US20130150884A1

US20130150884A1 - Balloon insertion apparatus and method of sealing a tissue puncture

Info

Publication number: US20130150884A1
Application number: US13/763,420
Authority: US
Inventors: Kedar R. Belhe; Michelle Boucha-Rayle; Catherine A. Pipenhagen
Original assignee: St Jude Medical Puerto Rico LLC
Current assignee: St Jude Medical Puerto Rico LLC
Priority date: 2006-01-04
Filing date: 2013-02-08
Publication date: 2013-06-13
Also published as: WO2007081448A3; US20070156084A1; WO2007081448A2; US8382794B2

Abstract

The present invention provides apparatus and methods of closing internal tissue punctures. The apparatus and method provide for an introducer sheath having at least one side port enabling aspiration of an internal tissue puncture site and injection of a sealant.

Description

CROSS-REFERENCE TO RELATED APPLICATION

This application is a divisional of application Ser. No. 11/325,206, filed Jan. 4, 2006, and entitled BALLOON INSERTION APPARATUS AND METHOD OF SEALING A TISSUE PUNCTURE, pending, the disclosure of which is hereby incorporated herein, in its entirety, by this reference.

FIELD OF THE INVENTION

The present invention relates to medical devices, and, more particularly, to tissue puncture sealing devices.

BACKGROUND OF THE INVENTION

Various medical procedures, particularly cardiology procedures, involve accessing a corporeal vessel or other lumen through a percutaneous sheath. The sheath necessarily requires the formation of a hole or opening in the vessel wall so that a medical procedure can be performed via the sheath. After the particular medical procedure has been performed, the sheath must eventually be removed from the vessel and the access hole in the vessel wall must be closed.
Historically, the access hole is closed by the application of prolonged manual pressure over the puncture site by a physician or other trained medical professional. The time involved with this method is extensive and costly. In addition, because patients are often treated with a variety of anticoagulant and thrombolytic agents, the manual pressure required to close the access opening in the vessel wall may be even longer. The discomfort and delay in mobilization for patients resulting from this prolonged manual pressure is significant.
Therefore, a number of vascular closure devices have been developed to close an access opening in the vessel wall more efficiently. For example, closing an access opening in the vessel wall may involve packing a resorbable sealing plug at the hole or sandwiching the hole between the sealing plug and an anchor. Examples of such vascular closure devices and methods are described in U.S. Pat. Nos. 6,090,130 and 6,045,569 and related patents that are hereby incorporated by reference.
Alternatively, closing an access opening in the vessel wall may include the use of a balloon catheter. For example, an access opening in the vessel wall may be closed by inserting a balloon catheter through the opening in the vessel wall, inflating the balloon, pulling the balloon against the inner wall of the vessel, introducing a procoagulant to the incision site external to the puncture in the vessel wall, and withdrawing the balloon catheter. This method relies on a biochemical reaction between the procoagulant and the blood. The reliance on a biochemical reaction, however, can be problematic. For example, the mixing of the procoagulant with the blood is arbitrary. Therefore, in many cases an exaggerated dose of the procoagulant is applied in an attempt to ensure hemostatis. An exaggerated dose, however, can accidentally enter the blood stream and introduce complications. Moreover, reliance on a chemical reaction based on arbitrary mixing between the procoagulant and the blood often results in an inconsistent seal composition, which in turn results in inconsistent hemostatic sealing performance.

SUMMARY OF THE INVENTION

In one of many possible embodiments, the present invention provides an internal tissue puncture sealing apparatus. The internal tissue puncture sealing apparatus comprises a first thin, elongated conduit having a first central lumen and first and second ends. The first end is insertable through the internal tissue puncture and has an inflation segment in fluid communication with the central lumen. The first end includes an expandable member that is selectively inflatable with a fluid via the central lumen. The apparatus also includes a second thin, elongated conduit having a second central lumen receptive of the first thin, elongated conduit. The proximal end of the second conduit has at least one valved side-port in fluid communication with an annulus between the first and second conduits. The valved side-port may include a vacuum communication path and a sealant injection path, which enable aspiration of a tissue puncture site and sealing of the puncture.
Another aspect of the invention provides a method of closing a hole in a vessel wall. The method may include inserting an inflatable device through an introducer that is disposed in the vessel, inflating the inflatable device, sealing the inflatable device against an inner wall of the vessel, reducing the pressure inside of the introducer, injecting a sealant into the introducer, deflating the inflatable device, and removing the inflatable device through the sealant. Following removal of the inflatable device, manual pressure may be applied to the hole for a short period of time to ensure continued hemostasis. According to some aspects of the invention, a specially designed introducer is swapped with a standard introducer used to facilitate insertion of vascular tools used to perform a vascular procedure prior to inserting the inflatable device.
The foregoing and other features, utilities and advantages of the invention will be apparent from the following more particular description of preferred embodiments of the invention as illustrated in the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings illustrate various embodiments of the present invention and are a part of the specification. The illustrated embodiments are merely examples of the present invention and do not limit the scope of the invention.

