-described embodiment, the device 410 can include a positioning member 414 and a cartridge 416 that is carried by the positioning member 414 and delivers a sealant 2 therein into a puncture (not shown). The cartridge 416 can be devoid of a tubular member carrying the sealant and support member therein. Instead, the cartridge 416 can include a sealant sleeve 450 that carries the sealant 2 therein and that surrounds a distal end 434 of the support member 430 adjacent the sealant 2, and a handle or hub 423 at a proximal end 432 of the support member 430. As shown, the cartridge 416 can be initially positioned adjacent to the hub 448 of the positioning member 414, but alternatively, the cartridge 416 can be initially positioned such that the sealant sleeve 450 and sealant 2 are immediately adjacent to the positioning element 446 of the positioning member 414, similar to the apparatus 710 shown in Figures 16A-16D and described elsewhere herein.

[0108] 12A, the sleeve 450 can have a relatively large proximal portion 452 sized to abut or contact the hub or proximal end 83 of the introducer sheath 80 (not shown, but see, e.g., Figures 13A-13C) and a relatively small distal portion 454 sized to enter the hub 83 and / or lumen of the introducer sheath 80. For example, the introducer sheath hub 83 can have one or more valves therein, e.g., a hemostatic valve, and the sleeve distal portion 454 can be sized to enter the hub 83 and at least partially open the valve when the cartridge 416 is advanced, e.g., to facilitate entry of the sealant 2 and / or support member 430 into the lumen of the introducer sheath, as described below.

[0109] The sleeve 450 can have a length that is substantially shorter than the support member 430, e.g., such that the sleeve 450 can slide proximally over the support member 430 a desired distance. For example, the sleeve 450 can have an overall length of about five millimeters to forty millimeters (5-40 mm), about ten to twenty-four millimeters (10-24 mm), etc., and the distal portion 454 can have a length of about three to twenty millimeters (3-20 mm), about twelve to twenty-four millimeters (12-24 mm), about fifteen to eighteen millimeters (15-18 mm), etc., e.g., sufficient to substantially cover the sealant 2.

[0110] Optionally, sleeve 450 has an internal lumen 456 that can be configured to provide differential and / or differing frictional interference with the exterior surface of support member 430. For example, internal lumen 456 can provide increased friction that resists distal movement of sleeve 450 on support member 430 while allowing sleeve 450 to slide freely proximally relative to support member 430. Additionally or alternatively, sleeve 450 can be releasably attached to distal end 434 of support member 430, for example, using a low bond adhesive or the like that can be overcome to release or bind when cartridge 416 is advanced into the introducer sheath.

[0111] In an exemplary embodiment, sleeve 450 can be formed from an outer annular body and a tubular section (not shown) that is at least partially contained within the annular body. In some aspects, sleeve 450 can be integrally formed as a single piece, e.g., by molding, machining, casting, etc. The components of sleeve 450 can be formed from the same or different materials, e.g., plastic, metal, or composite materials. Exemplary materials and methods for forming sleeve 450 are described in U.S. Pat. No. 7,993,367, the disclosure of which is incorporated herein by reference in its entirety.

[0112] 13A-13C, device 410 can be used to position and deliver sealant 2 into puncture 90, for example, extravascularly, immediately above or adjacent an arteriotomy in a blood vessel or other body lumen 94, as described elsewhere herein. As shown in FIG. 13A, cartridge 416 is initially disposed at proximal end 442 of positioning member 414, along with sealant 2 and sleeve 450 located on distal end 434 of support member 430. For example, hub 448 of positioning member 414 and housing 423 of cartridge 416 can initially be coupled together, for example, using one or more releasable detents (not shown). As shown in FIG. 13B, cartridge 416 can be slid distally along positioning member 414, for example, by disengaging housing 423 from hub 448 and then advancing cartridge 416 toward positioning element 446.

[0113] 13A-13C, the device 40 may generally be used in conjunction with an introducer sheath 80 to deliver the sealant 2 to the puncture 90. The introducer sheath 80 may be part of a system or kit that includes the device 410, or may be a separate device. Generally, the introducer sheath 80 has a proximal end 82, a distal end 84 sized for insertion into the puncture 90 in tissue, and a lumen 86 extending between the proximal end 82 and the distal end 84. The introducer sheath 80 may be formed from a generally rigid, semi-rigid, and / or flexible tubular body having a hub 83 at the proximal end 82. The introducer sheath 80 may have a length sufficient to extend from the patient's skin, through the intervening tissue, and into a blood vessel or other body lumen, and may, for example, have a length of about ten to twenty centimeters (10-20 cm) and an outer diameter of about one-sixth to five millimeters (1.6-5 mm). Distal end 84 may be tapered and / or provided with a generally atraumatic distal tip to facilitate advancement into the puncture.

[0114] The introducer sheath 80 may be formed using known materials and / or methods, e.g., plastic, and the tubular body and hub 83 may be substantially permanently coupled together, e.g., using an interference fit, one or more mating connectors (not shown), adhesive bonding, ultrasonic welding, etc. The hub 83 may generally include one or more seals, e.g., one or more hemostatic seals (not shown), to prevent blood or other bodily fluids from the lumen 86 from exiting the hub 83, but to allow one or more instruments, such as the positioning member 414 and / or cartridge 416, to be inserted and received within the lumen 86. Optionally, as shown, the hub 83 may include a side port 89 in communication with the lumen 86 for connection to a source of saline or other fluid (not shown).

[0115] Initially, as shown in FIGURE 13A, the positioning member 414 can be introduced into and / or through the lumen 86 of the introducer sheath 80, e.g., with the expandable positioning element 446 in a contracted state. The cartridge 416, along with the sealant 2 and the support member 430, can initially be provided at the proximal end 442 of the positioning member 440, e.g., as shown in FIGURE 12. Thus, the distal end 454 of the sleeve 450 can initially be positioned outside the puncture 90 and spaced from the hub 83 as the positioning member 414 is advanced into the puncture 90.

[0116] 13A, the distal end 444 of the positioning member 414 can be inserted through the puncture 90 (through the introducer sheath 80) and into the blood vessel 94. After the positioning element 446 is positioned within the blood vessel 94, i.e., beyond the distal end 84 of the introducer sheath 80, the positioning element 446 is expanded to an enlarged condition and at least partially withdrawn until the positioning element 446 contacts the blood vessel wall 96, as with other embodiments described herein.

[0117] 13B and 13C, the cartridge 416 (carrying the sealant 2) may be advanced distally on the positioning member 414 towards the introducer sheath 80. As the cartridge 416 advances, the sleeve 450 contacts the introducer sheath 80, thereby preventing further advancement of the sleeve 450. For example, the distal end 454 of the sleeve 450 may at least partially enter the hub 83 of the introducer sheath 80, and the proximal portion 452 of the sleeve 450 may abut the hub 83, as best seen in FIG. 13C, thereby preventing further advancement of the sleeve 450. If the sleeve 450 is releasably attached to the support member 430, advancing the cartridge 416 to this point may release the sleeve 450 from the distal end 434 of the support member 430.

[0118] The cartridge 416 may be moved further distally towards the positioning member 446 while the sleeve 450 remains substantially stationary relative to the introducer sheath 80 and may then be slid proximally over the support member 430. This causes the distal end 434 of the support member 430 to exit the distal portion 454 of the sleeve 450 and enter the lumen 86 of the introducer sheath, thereby allowing the sealant 2 to be expelled from the sleeve 450 and into the lumen 86 of the sheath, as shown in FIG. 13C. The distal portion 454 of the sleeve 450 may have a sufficient length and / or other functional feature to at least partially open a valve (not shown) in the hub 83 of the introducer sheath, for example, to facilitate introduction of the sealant 2 and the distal end 434 of the support member 430 into the lumen 86 of the introducer sheath. In this manner, the sleeve 450 protects the sealant 2 until it passes through the hub 83 and any valves therein and into the lumen of the introducer sheath 80.

[0119] The cartridge 416 is then advanced until the sealant 2 is disposed adjacent the positioning element 446 and / or the blood vessel 94, and the sealant 2 is guided through the sheath lumen 86. Optionally, the cartridge 416 can be advanced until a component of the cartridge 416 abuts a stop on the positioning member 414, thereby preventing further advancement of the cartridge 416 and / or spacing the sealant 2 a predetermined distance from the positioning element 446, for example, approximately zero to five millimeters (0-5 mm). In some embodiments, the cartridge 416 can be advanced until the sealant 2 contacts the positioning element 446 and / or the blood vessel 94 and resistance is detected.

[0120] The introducer sheath 80 can then be at least partially retracted to expose the sealant 2 in the puncture 90 beyond the introducer sheath's distal end 84. Optionally, the sleeve 450 can be provided with one or more locking elements (not shown) that couple the introducer sheath 80 to the sleeve 450, thereby allowing the introducer sheath 80 and sleeve 450 to be withdrawn together, retracting the distal end 84 of the introducer sheath 80 if the user pulls proximally on the sleeve 450 but not on the introducer sheath 80.

[0121] When the introducer sheath 80 is retracted, the support member 430 substantially prevents proximal movement of the sealant 2, thus allowing the sealant 2 to be exposed within the puncture 90. When the sealant 2 is exposed within the puncture 90, it is exposed to blood and / or other bodily fluids within the puncture 90. This exposure may cause the sealant 2 to absorb bodily fluids and / or expand within the puncture 90, e.g., to provide hemostasis.

[0122] If desired, after the sealant 2 is exposed within the puncture 90, the support member 430 can be advanced to compress or tamp the sealant 2, for example, against the positioning element 446. Optionally, the support member 430 can be provided with one or more markers (not shown), for example, at or near the proximal end 432, and the support member 430 can be advanced a desired distance within the puncture 90, which can be confirmed by monitoring the markers. Additionally or alternatively, the positioning member 414 can be provided with a detent or other feature through which the support member 430 can pass when advanced a predetermined distance. The detent can provide an audible confirmation (in addition to or as an alternative to the visual confirmation provided by the marker) that the support member 430 has been advanced a predetermined distance.

[0123] After the sealant 2 has been exposed and / or tamped by the support member 430 for a sufficient period of time, the positioning element 446 can be retracted and the positioning member 414 can be withdrawn from the blood vessel 94 and the puncture 90, e.g., the retracted positioning element 446 can be pulled through the sealant 2 and the support member 430. The support member 430 can be maintained substantially stationary during withdrawal of the positioning member 414, e.g., to prevent the sealant 2 from moving and / or peeling within the puncture 90. Optionally, the cartridge 416 can be provided with an automatic retraction assembly that automatically retracts the positioning member 414, as with other embodiments described herein. After the positioning member 414 is fully removed, the support member 430 can be removed from the puncture 90, leaving the sealant 2 in the puncture 90.

[0124] 16A-16D, another embodiment of a device 710 is shown generally including a positioning member 714 and a cartridge 716 carried by the positioning member 714 for delivering a sealant 2 therein to a puncture (not shown). Similar to the device 410 of FIG. 12, the cartridge 716 includes a sealant sleeve 750 that carries the sealant 2 and surrounds a distal end 734 of the support member 430 adjacent the sealant 2, and a handle or hub 723 at a proximal end 732 of the support member 730. The sealant sleeve 750 can have a relatively large diameter proximal portion 752 that surrounds the distal end 734 of the support member 730 and is sized to abut or contact, for example, the hub or proximal end 783 of the introducer sheath 780 as shown in FIG. 16D, and a relatively small diameter distal portion 754 that surrounds the sealant 2 and is sized to enter, for example, the hub 783 and / or lumen 786 of the introducer sheath 780. The hub 783 can have a cavity that releasably receives the smaller diameter portion of the sealant sleeve. Unlike the device 410, the cartridge 716 can be provided such that the sealant sleeve 750 and sealant 2 are initially positioned immediately adjacent to the positioning element 746 of the positioning member 714.

[0125] The handle 723 can include an outer housing or shroud 772 that encloses an inner housing or frame 774 and one or more actuators 760-764 to allow movement of one or more components of the device 710 relative to one another, as described below. As shown, the outer housing 772 can include a first opening or slot 773 having a first actuator 760 and a second actuator 762 disposed therein, and a second slot 775 having a third actuator 764 disposed therein. The opening 773 can include one or more functional features that interact with the first and / or second actuators 760, 762, as described below.

[0126] The inner housing 774 is axially slidable relative to the outer housing 772, e.g., between an initial position, a proximal position, and a distal position. For example, the outer housing 772 may have clam shell halves or other components that may be mounted about the inner housing 774 such that cooperating rails or grooves (not shown) allow the inner housing 774 to slide axially without significant lateral movement. In an exemplary embodiment, the inner surface of the outer housing 772 is molded or otherwise provided with one or more elongated ribs or rails (not shown) that may be slidably received between rails or grooves (also not shown) in the inner housing 774.

[0127] The handle 723 may have a distal shroud 776 integrally formed with or projecting from the outer housing 772. One or more detents or other features, such as a pair of fork tines 778, may be provided on the shroud 776 to allow the hub 723 to engage an introducer sheath, such as the sheath 780 shown in FIG. 16D. For example, the sheath 780 may have a hub 783 having a pair of pockets 783a extending axially along opposing sides of the hub 783. The fork tines 778 may have tabs or detents 778a that may be slidably received within the pockets 783a when the device 710 is introduced into the sheath 780 during use, as described below. The relative lengths of the fork tines 778 and the pockets 783a are configured such that the detents 778a pass through the pockets 783a and project from their distal ends. Detent 778a has a beveled or tapered distal edge to facilitate insertion and a smooth proximal edge which engages the distal end of pocket 783a to prevent fork tines 778 from backing out of pocket 783a, thereby allowing sheath 780 and outer housing 723 of hub 723 to interlock, as described below.

[0128] As shown in FIG. 16C, the device 710 can have a rack and pinion configuration similar to any of the other embodiments described herein. For example, as shown, a rack 766 can be coupled to the proximal end 732 of the support member 730 and slidably received within the outer housing 772 and / or inner housing 774. A pinion 768 can be rotatably mounted to the inner housing 774 and coupled to the rack 766 by interlocking teeth 766a, 768a, for example, as in other embodiments herein. A second or support actuator 762, for example a button, pivotally coupled to the inner housing 774 can be coupled to the pinion 768 by interlocking teeth 762a, 768a to selectively rotate the pinion 768. For example, the second actuator 762 can be depressed to rotate the pinion 768 and thus advance the rack 766 distally, thereby advancing the support member 730, as described below.

[0129] Optionally, as shown, a first or lock actuator 760 may be provided on the hub 723 to prevent relative movement of the outer and / or inner housings 772, 774 until movement and / or limiting movement of the support member 730 occurs. For example, as best seen in FIG. 16C, the lock actuator 760 may be pivotally mounted to the inner housing 774 and have a distal end 760a that abuts or engages a distal edge 773b of an opening 773 in the outer housing 772. As a result, the inner housing 774 is substantially fixed in a proximal position and cannot be guided to a distal position until the lock actuator 760 is actuated to disengage the distal end 760a of the actuator 760 from the distal edge 773b of the opening 773.

[0130] Additionally or alternatively, the first actuator 760 has a detent or other locking feature 760b for selectively locking the support member 730 to the inner housing 774. For example, as shown in FIG. 16C, the detent 760b extends inwardly from the first actuator 760 and does not engage any other feature. When the first actuator 760 is actuated, i.e., directed inwardly to disengage the distal end 760a of the actuator 760 from the distal edge 773b of the outer housing 772, the detent 760b can drop downwardly into the inner housing 774. After the inner and outer housing portions 774, 772 are able to move relative to one another, as described in more detail herein, the handle 723 can be moved proximally to retract the outer sheath 780 and expose the sealant.

[0131] Thereafter, when the support actuator 762 is actuated, the rack 766 can be advanced to tamp the sealant toward the arteriotomy against the support member 730 until the distal end 766b of the rack 766 passes under the detent 760b and the detent 760b is captured within a pocket (not shown). With the detent 760b captured in the pocket, the rack 766 cannot be directed proximally, thus preventing proximal movement of the support member 730 coupled to the rack 766.

[0132] The device 710 may further include a third or balloon retraction actuator 764 to selectively retract the positioning element 746 through the sealant 2 after sealant deployment, for example, as in other embodiments herein. For example, as shown in FIG. 16C, the third actuator 764 may be slidably mounted to the inner housing 774 and selectively coupled to a hub 748 of the positioning member 714. The hub 748 may be configured and / or operate as in other embodiments herein or as in other references incorporated herein.

[0133] Initially, the third actuator 764 is coupled to the inner housing 774, but can be separated from the inner housing 774 after deploying and / or tamping the sealant 2. For example, as best seen in FIGURE 16C, the third actuator 764 has a third arm 764c that can be separated from the inner housing 774, such that proximal movement of the third actuator 764 relative to the outer and / or inner housings 772, 774 can likewise move the hub 748 proximally, thereby directing the positioning element 746 proximally, as in other embodiments herein.

[0134] Additionally, the third actuator 764 may include a second arm 764b slidably positioned adjacent the proximal end 766c of the rack 766. With the second arm 764b so positioned, the third arm 764c may remain connected to the hub 748. When the rack 766 is distally directed, for example, by actuating the second actuator 762, the second arm 764b may slide away from the proximal end 766c of the rack 766, thereby separating the third arm 764c from the inner housing 774. For example, as shown, a spring or other biasing mechanism 764a may be provided on the third actuator 764 (or optionally the outer housing 772) to bias the second arm 764b outwardly when the rack 766 is distally directed such that the second arm 764b moves away from the proximal end 766c of the rack 766. Additionally, a spring or biasing mechanism 764a may be required to depress the actuator to separate the third arm 764c from the inner housing, thereby preventing inadvertent movement of the positioning element 746. The third actuator 764 may then be directed proximally to retract the hub 748 and positioning element 746.