FIG. 1 is an exploded assembly view of an introducer sheath and an associated balloon catheter according to one embodiment of the present invention.

FIG. 2 is a perspective view of the balloon catheter inserted into the introducer sheath.

FIG. 3 is a sectional side elevation view of a patient with the introducer sheath of FIG. 1 in place within an arteriotomy and the associated balloon catheter extending through the introducer sheath and into a blood vessel according to one embodiment of the present invention.

FIG. 4 is a sectional side elevation view of the patient, introducer sheath, and balloon catheter of FIG. 3 with a balloon of the balloon catheter inflated and sealing the arteriotomy.

FIG. 5 is a sectional side elevation view of the patient, introducer sheath, and balloon catheter of FIG. 4 shown with the introducer sheath connected to a vacuum apparatus according to one embodiment of the present invention.

FIG. 6 is a sectional side elevation view of the patient, introducer sheath, and balloon catheter of FIG. 5 shown with the introducer sheath connected to a sealant injector according to one embodiment of the present invention.

FIG. 7 a sectional side elevation view of the patient, introducer sheath, and balloon catheter of FIG. 6 with the balloon deflated and being withdrawn through the sealant according to one embodiment of the present invention.

FIG. 8 is a sectional side elevation view of the patient following retraction of the introducer sheath and balloon catheter from the situs of the arteriotomy.

Throughout the drawings, identical reference numbers designate similar, but not necessarily identical, elements.