[0135] The device 710 can be used to deliver the sealant 2 into a puncture in communication with a body lumen in a patient's body, as with other embodiments herein. An introducer sheath 780, initially shown in FIG. 16D, can be positioned through the puncture into the body lumen, as described elsewhere herein.

[0136] Optionally, the introducer sheath 780 can be provided as part of an introduction kit, for example with a system that also includes a dilator 790 and a guidewire 799 and / or device 710. The dilator 790 can have a proximal end 792 and a distal end 794 sized to be slidably received within the lumen 786 of the introducer sheath 780, and the distal end 794 can terminate in a tapered, less invasive and / or other distal tip that facilitates introduction of the dilator 790 and introducer sheath 780 into a puncture (not shown), for example over a guidewire 799. As shown, the dilator 790 has a proximal housing 796 that can have fork tines 798 and detents 798a in a similar configuration to the distal shroud 776 of the device 710. Dilator 790 is guided through hub 783 and lumen 786 of introducer sheath 780 until tines 798 enter passageway 783a in hub 783 and detents 798a withdraw from passageway 783a.

[0137] In this manner, the dilator 790 and the introducer sheath 780 are coupled together, a guidewire (not shown, but positioned in a body lumen through a puncture as described elsewhere herein) can be loaded into the distal end 794 and lumen 796 of the dilator 790, and the dilator 790 and introducer sheath 780 can be introduced into the puncture. After the introducer sheath 780 is positioned in a desired location, the tines 798 can be squeezed inwardly to disengage the detents 798a from the pockets 783a, and the dilator 790 can be withdrawn from the lumen 786 of the introducer sheath 780. The introducer sheath 780 can then be used to access a body lumen and perform one or more procedures as described elsewhere herein.

[0138] When it is desired to seal the puncture, any instruments introduced within the introducer sheath 780 may be removed and the device 710 may be prepared, for example, as shown in Figures 16A and 16B. With the positioning element 746 in a retracted state, the distal end 744 of the positioning member 714 may be introduced into the hub 783 of the introducer sheath 780, through the lumen 786 and into the body lumen. The sealant sleeve 750 and sealant 2 are positioned immediately adjacent to the positioning element 746 such that as the distal end 744 is advanced into the introducer sheath 780, the sleeve 750 may contact the introducer sheath 780 and prevent further advancement of the sleeve 750. For example, the distal portion 754 of the sleeve 750 may advance at least partially into the hub 783 of the introducer sheath 780 and the proximal portion 752 of the sleeve 750 may abut the hub 783 and prevent further advancement of the sleeve 750. If the sleeve 750 is releasably attached to the support member 730 , advancement of the positioning member 714 may release the sleeve 750 from the distal end 734 of the support member 730 .

[0139] The positioning member 714 is advanced further within the introducer sheath 780, while the sleeve 750 remains substantially stationary relative to the introducer sheath 780, and may then be slid proximally over the support member 730. In this manner, the distal end 734 of the support member 730 exits the distal portion 754 of the sleeve 750 and enters the lumen 786 of the introducer sheath, thereby allowing the sealant 2 to be expelled from the sleeve 750 and into the lumen 786 of the introducer sheath, as in other embodiments herein. Optionally, the distal portion 754 of the sleeve 750 may have sufficient length and / or other functional features to at least partially open a valve (not shown) in the hub 783 of the introducer sheath, for example, to facilitate the advancement of the sealant 2 and the distal end 734 of the support member 730 into the lumen 78 of the introducer sheath. In this manner, the sleeve 750 can protect the sealant 2 until it passes through the hub 783 and any valves therein and into the lumen 786 of the introducer sheath 780 .

[0140] Positioning member 714 may then be advanced until positioning element 746 is disposed beyond distal end 784 of introducer sheath 780, i.e., within the body lumen. As this occurs, fork tines 778 of housing shroud 776 may align and enter pocket 783a in introducer sheath hub 783, e.g., until detent 778a engages the distal end of pocket 783a, as described above. With detent 778a engaged in pocket 783a, introducer sheath 780 and outer housing 772 couple to one another and may therefore move together, as in other embodiments herein.

[0141] The relative lengths of the positioning member 714 and the introducer sheath 780 can be configured such that the sealant 2 remains within the introducer sheath lumen 786, e.g., near the distal end 784 of the introducer sheath 780, with the positioning element 746 exposed from the distal end 784. The positioning element 746 can be expanded, e.g., using fluid from the syringe 148 and / or by inflating the positioning element 746 as in other embodiments herein. The entire device 710 and introducer sheath 780 can be retracted (whether by manipulating the device hub 723 or the introducer sheath hub 783) until the expanded positioning element 746 contacts the wall of the body lumen adjacent the puncture.

[0142] Once properly positioned, the first actuator 760 is actuated to separate the movement of the outer and inner housings 772, 774. For example, while holding the outer housing 772, the first actuator 760 is pushed inward to disengage the distal end 760a of the first actuator 760 from the distal end 773b of the outer housing 772, and then the outer housing 772 is retracted proximally, i.e., away from the patient and the puncture. With the inner housing 774 still connected to the positioning member 714 and support member 730, this action causes the inner housing 774 to slide from a proximal position (as shown in FIGS. 16A-16C) within the outer housing 772 to a distal position, thereby retracting the introducer sheath 780 relative to the support member 730 and exposing the sealant 2 adjacent the positioning element 746 and within the puncture.

[0143] With the inner housing 774 in the distal position, the second actuator 762 can be actuated to advance the support member 730, for example, to tamp or compress the sealant 2 against the expanded positioning element 746 and / or the outer wall of the body lumen, e.g., over the arteriotomy, as in other embodiments herein. For example, and referring specifically to FIG. 16C, the second actuator 762 can be forced inwardly, thereby rotating the pinion 768 and advancing the rack 766, which in turn advances the support member 730, directing the distal end 734 towards the positioning element 746 and compressing the sealant 2 therebetween.

[0144] Optionally, the second actuator 762 can be provided with one or more features, such as tabs or detents 762a, that can engage the outer housing 772 when the second actuator 762 is fully depressed. For example, as shown in Figures 16A and 16B, the opening 773 in the outer housing 772 can have one or more pockets or recesses 773a that can align with the tabs 762a on the second actuator 762 when the inner housing 774 is brought into its fully distal position. With the tabs 762a contained within the pockets 773a, the inner housing 774 cannot move proximally relative to the outer housing 772, thus securing the outer and inner housings 772, 774 together.

[0145] After the sealant 2 has been exposed and / or tamped by the support member 730 for a sufficient time, the positioning element 746 can be deflated and the positioning member 714 can be withdrawn from the body lumen, e.g., pulling the deflated positioning element 746 into the sealant 2 and support member 730. For example, the positioning element 746 can be deflated using a syringe 148, and then the third actuator 764 can be operated to retract the deflated positioning element 746 through the sealant 2 and into the distal end 734 of the support member 730, as in other embodiments herein.

[0146] Optionally, as described above, the third actuator 764 can remain coupled to the inner housing 774 until the rack 766 has advanced sufficiently to release the third arm 764c of the third actuator. Proximal movement of the third actuator 764 relative to the outer and inner housings 772, 774 then moves the hub 748 and positioning member 714 as a whole proximally, thereby retracting the positioning element 746 through the sealant 2 and into the distal end 734 of the support member 730. The length of the slot 775 in the outer housing 772 can be configured to retract the positioning element 746 a desired distance into the distal end 734.

[0147] After the positioning element 746 has been withdrawn from the sealant 2, the entire device 710 can be withdrawn to remove the positioning member 730 from the puncture and leave the sealant 2 in place at the puncture.

[0148] 14, an exemplary embodiment of a sheath catch assembly 550 is shown that may be provided with a puncture sealing device 510 and / or an introducer sheath 580. Generally, the device 510 may include a positioning member (not shown) and a cartridge 516, as with other embodiments herein. As shown, the cartridge 516 includes a housing 523 that may be coupled to a tubular member carrying a sealant and / or a support member (not shown for clarity). The introducer sheath 580 includes a tubular body having a proximal end 582 and a distal end 584, and a hub 583 at the proximal end 582, as with other embodiments herein.

[0149] As shown, the sheath hub 583 has a catch adapter 583a with a pocket 583b therein. The housing 523 of the cartridge 516, for example in the shroud 23 shown in FIG. 2B, has a sheath catch assembly 550 having a sheath catch 552 that is slidable within the housing 523, for example between a first lateral position and a second lateral position. For example, the housing 523 has a distal passage 523a within which the catch adapter 583a can be received when the cartridge 516 is advanced into the introducer sheath 580, as in any of the embodiments described elsewhere herein.

[0150] With the sheath catch 552 in the first position, the catch adapter 583a can pass through the distal passageway 523a and enter into the opening 553 in the sheath catch 552, for example, until the pocket 583b in the catch adapter 583a is aligned with the sheath catch 552. If the sheath catch 552 is then introduced laterally to the second position, the sheath catch 552 enters the pocket 583b, thereby preventing further axial movement of the introducer sheath 580 relative to the housing 523.

[0151] 14, the sheath catch 552 can be biased toward one of a first position and a second position, for example, by a spring 556 or other biasing mechanism. For example, the sheath catch 552 can be biased toward a first position, such that a default position of the sheath catch 552 allows the cartridge 516 to be separated from the introducer sheath 580. A hydraulic actuator can be provided having a piston 534 slidable within a chamber 558 to overcome the bias of the spring 556. As shown, the piston 534 can be moved laterally within the chamber to engage the sheath catch 552, for example, to overcome the bias of the spring 556 and move the sheath catch 552 from the first position to the second position.

[0152] Further, as shown, the chamber 558 communicates with a fluid line 559 from which fluid can be delivered and / or extracted to guide the piston 534 between the engaged and disengaged positions. In some embodiments, the fluid line 559 can be connected to the same inflation line as the positioning element in the positioning member (not shown). For example, and referring also to FIG. 1A, when the syringe 148 is depressed to deliver fluid to the inflation line 48c to inflate the balloon 46, fluid can be delivered to the fluid line 559 at approximately the same time, thereby engaging the piston 534 with the sheath catch 552 and guiding it to the second position, thereby coupling the introducer sheath 580 to the housing 523. When the syringe 148 is then used to extract fluid to deflate the balloon 46, fluid is also extracted from the fluid line 559, thus disengaging the piston 534 and the sheath catch 552 and separating the cartridge 516 from the introducer sheath 580.

[0153] Thus, the sheath catch assembly 550 can also provide a safety feature that allows the cartridge 516 to be quickly separated from the introducer sheath 580 if fluid pressure is lost in the fluid line 559, for example if the balloon 46 bursts or otherwise leaks fluid. In the absence of fluid in the fluid line 559, the spring 556 can automatically guide the sheath catch 552 to the first position and disengage the sheath catch 552 from the sheath adapter 583a. Furthermore, during balloon deflation, the flow of fluid from the fluid line 559 for the piston 534 is slower than that from the balloon 46, and therefore the balloon 46 must deflate before the sheath catch 550 can release, which can ensure that the inflated balloon 46 is not pulled by the spring 556. Additionally, if the balloon 46 ruptures, the sheath catch assembly 550 disengages, thus maintaining access to the body lumen even when the positioning member 14 is withdrawn from the body lumen because the introducer sheath 580 remains within the puncture.

[0154] In some embodiments, other features that secure the introducer sheath to the cartridge can be provided on the cartridge, e.g., the housing in any of the embodiments described herein. For example, a simple sheath catch can be provided in the shroud 23a shown in FIG. 2B, which automatically engages a feature in the hub (not shown) of the introducer sheath. For example, a detent can be provided in the shroud 23a, e.g., a tubular sleeve or other support (not shown), which can be configured to freely enter the hub of the introducer sheath but prevent subsequent removal, e.g., similar to the embodiment described in U.S. Pat. No. 7,993,367. If such a sheath lock is provided on the tubular member of the cartridge, a deployment mechanism that retracts the tubular member can also automatically retract the introducer sheath when the sheath is engaged by the sheath lock.

[0155] For example, after a device such as device 210 of Figures 8A-8C is inserted into an introducer sheath (not shown), a sheath lock can couple the sheath hub to the housing 223 (e.g., in shroud 23a, similar to that shown in Figure 2B). With positioning element 246 expanded within the vessel, the entire device 210 and introducer sheath can be withdrawn together, for example, in a manner similar to that shown in Figures 10A and 10B (except that cartridge 216 is positioned within the sheath), until positioning element 246 is positioned against the vessel wall. Thus, in some embodiments, the expanded positioning element 246 is not used to pull the introducer sheath back into the puncture, thereby reducing stress on positioning element 246.

[0156] Optionally, device 210 can include a release feature that allows cartridge 216 and introducer sheath to be retracted after positioning element 246 is positioned against the vessel wall. For example, when positioning element 246 is positioned against the vessel wall, an actuator of a release feature in housing 223 can be actuated, for example, to cause cartridge 216 and sheath to be retracted a predetermined distance, for example 1.5 cm, relative to positioning member 214. Thus, distal end 224 of tubular member 220 and sheath are retracted away from positioning element 246, which can overcome friction at the puncture around the sheath just prior to deployment of sealant 2. Otherwise, for example, tissue around a relatively small profile puncture may provide friction against the introducer sheath resisting retraction, thereby advancing the device relative to the sheath when deployment mechanism 260 is actuated, thereby directing positioning element 246 and sealant 2 further into the puncture (and potentially into the blood vessel) rather than simply retracting tubular member 220 and sheath to deploy sealant 2 outside the blood vessel.

[0157] Optionally, a sheath stabilizer (not shown) may be provided that provides coupling between the housing 223 and the introducer sheath, for example, to prevent distal movement of the cartridge 216 relative to the sheath.

[0158] 15A and 15B, another exemplary embodiment of an apparatus 610 is shown having a bleed back assembly 650 in a housing 623 of a cartridge 616. In general, the apparatus 610 can include a cartridge 616 having a tubular member carrying a sealant and a support member (not shown) coupled to the housing 623. The apparatus 610 can further include a positioning member as in other embodiments herein, or can omit the positioning member.

[0159] The bleed back assembly 650 can have a sheath catch 652 that protrudes from the housing 623 and is housed within the hub 83 or otherwise coupled to the introducer sheath 80, as in other embodiments herein. The bleed back assembly 650 can further have a lumen 653 that communicates with the bleed back port 654 and communicates with the lumen 86 of the introducer sheath 80. For example, as best seen in FIG. 15B, during use, the cartridge 616, e.g., a tubular member (not shown), is advanced into the lumen 86 of the introducer sheath until the sheath catch 652 enters the sheath hub 83. As shown, the sheath catch 652 can have a tip 652a that enters and / or opens the valve 83a of the sheath hub 83. Additionally, the sheath catch 652 resiliently or otherwise engages the wall 83b of the hub 83 to prevent the introducer sheath 80 from being subsequently separated from the housing 623.

[0160] In use, device 610 (tubular member distal end adjacent to positioning element not shown) can be introduced into introducer sheath 80 as in other embodiments herein. The relative lengths of introducer sheath 80 and positioning element can be determined such that distal end 84 of introducer sheath 80 is offset a predetermined distance from the positioning element when sheath catch 652 engages sheath hub 83. For example, distal end 84 can be spaced 0.1 to 2.0 mm from the positioning element when sheath catch 652 is engaged.

[0161] Due to this distance and the space around the cartridge within the sheath lumen 86, when the distal end 84 is exposed within the vessel, blood can flow into the sheath lumen 86. Intravascular pressure can cause blood flow within the sheath lumen 86 to flow into the lumen 653 of the sheath catch assembly 650 and out of the bleed back port 654. When the device 610 is withdrawn to direct the expanded positioning element against the vessel wall, the positioning element isolates the puncture and thus the sheath lumen 86 from vessel pressure, thus blocking blood flow through the sheath lumen 86 and out of the bleed back port 654, providing visual confirmation that the positioning element is positioned against the vessel wall.

[0162] In some embodiments, the relative lengths of the introducer sheath 80 and cartridge 616 can be set so that the distal end 84 of the sheath contacts or slightly interferes with the positioning element when the sheath catch 652 engages the sheath hub 83. In this configuration, blood may not flow into the sheath lumen 86 while the device 610 is being introduced into the blood vessel, for example, as the positioning element expands and retracts within the blood vessel. If the introducer sheath 80 is then retracted (e.g., along with the tubular member), this configuration allows the introducer sheath 80 to be reintroduced into the puncture, and a bleed back signal can be used to indicate when the introducer sheath 80 again contacts the positioning element.

[0163] In some embodiments, bleed back can be used to position the introducer sheath at a desired location relative to the arteriotomy and / or vessel wall. For example, as shown in Figures 15A and 15B, an introducer sheath 80 can be provided with one or more side ports 85 (only one shown) at a distal end 84 that communicate with a sheath lumen 86. The side ports 85 can be offset a predetermined distance, e.g., 1.5 cm, from the distal end 84 of the sheath 80.

[0164] An elongate dilator (not shown) can be provided having a distal end sized for introduction into the sheath lumen 86 and a relatively small bleed back lumen extending from one or more side ports at the distal end to the proximal end of the dilator. When the dilator is fully inserted into the sheath lumen 86, the side ports can align with one another to provide a flow path from outside the distal end 84 of the sheath 80, through the interior of the dilator, to the bleed back port at the proximal end of the dilator.

[0165] In this manner, when the side port is positioned within the vessel and exposed to blood pressure, blood will enter the side port 85 of the sheath 80, flow into the side port of the dilator, and travel up the dilator lumen. Blood exiting the bleed back port provides visual confirmation that the distal end 84 is positioned within the vessel. For example, as the distal end 84 is withdrawn from the vessel wall into the puncture, the bleed back signal will cease after the side port 85 in the sheath 80 is no longer exposed to arterial blood pressure, thus providing visual confirmation that the sheath has extended into the vessel approximately the distance that the side port is offset from the distal end 84. Alternatively, the bleed back lumen and port can be provided on the dilator such that when the dilator is fully inserted into the sheath lumen 86, the port is exposed beyond the sheath distal end 84. The port is spaced a predetermined distance from the sheath distal end 84, for example, approximately 2 centimeters, such that when the bleed back stops, the sheath 80 can be advanced a predetermined distance to position the distal end 84 adjacent the vessel wall.