DETAILED DESCRIPTION

As mentioned above, vascular procedures are commonly performed throughout the world and require access to a blood vessel through a puncture or opening in the vessel. Often an introducer sheath is placed in the opening to facilitate access to the vessel by one or more vascular instruments, including puncture closure devices. Proper location of an artery or other lumen is typically indicated by a flow of blood through the lumen into the introducer sheath or other instrument as the instrument enters the vessel. The present invention describes methods and apparatus for sealing the vessel opening or arteriotomy following completion of a vascular procedure. The methods and apparatus may also be used, however, to close punctures caused by accidents or other injuries, and are not limited to use following a vascular procedure. The principles described herein may be used to close internal tissue punctures of any kind in any live body. Therefore, while the description below is directed primarily to closing arteriotomys, the methods and apparatus may be used according to principles described herein with any bodily lumen to close a hole or puncture.
As used throughout the claims and specification, the term “sealant” is used broadly to encompass any fluid, foam, or gel that does not require a biochemical reaction with bodily fluids to set or cure for sealing purposes. The term “fluid” refers to molecules of a substance that move freely past one another and have the tendency to assume the shape of its container, including liquids, foams, gels, and gasses. A “lumen” refers to any open space or cavity in a bodily organ, especially in a blood vessel, or a fluid passageway through a vascular device. “Aspirate” or “aspirating” means to remove fluids with a suction device. The term “vacuum” means lower pressure than local atmospheric pressure or a device that creates a lower pressure. The words “having” and “including” have the same meaning as the word “comprising.”
Referring now to the drawings, and in particular to FIG. 1, an internal tissue puncture sealing apparatus 100 according to one embodiment of the present invention is shown. As shown in FIG. 1, the internal tissue puncture sealing apparatus 100 includes a first thin, elongated conduit. According to FIG. 1, the first thin, elongated conduit is a balloon catheter 102 and includes a first central lumen 104 and first and second ends 106, 108, respectively. The first end 106 includes an inflation segment 112. According to FIG. 1, the inflation segment 112 comprises an expandable member such as a balloon 114 that is in fluid communication with the central lumen 104. Therefore, the balloon 114 is selectively inflatable with a fluid via the central lumen 104. The balloon 114 may be inflated by increasing the pressure of the fluid inside the central lumen 104. For example, the second end 108 of the balloon catheter includes a syringe 116 that may be depressed to inflate the balloon 114 with saline solution. Downstream of the syringe 116 is a valve 118 that selectively isolates the central lumen 104 from the syringe 116. Accordingly, when the valve 118 is open, the syringe 116 may be depressed, resulting in expansion or inflation of the balloon 114. Further, following inflation, the valve 118 may be closed, maintaining the expansion of the balloon 114. When uninflated as shown in FIG. 1, the balloon 114 is coaxial and substantially flush with the central lumen 104.
The internal tissue puncture sealing apparatus 100 also includes a second thin, elongated conduit. According to FIG. 1, the second thin, elongated conduit comprises an introducer assembly or sheath 120. The introducer sheath 120 has a second central lumen 122 that is receptive of the balloon catheter 102.
The introducer sheath 120 also has a distal end 124 and a proximal end 126. The proximal end 126 includes at least one side-port 128 extending into the second central lumen 122. According to FIG. 1, the side-port 128 is in fluid communication with an external valve 130. The external valve 130 branches to a vacuum port 132 and a sealant injection port 134. However, according to some embodiments the vacuum port 132 and sealant injection port 134 are one and the same, and thus there may be no branching.
As shown in FIG. 1, the vacuum port 132 is in fluid communication with a vacuum source or other evacuator, for example a vacuum syringe 136. Similarly, the sealant injection port 134 is in fluid communication with a sealant supply, such as a sealant-containing syringe 138. Therefore, the external valve 130 may comprise a translucent three-way valve positionable between a first or closed position isolating both the vacuum port 132 and the sealant injection port 134 from the second central lumen 122, a second position opening a fluid communication path between the second central lumen 122 and the vacuum port 132, and a third position opening a fluid communication path between the second central lumen 122 and the sealant injection port 134. Details of the external valve 130 and the associated vacuum port 132 and sealant injection port 134 are shown in FIGS. 3-7.
The balloon catheter 102 may be inserted into the introducer sheath 120 as shown in FIG. 2. When the balloon catheter 102 is inserted into the introducer sheath 120, an annulus 142 is created between the balloon catheter 102 and the introducer sheath 120. The side-port 128 is thus in fluid communication with the annulus 142.
A stopper sleeve or spacer 140 is shown disposed over the balloon catheter 102 to limit the insertion distance of the balloon catheter into the introducer sheath 120. The length of the spacer 140 is chosen such that the first end 106 of the balloon catheter 102 extends beyond the distal end 124 of the introducer sheath 120 by a predetermined distance. According to some embodiments, the predetermined distances is approximately 2.5-4.0 cm. The predetermined distance allows for the balloon 114 of the inflation segment 112 to pass into a vessel as discussed in more detail below. The spacer 140 may comprise a split tube that can be easily removed as desired.