[0166] The introducer sheath 80 can then be maintained in this position, for example, when introducing the device 610 to deliver the sealant. When the positioning element is advanced into the sheath lumen 86, the position of the positioning element relative to the vessel wall and arteriotomy is known based on the known position of the introducer sheath 80. For example, if the side port 85 is offset 2 cm from the distal end 84 of the sheath 80, the user knows that the expanded positioning element needs to be retracted 2 cm to reach the vessel wall. This embodiment of positioning the sheath 80 can minimize drag of the expanded positioning element within the vessel, reducing the risk of the positioning element bursting with calcium or other material within the vessel and / or false positive tactile positioning due to vessel stenosis or bifurcation.

[0167] 17A-17F diagrammatically illustrate a method of delivering sealant from device 810 to an arteriotomy site. Device 810 may include any of the functional features described for device 710. For example, device 810 may include sealant 2 disposed at a distal portion of positioning assembly 814. Positioning assembly 814 penetrates the puncture and enters the vessel such that positioning element 846 is located within the vessel lumen and sealant 2 is located on the exterior of the vessel wall (FIG. 17A). Positioning element 846 is expanded to secure device 810 to the arteriotomy site (FIG. 17B). Sheath 880 is retracted to expose sealant 2 to the arteriotomy site (FIG. 17C), and support member 830 is advanced to tamp sealant 2 (FIG. 17D). After the positioning element 846 is collapsed (FIG. 17E), it can be moved proximally through the sealant 2 (FIG. 17F) to place the sealant 2 outside the blood vessel. The support member 830 can maintain the position of the sealant 2 while the positioning element 846 is withdrawn. After the positioning element 846 is withdrawn, the entire device 810, including the sheath 880 and the positioning assembly 814, can be withdrawn from the patient. The device 810 and methods of using the device 810 are described in detail below.

[0168] 17A-17F, device 810 can have a handle 823. Handle 823 can have an outer housing 872 and an inner housing 874. Outer housing 872 can move relative to inner housing 874, for example, when sheath 880 is moved proximally relative to positioning assembly 814.

[0169] Handle 823 may have one or more actuators that control device 810. Each actuator may control one or more functions of device 810. One or more actuators may be located anywhere along handle 823. In FIGS. 17A-17F, actuators 860, 862, 864, and 848 are located along handle 823 based on the procedural step that each actuator controls. The actuator configuration shown in FIGS. 17A-17F reduces confusion for the user associated with operating device 810 by only requiring the user to move their hand proximally for each sequential step in the procedure. Although FIGS. 17A-17F show four actuators 860, 862, 864, and 848, fewer or additional actuators may be used to perform the same functions.

[0170] The apparatus 810 can include an inflation line 48c. The inflation line 48c is in fluid communication with the positioning element 846. The inflation line 48c is connected to a syringe 148 or other device that delivers fluid to the positioning element 846.

[0171] The device 810 can have a first actuator 860 that controls the flow of fluid through the inflation line 48c. The first actuator 860 moves between an open position and a closed position. As shown in FIG. 17A, when the first actuator 860 is in the open position, the syringe 148 can deliver fluid through the inflation line 48c to expand the positioning element 846. In FIG. 17B, the first actuator 860 moves to a closed position, restricting the flow of fluid through the inflation line 48c to maintain the expanded state of the positioning element 846. After the positioning element 246 expands, the device 810 is moved proximally to position the positioning element 846 adjacent the arteriotomy.

[0172] The device 810 can have a second actuator 862 that controls the movement of the sheath 880 relative to the positioning assembly 814. The second actuator 862 moves between a first position and a second position. In the first position (FIGS. 17A and 17B), the sheath 880 cannot move relative to the positioning assembly 814, thus preventing inadvertent exposure of the sealant 2. Moving the second actuator 862 from the first position to the second position can move the sheath 880 relative to the positioning assembly 814, as shown in FIG. 17C. With the positioning assembly 814 stationary, the sheath 880 is retracted to expose the sealant 2 to the arteriotomy. Retracting the sheath 880 at least partially covers the second actuator 862 against a portion of the outer housing 872.

[0173] The device 810 can have a locking mechanism that prevents the inner housing 874 from moving relative to the outer housing 872. When the sheath 880 is retracted, the outer housing 872 moves between a first position and a second position. When the outer housing 872 is in the first position (FIGS. 17A and 17B), the inner housing 874 can move relative to the outer housing 872. When the outer housing 872 is in the second position (FIG. 17C), the inner housing 874 cannot move proximally relative to the outer housing 872.

[0174] 17C and 17D, the device 810 can include a third actuator 864. The third actuator 864 moves between a first position and a second position. Moving the third actuator 864 from the first position to the second position advances the support member 830 and tamps the sealant 2. Tamping the sealant 2 substantially prevents movement of the sealant 2 and promotes hemostasis.

[0175] Moving the third actuator 864 from the first position to the second position releases the retraction lock 816. The retraction lock 816 prevents the positioning assembly 814 from inadvertently retracting prior to tamping the sealant 2. Releasing the retraction lock 816 allows at least a portion of the positioning assembly 814 to move proximally relative to the support member 830.

[0176] The apparatus can include a fourth actuator 848 movable between a first position and a second position. The fourth actuator 848 can be moved by unlocking the retract lock 816. Moving the fourth actuator 848 from the first position to the second position at least partially retracts the positioning assembly 814 relative to the support member 830.

[0177] In Figure 17E, the first actuator 860 is moved to the open position to allow fluid flow through the inflation line 48c. When the first actuator 860 is in the open position, the positioning element 846 can be deflated by the syringe 148. In Figure 17F, the positioning member 814 is retracted past the sealant 2, allowing the entire device 810 to be removed from the patient.

[0178] As mentioned above, the device 810 can include an actuation mechanism for controlling fluid flow to the positioning element 846. The actuation mechanism can include any of the functional features described with respect to Figures 18A-20B, either alone or in combination with each other.

[0179] Figures 18A and 18B show the first actuator 860a moving between an open and a closed position. Figures 18A-1 and 18B-1 show a cross-sectional view of the inflation line 48a. The outer housing 872a of the handle has an opening through which a portion of the first actuator 860a protrudes. In Figures 18A and 18B, the first actuator 860a is a valve, however, the first actuator 860a and the valve can be separate components. The valve can have a pinch mechanism that restricts fluid flow through the inflation line 48a.

[0180] The first actuator 860a can be moved between an open position (FIG. 18A) and a closed position (FIG. 18B). In the open position, fluid can flow through the inflation line 48a. Although FIGS. 18A and 18B show the first actuator 860a as a rocking rocker, the first actuator 860a can have other shapes.

[0181] Figures 19A and 19B show a device having a first actuator 860b and a deflation actuator 866b. Figures 19A-1 and 19B-1 show a cross-sectional view of the inflation line 48b. A linkage portion 867b connects the first actuator 860b to the deflation actuator 866b. Although the linkage portion 867b shown in Figures 19A and 19B has multiple link members, the linkage portion 867b may have only one link member (see Figures 19E to 19F). The outer housing 872b has two openings through which the first actuator 860b and the deflation actuator 866b protrude.

[0182] 18A and 18B, the first actuator 860b moves from a first position to a second position to restrict fluid flow through the inflation line 48b. The movement of the first actuator 860b from the first position to the second position moves the deflation actuator 866b from the first position to the second position. The movement of the deflation actuator 866b from the second position to the first position moves the first actuator 860b from the second position to the open position to allow fluid flow through the inflation line 48b.

[0183] Similar to Figures 19A and 19B, the device of Figures 19C and 19D can include a first actuator 860c and a retract actuator 866c connected by a linkage portion 867c. The linkage portion 867c can include one or more link members. Unlike Figures 19A and 19B, the first actuator 860c and the retract actuator 866c can be different from the valve 884c. For example, the valve 884c can be located distal to the first actuator 860c and the retract actuator 866c.

[0184] The first actuator 860c can be moved from a first position to a second position to close the valve 884c and restrict fluid flow through the inflation line. Moving the first actuator 860c from the first position to the second position moves the deflate actuator 866c from the first position to the second position. Moving the deflate actuator from the second position to the first position moves the first actuator 860c from the second position to the first position to open the valve 884c.

[0185] Similar to Figures 19A-D, the device of Figures 19E and 19F can have a first actuator 860d and a retract actuator 866d connected by a linkage portion 867d. Unlike Figures 19A and 19B, the linkage portion 867d can only have one link member. Additionally, similar to Figures 19A and 19D, the first actuator 860d and the retract actuator 866d can be different from the valve 884d. For example, the valve 884d can be located distal to the first actuator 860d and the retract actuator 866d.

[0186] The first actuator 860d can be moved from a first position to a second position to close the valve 884d and restrict fluid flow through the inflation line. Moving the first actuator 860d from the first position to the second position moves the deflate actuator 866d from the first position to the second position. Moving the deflate actuator from the second position to the first position moves the first actuator 860d from the second position to the first position to open the valve 884d.

[0187] Devices having a first actuator and a retraction actuator are useful for reducing confusion associated with operating the device. For example, if the device includes an additional actuator to control the steps of inflating and deflating the positioning element, the additional actuator can be located along the handle between the first actuator and the retraction actuator. The actuators are positioned based on the procedure step that each actuator controls, allowing the user to move their hand proximally for each step in the procedure sequence. Since retracting the positioning element is the final step before withdrawing the device, the retraction actuator can be located proximal to the additional actuator.

[0188] As mentioned above, the first actuator and the valve can be separate components. As shown in Figures 20A-B, the first actuator 960 moves between a first position and a second position to control the position of the valve 961. Moving the first actuator 960 from the first position (Figure 20A) to the second position (Figure 20B) moves the valve 961 from an open position to a closed position. In the closed position, the valve 961 restricts the flow of fluid through the inflation line 948. Figures 20A-1 and 20B-1 show cross-sectional views of the inflation line 948 moving from an open to a closed configuration. Moving the first actuator 960 from the second position to the first position moves the valve 961 from a closed position to an open position, thereby allowing the flow of fluid through the inflation line 948.

[0189] The first actuator 960 can be a lever. A pin connects the first actuator 960 to the valve 961. The valve 961 can be a sliding valve with a pin mechanism to restrict the flow of fluid through the inflation line 948. Moving the first actuator 960 between a first position and a second position causes the valve 961 to slide linearly between an open position and a closed position. Although FIGS. 20A-B show the first actuator 960 as a lever, the device can have any other mechanism capable of moving the valve 961, such as a rack and pinion arrangement, a cam mechanism, or any other actuator.

[0190] The device 810 can have a second actuator 862 that controls movement of the sheath 880 relative to the positioning assembly 814. The outer housing 872 can have an opening through which at least a portion of the second actuator 862 protrudes. As shown in Figures 21A and 21B, the second actuator 862 can be a spring loaded button.

[0191] The second actuator 862a moves between a first position (FIG. 21A) and a second position (FIG. 21B). When the second actuator 862a is in the first position, the second actuator 862a blocks proximal movement of the sheath relative to the positioning assembly. When the second actuator 862a is in the second position, the sheath can move proximally relative to the positioning assembly. When the sheath moves proximally, the outer housing 872a blocks the second actuator 862a from moving to the first position. Although the second actuator 862a shown in FIGS. 21A and 21B includes a spring mechanism 868a, any of the other locking mechanisms described herein may be used to control movement of the sheath relative to the positioning assembly.

[0192] As shown in Figures 22A and 22B, the second actuator 862b can have a detent 869b. When the second actuator 862b is in a first position (Figure 22A), the sheath cannot move relative to the positioning assembly. When the second actuator 862b is in a second position (Figure 22B), the detent 869b locks the second actuator 862b in a depressed position, thereby allowing the sheath to move proximally relative to the positioning assembly. When the sheath moves proximally, the outer housing 872b moves over the second actuator 862b to keep the second actuator 862b in the depressed state.

[0193] The device 810 can further include a mechanism to limit the distance that the sheath 880 can move relative to the positioning assembly 814. For example, it can only move until the distal end of the inner housing 874 abuts the distal end of the outer housing 872, or a different functional feature in the handle 823, as shown in Figures 21B and 22B.

[0194] As discussed above, the handle 823 can include a locking mechanism that locks the inner housing 874 relative to the outer housing 872. As shown in FIGS. 17A-17F, the locking mechanism can include one or more protrusions 863 positioned along an inner wall of the outer housing 872 and one or more resilient members 875 positioned on the inner housing 874. As the sheath 880 is moved proximally, the one or more resilient members 875 deflect inwardly and pass the one or more protrusions 863. After the one or more resilient members 875 deflect inwardly and pass the one or more protrusions 863, the inner housing 874 cannot move proximally relative to the outer housing 872.

[0195] 23A and 23B, the locking mechanism includes at least two protrusions 863 along the inner wall of outer housing 872 and at least two resilient members 875 disposed at the proximal end of inner housing 874. Resilient members 875 are capable of deflecting inwardly and moving distally past one or more of protrusions 863. When sheath 880 is withdrawn, resilient members 875 are capable of deflecting inwardly and moving distally past protrusions 863. After resilient members 875 have passed the protrusions, inner housing 874 cannot move proximally relative to outer housing 872.

[0196] Alternatively, the locking mechanism may include one or more protrusions 863 disposed on the inner housing 874 and one or more resilient members disposed along the inner wall of the outer housing 872. Other locking mechanisms described herein may also be used to lock the inner housing 874 to the outer housing 872.

[0197] The device 810 can include a mechanism for releasing the positioning assembly 814 from the inner housing 874. Releasing the positioning assembly 814 allows the positioning assembly 814 to move proximally while maintaining the position of the support member 830.

[0198] 24A-24C show a mechanism for preventing the advancement of the support member 830 prior to retraction of the outer sheath 880. As shown in FIG. 24A, the locking mechanism can be a tab 873 that prevents movement of the third actuator 864. However, after the sheath 880 has been moved proximally (FIG. 24B), the tab 873 can move proximally to move the third actuator 864 from the first position (FIG. 24B) to the second position (FIG. 24C). Other locking mechanisms described herein can also be used to prevent the advancement of the support member 830.

[0199] 25A and 25B show one mechanism for advancing support member 830. Moving third actuator 864 from a first position to a second position extends link element 865 to advance support member 830. Support member 830 extends until a portion of support member 830 abuts a feature of the handle, such as an end portion of inner housing 874 or outer housing 872. The distance support member 830 advances is limited by the distance link element 865 extends.

[0200] 26A and 26B show device 810 having a spring member 870. Moving third actuator 864 from a first position to a second position extends spring member 870 and advances support member 830 distally. Support member 830 can extend until a portion of support member 830 abuts a feature of the handle, such as inner housing 874 or the distal end of outer housing 872. The distance support member 830 advances is limited by the distance spring member 870 extends. Other mechanisms can be used to advance support member 830, such as the rack and pinion arrangement described for device 710 or any other actuator.

[0201] As mentioned above, the device 810 can have a retraction lock 816 that locks the position of the positioning assembly 814 relative to the inner housing 874. The retraction lock 816 can be released by moving the third actuator 864 from a first position to a second position, which is achieved by moving the lever 817 from the first position to the second position. When the lever 817 is in the second position, the positioning assembly 814 can be moved relative to the outer housing 872. The positioning assembly 814 can be retracted past the sealant 2 by retracting the fourth actuator 848 of the positioning assembly 814. While the positioning assembly 814 is retracted, the support member 830 holds the sealant 2 in position. After the positioning assembly 814 is retracted, the entire device 810 is removed from the patient. Other locking mechanisms described herein can also be used to lock the positioning assembly 814 relative to the inner housing 874.

[0202] 28A-28F diagrammatically illustrate a sealant delivery method similar to that shown in FIGS. 17A-17F. However, as noted above, the handle 823 need not include the four actuators 860, 862, 864, and 848. For example, as shown in FIGS. 28A-28F, the handle does not include the first actuator 860. Instead, the inflation line 48c includes a valve 882. The valve 882 moves between a first position and a second position. When the valve 882 is in the first position, as shown in FIG. 283, fluid can flow from the syringe to the positioning member 846. When the valve 882 moves from the first position to the second position, as shown in FIG. 28B, fluid can no longer flow from the syringe to the positioning member 846.

[0203] 29A-B show a device 1010 for delivering sealant to an arteriotomy site. The device 1010 can have any of the functional features of the sealant delivery device detailed herein. For example, the device 1010 can have a handle 1023 and a positioning assembly 1014 having a positioning element 1046. At least a portion of the positioning assembly 1014 can extend into a sheath 1080. An inflation line 48c can extend from the positioning element 1046 to a syringe 148, or any other mechanism for inflating and deflating the positioning element 1046. The inflation line 48c can have a first actuator 1082 that controls fluid flow to the positioning element 1046. The handle 1023 may have a second actuator 1062 that can retract the sheath 1080 relative to the positioning member 1014, a third actuator 1064 that advances a support member (not shown), and / or a fourth actuator 1048 that retracts at least a portion of the positioning assembly 1014 relative to the sheath 1080.

[0204] The sheath 1080 can have a feature that indicates when the distal portion of the sheath enters the blood vessel. For example, the sheath 1080 can have one or more inflow openings 1089 at the distal portion of the sheath 1080. When the sheath 1080 enters the blood vessel, blood flows into the inflow openings and out of the outflow openings external to the user.