Methods of closing a hole or puncture such as an arteriotomy 144 using the internal tissues puncture sealing apparatus 100 are next discussed with reference to FIGS. 3-8. Referring first to FIG. 3, the tissue puncture sealing apparatus 100 is shown with the introducer sheath 120 inserted into the arteriotomy 144. Although FIG. 3 shows the introducer sheath 120 passing through an incision tract 146 leading to the arteriotomy 144, according to some methods the introducer sheath 120 may be swapped with a standard introducer that may have been used to perform a vascular procedure. Preferrably, however, the introducer sheath 120 is used both for introducing instruments used to perform a vascular procedure and for closing the arteriotomy 144.
With the introducer sheath 120 inserted into the arteriotomy, the balloon catheter 102 is introduced through the second central lumen 122 until the first or distal end 106 of the balloon catheter 102, including the inflation segment 112, extends beyond the distal tip 124 of the introducer sheath 120 and into a blood vessel 148. The balloon 114 is in fluid communication with the first central lumen 104. Therefore, opening the catheter valve 118 (FIG. 2) and depressing the syringe 116 (FIG. 2) inflates the balloon 114 of the inflation segment 112 as shown in FIG. 4. To maintain the balloon 114 in an inflated posture, the catheter valve 118 may be closed. The balloon catheter 102 and the introducer sheath 120 are retracted until the balloon 114 bears against an inner wall 150 of the blood vessel 148 and seals the internal portion of the arteriotomy 144 as shown in FIG. 4.
With the balloon 114 in place internally sealing the arteriotomy 144, the side-port valve 130 is opened to allow fluid communication between the annulus 142 and the vacuum syringe 136 as shown in FIG. 5. A vacuum is created in the annulus 142 by a withdrawing a stem 152 of the vacuum syringe 136 or by some other vacuum device. As the vacuum is created in the annulus 142 and communicated to the incision tract 146, a situs 154 of the arteriotomy 144 and is aspirated, removing fluids from the incision tract 146 via the annulus 142.
As the arteriotomy 144 is aspirated, a surgeon or other medical professional may visually inspect the fluid contents evacuated through the translucent valve 130 to assess blood flow through the arteriotomy and thereby ensure proper positioning of the introducer sheath 120 and/or the balloon 114 within the blood vessel 148. A flow of blood may indicate that the balloon 114 is not properly sealing the arteriotomy 144.
When the surgeon is satisfied with the positioning of the introducer sheath 120 and the balloon 114, the side-port valve 130 is toggled to create a fluid communication path between the annulus 142 and the sealant contained by the sealant-containing syringe 138 or other sealant supply as shown in FIG. 6. The sealant-containing syringe 138 holds a volume of sealant that is injected into the introducer sheath 120 via the side-port 128 as a stem 156 is depressed. As shown in FIGS. 5 and 6, the side-port 128 provides a single, common access point for supplying the sealant and vacuum condition to the annulus 142. The sealant flows through the annulus 142 and into the incision tract 146. Further, because the incision tract 146 has been evacuated and is in a vacuum condition, the sealant is drawn through the annulus 142 toward the arteriotomy 144. The vacuum condition of the situs 154 external to the arteriotomy 144 causes the sealant to quickly and efficiently fill all of the voids around the arteriotomy 144 and in the incision tract 146. Preferably, the sealing-containing syringe 138 holds a volume of sealant sufficient to fill the annulus 142 and therefore the incision tract 146. As the sealant is injected, the sheath 120 is preferably withdrawn with respect to the balloon 114 to allow the sealant to fill the incision tract 146. Therefore, in order to facilitate retraction of the sheath 120, the spacer 140 (FIG. 2) is removed.
Following injection of the sealant, the sealant may be optionally activated, cured, or set. The sealant may comprise a gel or foam made of materials including, but not limited to: collagen, polyvinyl alcohol, polyethylene glycol, cyanoacrylates, chitosan, poly-n-acetyl glucosamine. Unlike the materials used in previous devices, none of the materials recited herein is dependent on a biochemical reaction with blood or other bodily fluids to create a hemostatic seal. However, the gels or foams used according to some aspects of the present invention may in some cases be activated or cured by, for example, application of a second fluid, UV light, or other activation mechanisms.
When the sealant is in place adjacent the exterior of the arteriotomy 144, the balloon 114 is deflated as shown in FIG. 7. The balloon 114 is deflated by reopening the catheter valve 118 (FIG. 2). The stem 158 (FIG. 2) of the catheter syringe 116 (FIG. 2) may be retracted to ensure full deflation of the balloon 114. The balloon catheter 102 and the introducer sheath 120 are retracted, with the balloon 114 sliding through the sealant and in contact with the sealant while at least a portion of the sealant remains positioned in and in contact with the introducer sheath 120 as shown in FIG. 7. According to some embodiments, following removal of the balloon catheter and the introducer sheath 120, manual pressure may be applied to the arteriotomy site to counteract any sealing action disruption caused by the act of pulling the balloon 114 through the sealant. However, the manual pressure is applied for only a fraction of the time allocated to traditional arteriotomy closures. For example, according the principles described herein, manual pressure may be applied following retraction of the internal tissue puncture sealing apparatus 100 for only ten minutes or less. The sealant remains in the incision tract 146 sealing the arteriotomy 144 as shown in FIG. 8.
While the invention has been particularly shown and described with reference to embodiments thereof, it will be understood by those skilled in the art that various other changes in the form and details may be made without departing from the scope of the invention.