[0205] 29A, the sheath 1080 can have a hub 1083 that engages the handle 1023. The sheath 1080 can be released from the positioning assembly 1014 by pushing in the sheath hub 1083. The sheath hub can be provided with a catch that engages a sealant sleeve (not shown). When the positioning assembly 1014 enters the sheath 1080, the sheath catch engages the sealant sleeve and transfers the sealant from the sealant sleeve to the sheath 1080.

[0206] The device 1010 may further include an inflation indicator 1002. The inflation indicator 1002 indicates when the positioning element 1046 has been inflated to a predetermined pressure and signals the user to seal the inflation line 48c. The inflation line is connected to the plunger system 1004 as shown in FIG. 29B. When the positioning element 1046 is inflated, the shaft member 1005 moves from the first position to the second position. When the shaft member 1005 moves to the second position, the indicator 1002 moves from the first position to the second position. When the indicator 1002 is in the second position, the positioning element 1046 is fully inflated. When the positioning element 1046 is deflated, the shaft member 1005 moves from the second position to the first position and the indicator 1002 moves from the second position to the first position. When the indicator 1002 is in the first position, the positioning element 1046 is not fully inflated.

[0207] The indicator 1002 can have a first indicator 1003a and a second indicator 1003b. When the positioning element 1046 is not fully expanded, the first indicator 1003a is visible through the opening 1006 in the handle 1023. When the positioning element 1046 is fully expanded, the second indicator 1003b is visible through the opening 1006 in the handle 1023.

[0208] Any of the sealant delivery devices detailed herein can be components of a system that includes, but is not limited to, a guidewire or a dilator. The guidewire can have any of the functional features described for guidewire 799 above. The dilator can also have one or more of the functional features described for dilator 790 above and / or dilator 1190 (FIGS. 30A-30B) and dilator 1290 (FIGS. 31A-31C) described below.

[0209] As shown and described in Figures 30A-31C, the dilator can have a fluid lumen through which blood can flow from an inflow opening near the distal tip of the dilator to an outflow opening near the proximal end of the dilator. As the tip of the sheath enters the blood vessel, blood exits the proximal port. The sheath is advanced further to ensure that the distal tip of the sheath is within the blood vessel lumen.

[0210] As shown in FIGS. 30A-30D, the dilator 1190 includes an elongate structure 1191 having a lumen extending therethrough. The dilator 1190 can further include a proximal portion 1193 having a dilator hub 1196 for engaging a sheath, and / or a distal portion 1192 having a tapered end. As shown in FIG. 30A, the dilator hub 1196 can be U-shaped. The U-shaped dilator hub 1196 defines an opening for receiving the proximal end of the sheath. The dilator hub 1196 can further include hub members 1197a, 1197b configured to engage an exterior surface of the sheath. The dilator hub 1196 can further include one or more flanges for engaging corresponding features of the sheath. For example, as shown in FIG. 30A, hub members 1197a, 1197b can have flanges 1198a, 1198b and / or hub 1196 can have flanges 1199a, 1199b near the top surface of the dilator hub.

[0211] The dilator 1190 may further include a bleed back feature that aids in determining when the distal portion 1192 of the dilator 1190 enters the blood vessel. For example, the dilator 1190 may have one or more inflow openings 1194 at the distal portion 1192 of the dilator 1190. As shown in FIG. 30A, the dilator 1190 may have two inflow openings 1194. The inflow openings 1194 may be located proximal to the tapered portion of the elongate structure 1191 and / or along the same plane perpendicular to the longitudinal axis of the dilator 1190. The dilator 1190 may further include one or more outflow openings 1195 located proximal to the dilator hub 1196. As shown in FIG. 30A, the dilator 1190 may have one outflow opening 1195. The outflow opening 1195 may be located along the same plane as one of the inflow openings 1194. The dilator hub can have a directional feature 1197 that indicates the direction that blood flow will exit. As shown in FIG. 30C, the directional feature 1197 can be an arrow along the top surface of the dilator hub 1196.

[0212] The lumen through the elongate structure 1191 can have a variable diameter. For example, the lumen can have a first diameter 1189 at the distal and proximal portions 1192, 1193 of the elongate structure 1191, and a second diameter 1188 between the distal and proximal portions 1192, 1193. The first diameter 1189 can be smaller than the second diameter 1188. The first diameter 1189 can be larger than an outer diameter of the guidewire and smaller than the second diameter 1188. In some embodiments, the first diameter 1189 can be at least about half the second diameter 1188 and / or less than or equal to about 3 / 4 the second diameter 1188. In some embodiments, the first diameter 1189 is about 2 / 3 the second diameter 1188.

[0213] The lumen diameter can be variable while the outer diameter of the elongate structure 1191 remains the same. For example, the proximal section 1193 can have the same outer diameter as the section between the proximal section 1193 and the distal section 1192. The variable diameter allows the proximal section 1193 and the distal section 1192 of the dilator 1190 to form a seal around the guidewire. In this manner, blood flows only via the inflow opening 1194 to the outflow opening 1195.

[0214] 31A-C show an elongate structure 1291 having a lumen extending therethrough. The dilator 1290 can further include a proximal portion 1293 having a dilator hub 1296 for engaging a sheath, and / or a distal portion 1292 having a tapered end. As shown in FIG. 31A, the dilator hub 1296 can include hub members 1297a, 1297b configured to engage an outer surface of the sheath. For example, the sheath can include corresponding features that accommodate the hub members 1297a, 1297b. The hub members 1297a, 1297b can further include one or more flanges that engage corresponding features of the sheath. For example, as shown in FIG. 31A, the hub members 1297a, 1297b can include outwardly directed flanges 1298a, 1298b and / or inwardly directed flanges 1299a, 1299b. Flanges can be located on proximal (eg, flanges 1299a, 1299b) and / or distal portions (eg, flanges 1298a, 1298b) of hub members 1297a, 1297b.

[0215] The dilator 1290 may further include a bleed back feature that aids in determining when the distal portion 1292 of the dilator 1290 enters the blood vessel. For example, the dilator 1290 may include one or more inflow openings 1294 at the distal portion 1292 of the dilator 1290. As shown in FIG. 31A, the dilator 1290 may include two inflow openings 1294. The inflow openings 1294 may be located proximal to the tapered portion of the elongate structure 1291 and / or along the same plane perpendicular to the longitudinal axis of the dilator 1290. The dilator 1290 may further include one or more outflow openings 1295. As shown in FIG. 31A, the dilator 1290 may include one outflow opening 1295. In some embodiments, the outflow opening 1295 may be located along the same plane as one of the inflow openings 1294. In other embodiments, the outlet openings 1295 can be disposed in a different plane than any of the inlet openings 1294. For example, the outlet openings 1295 can be disposed in a plane that is orthogonal to a plane passing through the inlet openings 1294.

[0216] The lumen through the elongate structure 1291 can have a variable diameter. For example, the lumen can have a first diameter 1289 at the distal and proximal portions 1292, 1293 of the elongate structure 1291, and a second diameter 1288 between the distal and proximal portions 1292, 1293. The first diameter 1289 can be smaller than the second diameter 1288. The first diameter 1289 can be larger than an outer diameter of the guidewire and smaller than the second diameter 1288. In some embodiments, the first diameter 1289 can be at least about half the second diameter 1288 and / or less than or equal to about 3 / 4 the second diameter 1288. In some embodiments, the first diameter 1289 is about 2 / 3 the second diameter 1288.

[0217] The lumen diameter can be variable while the outer diameter of the elongate structure 1291 remains the same. For example, the proximal section 1293 can have the same outer diameter as the section between the proximal section 1293 and the distal section 1292. The variable diameter allows the proximal section 1293 and the distal section 1292 of the dilator 1290 to form a seal around the guidewire. In this manner, blood flows only via the inflow opening 1294 to the outflow opening 1295.

[0218] In any of the dilators described above, the diameter of any of the outflow openings can be less than the diameter of any of the inflow openings, for example, the diameter of any of the outflow openings can be less than or equal to half the diameter of any of the inflow openings.

[0219] 32A-32E illustrate how any of the positioning assemblies described above may engage a sheath. FIG. 32A illustrates the device 1310 prior to introduction of the device 1310 into the sheath 1380. The device 1310 may have any of the functional features of the sealant delivery device described above. The positioning assembly 1314 engages the sheath 1380 such that movement of the handle 1323 may also move the sheath 1380. For example, the handle 1323 may have a shroud portion 1376 configured to engage a hub 1383 of the sheath 1380. As shown in FIG. 32A, the shroud 1376 may have two tines 1378, each of which may have barbs 1379 located at a distal portion of the tines 1378. The hub 1383 may have an opening 1385 to accommodate the tines 1378. Other fastening mechanisms without prongs can also be used to connect device 1310 to sheath 1380, such as a snap fit, interference fit, or other threaded mechanism.