Claims

What is claimed is:

1. An internal tissue puncture sealing apparatus, comprising:

a first thin, elongated conduit having a first central lumen and first and second ends, the first end being insertable through the internal tissue puncture and having an inflation segment in fluid communication with the central lumen;

an expandable member disposed at the first end, the expandable member being selectively inflatable with a fluid via the central lumen;

a second thin, elongated conduit having a second central lumen receptive of the first thin, elongated conduit and having a distal and a proximal end, the proximal end having at least one valved side-port in fluid communication with an annulus between the first thin, elongated conduit and the second thin, elongated conduit.

2. An internal tissue puncture sealing apparatus according to claim 1, further comprising a volume of sealant in fluid communication with the valved side-port for selective injection of the sealant to a situs of the internal tissue puncture via the annulus.

3. An internal tissue puncture sealing apparatus according to claim 1 wherein the valved side-port comprises a vacuum evacuation port.

4. An internal tissue puncture sealing apparatus according to claim 1 wherein the valved side-port comprises a vacuum evacuation port and a sealant introduction port.

5. An internal tissue puncture sealing apparatus according to claim 1 wherein the valved side-port comprises branches to a vacuum evacuation port and a sealant introduction port; and wherein the vacuum evacuation port is in fluid communication with a vacuum syringe, and the sealant introduction port is in fluid communication with a sealant-containing syringe.

6. An internal tissue puncture sealing apparatus according to claim 1 wherein the valved side-port is selectively positionable between a closed position, a position open to an evacuator, and a position open to a sealant.

7. An internal tissue puncture sealing apparatus according to claim 1, further comprising a spacer disposed on the first thin, elongated conduit limiting an insertion distance of the first thin, elongated conduit through the second thin, elongated conduit.

8. An internal tissue puncture sealing apparatus according to claim 1, further comprising a spacer disposed on the first thin, elongated conduit limiting an insertion distance of the first thin, elongated conduit through the second thin, elongated conduit such that the first end thereof extends beyond the distal end of the second thin, elongated conduit by a predetermined distance.

9. An internal tissue puncture sealing apparatus according to claim 1 wherein the expandable member is coaxial and flush with the first thin, elongated conduit when uninflated.

10. An internal tissue puncture sealing apparatus according to claim 1 wherein the first thin, elongated conduit and expandable member comprise a balloon catheter.

11. An internal tissue puncture sealing apparatus according to claim 1 wherein the second thin, elongated conduit comprises a vascular insertion sheath.

12. A vascular puncture sealing system, comprising:

a balloon catheter;

an introducer assembly receptive of the balloon catheter;

at least one side port in the introducer assembly for evacuating the introducer assembly.

13. A vascular puncture sealing system according to claim 12, further comprising a volume of sealant in fluid communication with the side port of the introducer assembly.

14. A vascular puncture sealing system according to claim 12 wherein the side port comprises a three-way valve.

15. A vascular puncture sealing system according to claim 12 wherein the side port comprises a three-way valve operable between a closed position, an first open position fluidly connecting the introducer assembly with a vacuum device, and a second open position fluidly connecting the introducer assembly with a sealant supply.

16. A vascular puncture sealing system according to claim 12 wherein the side port comprises a three-way valve operable between a closed position, an first open position fluidly connecting the introducer assembly with a vacuum device, and a second open position fluidly connecting the introducer assembly with a sealant supply;

wherein the vacuum device comprises a first syringe, and the sealant supply comprises a second syringe containing a volume of sealant.

17. A vascular puncture sealing system according to claim 12 wherein the side port comprises a translucent valve for providing visual indication of blood flow.

18. A vascular puncture sealing system according to claim 12 wherein one of the balloon catheter and introducer assembly comprises a stopper sleeve limiting insertion of the balloon catheter into the introducer assembly.

19. A vascular puncture sealing system according to claim 12 wherein the side port comprises a valve operable between a closed position an open position fluidly connecting the introducer assembly with a sealant supply;

wherein the sealant supply comprises a syringe containing a volume of sealant;

wherein the sealant comprises a gel or foam comprising one of: collagen, polyvinyl alcohol, polyethylene glycol, cyanoacrylates, chitosan, or poly-n-acetyl glucosamine.

20. An internal tissue puncture sealing apparatus, comprising:

a balloon catheter;

an introducer assembly having an introducer lumen receptive of the balloon catheter and at least one side port in flow communication with the introducer lumen, the at least one side port providing a common access point for applying a vacuum force to evacuate the introducer lumen and delivering sealant to the introducer lumen after evacuating the introducer lumen.