[0220] As described above, the sealant 1302 is initially disposed at the distal portion of the positioning assembly 1314 (see FIG. 32A). Before the positioning assembly 1314 is advanced into the sheath 1380, the sealant sleeve 1350 covers the sealant 1302 and prevents the sealant 1302 from being exposed to the environment. The sealant sleeve 1350 can have any of the functional features of the sealant sleeve 450, as described above. When the positioning assembly 1314 advances into the sheath 1380, the sealant 1302 is transferred from the sealant sleeve 1350 to the sheath 1380 (see FIG. 32B). The sheath hub 1383 and / or the shroud 1376 retain the sealant sleeve 1350. The sheath hub 1383 and / or shroud 1376 retain the sealant sleeve 1350 even when the sheath 1380 is retracted (FIG. 32C) or the support member 1330 is used to tamp the sealant (FIG. 32D).

[0221] 33, the fork tines engage the exterior of a sheath hub 1483. For example, the hub 1483 can have grooves 1486 configured to engage the barbs 1478. The sheath hub 1483 can also have an inner diameter that is smaller than the outer diameter of the sealant 1450 to facilitate transfer of the sealant from the sealant sleeve 1450 to the sheath 1480.

[0222] 34A-34I illustrate a method of using a system having any of the sealant delivery devices and dilators described herein. The method may include one or more of the steps described below. A procedure sheath (not shown) is inserted through a puncture 1504 into a vessel wall 1506 to gain access to the vessel lumen. After a guidewire 1502 is threaded through the procedure sheath and into the vessel, the procedure sheath is removed from the tissue and the guidewire 1502 is left in place with the distal tip of the guidewire 1502 positioned within the vessel lumen. A dilator 1508 may then be advanced into a closure system sheath 1510 and the dilator-sheath assembly may be advanced over the guidewire 1502 (FIG. 34A). Any of the mechanisms described above (e.g., bleed-back ports on the dilator and / or sheath) may be used to determine when the dilator-sheath assembly enters the vessel lumen.

[0223] After the distal end of the sheath 1510 has entered the vascular lumen, the dilator 1508 and guidewire 1502 are retracted proximally and removed, and the distal end of the sheath 1510 is left in the vascular lumen (FIG. 34B). The positioning assembly 1512 is then introduced into the proximal end of the sheath 1510 and advanced distally through the sheath 1510 (FIGS. 34C-E). As described herein, the positioning assembly 1512 can have a sealant 1516 located at a distal portion of the positioning assembly 1512 prior to entering the sheath 1510. After the positioning element 1514 has exited the distal end of the sheath 1510 and entered the vascular lumen, the positioning element 1514 can be expanded within the vascular lumen (FIG. 34F).

[0224] The positioning assembly 1512 can then be withdrawn, seating the positioning element 1514 against the vascular puncture 1504 and disposing the sealant 1516 and sheath 1510 against the exterior of the vessel wall 1506 (FIG. 34G). The sheath 1510 can then be partially retracted, exposing the sealant 1516 (FIG. 34H). The support member 1518 can then be advanced, tamping the sealant 1516 against the vessel wall 1506 (FIG. 34I). The positioning element 1514 then reduces its cross-section (e.g., collapses) and is retracted proximally past the sealant 1516. The support member 1518 remains pressed against the sealant during proximal retraction of the positioning element 1514, maintaining its position. After removal of the positioning element 1514 , the support member 1518 and sheath 1510 , if still present within the tissue tract, are removed from the patient, leaving the sealant 1516 in place adjacent the vessel wall 15056 .

[0225] In one embodiment of the invention, the positioning element 1514 is an inflatable balloon carried at a distal region of an elongate balloon catheter shaft. The balloon catheter shaft has an elongate tubular body with a central lumen therethrough and fluidly connects the inflatable balloon to a source of inflation media that is connected to the proximal end of the shaft. A central core wire extends through at least a portion of the central lumen and through the balloon and supports a distal end of the balloon. The core wire may extend distally beyond the balloon a distance of at least about 2 mm to 10 cm, and preferably at least 3 cm to 5 cm, to provide a flexible advancement segment.

[0226] The inner diameter of the central lumen is larger than the outer diameter of the core wire and provides an inflation lumen through which the balloon can be inflated.

[0227] The sealant 1516 preferably has a central lumen so that it can be pre-attached to the distal end of the balloon catheter shaft proximal to the inflatable balloon. The sealant 1516 is formed as a cylindrical plug with a central lumen extending therethrough. Alternatively, the sealant 1516 can be provided in the form of a sheet or film and wrapped around the catheter shaft in two, three, four or more layers.

[0228] For example, referring to Figures 34F and 34G, the sealant is pre-disposed on the distal end of the catheter shaft and spaced a short distance from the proximal surface of the inflated balloon. This distance is sized to coordinate with the expected wall thickness of the vessel, as shown in Figure 34G, so as to position the inflated balloon against the inner wall of the vessel and to position the sealant at the exterior puncture adjacent the outer wall of the vessel. The axial distance between the distal end of the sealant and the proximal surface of the balloon is typically no greater than about 4 mm, and in some embodiments, no greater than about 3 mm or 2 mm.

[0229] Using this configuration, the sealant is pre-placed on the balloon catheter shaft at the time of manufacture or in any case at the clinical location prior to introduction of the balloon catheter into the patient. The balloon catheter and sealant are then guided as a single unit by the sheath 1510 from outside the patient into the proximal end of the sheath 1510 and by the sheath 1510 to the vessel wall. The balloon can then be inflated within the vessel and the system can be withdrawn proximally as a unit from the distal position shown in FIG. 34F to the proximal seated position shown in FIG. 34G without any internal relative movement between the balloon catheter and the sealant. The sealant is then exposed by proximal retraction of the outer sleeve.

[0230] While the invention is susceptible to various modifications and alternative forms, specific embodiments thereof have been shown in the drawings and have been described in detail herein. However, the invention is not limited to the specific forms or methods described, but on the contrary, the invention covers all modifications, equivalents, and alternatives falling within the scope of the appended claims.

Claims

1. 1. An apparatus for sealing a puncture in a blood vessel wall, comprising: a positioning assembly (714) including a positioning element (746) used to position a sealant (2) at the puncture and an elongate member extending along an axis from a proximal portion (742) to a distal portion (744), the positioning element (746) being disposed at the distal portion and the sealant (2) being disposed adjacent to a proximal side of the positioning element (746) on the axis at the distal portion; a support member (730) advanceable on the axis relative to the elongated member of the positioning assembly (714), the elongated member of the positioning assembly (714) being at least partially exposed within the support member (730); a sealant sleeve (750) carrying the sealant (2) therein and surrounding the distal end of the support member (730); a deployment mechanism (766, 768) coupled to a proximal end of the support member (730), the deployment mechanism (766, 768) configured to advance the support member (730) in a distal direction by a second actuator (762) coupled to the deployment mechanism (766, 768) to expose the sealant (2) from the sealant sleeve (750) and deploy it to seal the puncture; a retraction mechanism (764) coupled to a proximal portion (748) of the elongate member, the retraction mechanism (764) configured to retract the positioning element (746) in a proximal direction relative to the sealant (2) independent of movement of the support member (730) by the deployment mechanism (766, 768) by moving the proximal portion (748) of the elongate member; 13. An apparatus comprising:

2. 10. The apparatus of claim 1, further comprising an introducer sheath (780) having a proximal end (783) that receives the sealant sleeve (750).

3. a handle (723) including an inner housing portion (774) coupled to a proximal end of the support member (730) and an outer housing portion (772) configured to move relative to the inner housing portion (774); The outer housing portion (772) includes a distal shroud (776) that engages a proximal end (783) of the introducer sheath (780); The handle (723) includes a first actuator (760) pivotally mounted to the inner housing portion (774); the first actuator (760) includes a distal end that engages a distal edge of an opening in the outer housing portion (772); 3. The apparatus of claim 2, wherein the distal end of the first actuator (760) disengages from a distal edge of an opening in the outer housing portion (772) to permit relative movement between the inner housing portion (774) and the outer housing portion (772).

4. The deployment mechanism (766, 768) includes a rack and pinion (766, 768); The rack (766) is connected to a proximal end of the support member (730); said pinion (768) is rotatably mounted in said inner housing portion (774); 4. The device of claim 3, wherein the handle (723) includes the second actuator (762) pivotally mounted to the inner housing portion (774), the second actuator (762) configured to advance the rack (766) in a distal direction by rotating the pinion (768).

5. The apparatus of claim 4 , wherein the second actuator (762) is configured to advance the support member (730) by advancing the rack (766) in a distal direction.

6. The retraction mechanism (764) includes a third actuator (764) selectively coupled to a proximal portion (748) of the elongate member; The apparatus of claim 4 , wherein the third actuator (764) is configured to proximally retract the proximal portion (748) of the elongate member when the rack (766) advances distally.

7. The apparatus of claim 6 , wherein the third actuator (764) is slidable relative to the inner housing portion (774).

8. The device of claim 3 , wherein the first actuator (760) is at least partially exposed outside the handle (723) to permit manipulation by a user.

9. The device of claim 4 , wherein the second actuator (762) is at least partially exposed outside the handle (723) to permit manipulation by a user.

10. The device of claim 6 , wherein the third actuator (764) is at least partially exposed outside the handle (723) to permit manipulation by a user.

Images