# Patent

## Title
Closure device

## Abstract

A closure device for closing an opening in tissue is provided. The closure device according the present invention includes a delivery system for deploying a closure element, wherein the closure element is movable between a delivery configuration and a deployed configuration to close an opening in tissue. The closure device of the present invention may further include a charge of hemostatic material.

## Background
CROSS REFERENCE
This application claims the benefit of, and priority to, U.S. Provisional Patent Application Ser. No. 61/109,822, filed on Oct. 30, 2008 and entitled “CLOSURE DEVICE,” and Ser. No. 61/143,748, filed on Jan. 9, 2009 and entitled “CLOSURE DEVICE,” both of which are incorporated in their entirety herein by this reference.


BACKGROUND
1. The Field of the Invention
The present disclosure relates generally to systems, devices, and methods for blocking an opening in body lumens. More particularly, the present disclosure relates to techniques for percutaneous closure of arterial and venous puncture sites, which are usually accessed through a tissue tract.
2. The Relevant Technology
A number of diagnostic and interventional vascular procedures are now performed translumenally. A catheter is introduced to the vascular system at a convenient access location and guided through the vascular system to a target location using established techniques. Such procedures require vascular access, which is usually established during the well-known Seldinger technique. Vascular access is generally provided through an introducer sheath, which is positioned to extend from outside the patient body into the vascular lumen. When vascular access is no longer required, the introducer sheath is removed and bleeding at the puncture site stopped.
One common approach for providing hemostasis (the cessation of bleeding) is to apply external force near and upstream from the puncture site, typically by manual compression. This approach suffers from a number of disadvantages. For example, the manual compression procedure is time consuming, frequently requiring one-half hour or more of compression before hemostasis is achieved. Additionally, such compression techniques rely on clot formation, which can be delayed until anticoagulants used in vascular therapy procedures (such as for heart attacks, stent deployment, non-optical PTCA results, and the like) wear off. The anticoagulants may take two to four hours to wear off, thereby increasing the time required before completion of the manual compression procedure.
Further, the manual compression procedure is uncomfortable for the patient and frequently requires analgesics to be tolerable. Moreover, the application of excessive pressure can at times totally occlude the underlying blood vessel, resulting in ischemia and/or thrombosis. Following manual compression, the patient typically remains recumbent from four to as much as twelve hours or more under close observation to assure continued hemostasis. During this time, renewed bleeding may resulting in blood loss through the tract, hematoma and/or pseudo-aneurysm formation, as well as arteriovenous fistula formation. These complications may require blood transfusion and/or surgical intervention.
The incidence of complications from the manual compression procedure increases when the size of the introducer sheath grows larger, and/or when the patient is anticoagulated. The compression technique for arterial closure can be risky, and is expensive and onerous to the patient. Although the risk of complications can be reduced by using highly trained individuals, dedicating such personnel to this task is both expensive and inefficient. Nonetheless, as the number and efficacy of translumenally performed diagnostic and interventional vascular procedures increases, the number of patients requiring effective hemostasis for a vascular puncture continues to increase.
To overcome the problems associated with manual compression, the use of bioabsorbable sealing bodies is one example approach that has been proposed. Generally, this example approach relies on the placement of a thrombogenic and bioabsorbable material, such as collagen, at the superficial arterial wall over the puncture site. While potentially effective, this approach suffers from a number of problems. For example, bioabsorbable sealing bodies may lack a solid mechanical attachment of the sealing body to the tissue. Due to the lack of a solid mechanical attachment, the sealing body can wander within the tissue tract or move out of the puncture site, thus causing late bleeds. Conversely, if the sealing body wanders and intrudes too far into the arterial lumen, due to the lack of a solid mechanical attachment, intravascular clots and/or collagen pieces with thrombus attached can form and embolize downstream, causing vascular occlusion.
In addition to not having a solid mechanical attachment to the tissue, the sealing bodies may rely upon expandable materials to achieve hemostasis. Again, the expandable materials lack the security of a hard mechanical closure, thus potentially causing late bleeds and prolonging hemostasis.
BRIEF SUMMARY
This Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This Summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter. Embodiments of the present invention provide systems, methods, and devices for closing an opening in tissue. Embodiments of the invention can be configured to close an opening within a body lumen.
In one example embodiment, a device for closing an opening in tissue includes a tubular body member having a wall thickness, a proximal end, and a distal end. The tubular body member of the device may include slits formed within the tubular member through the wall thickness. The slits are arranged above and below a waist portion located between the proximal end and distal end of the tubular body member.
In another example embodiment, a device for closing an opening in a body lumen wall includes a tubular body element having a first portion, a second portion, and a waist portion located between the first portion and second portion. The first and second portions have a delivery configuration and a deployed configuration. When the first and second portions are in the delivery configuration they have a delivery cross-sectional dimension, and when the first and second portions are in a deployed configuration they have a deployed cross-sectional dimension. The deployed cross-sectional dimension is larger than the delivery cross-sectional dimension.
Another example embodiment discloses a system for closing an opening in a body lumen. The system includes a closure element having a delivery configuration and a deployed configuration. The system further includes an actuator that is coupled to the closure element and operatively associated with a handle assembly. The handle assembly includes a rotatable handle element that may be inserted into a hub member such that when the handle element is rotated, the closure element changes from the delivery configuration to the deployed configuration.
In another example embodiment, a method for closing an opening in a body lumen is disclosed. The method includes inserting a closure device into an opening in a body lumen wall, the closure device including a closure element and actuator. After inserting the closure device, a force is applied to the closure element by way of the actuator such that a first portion of the closure element changes from a delivery configuration to a deployed configuration. Next, a second force may be applied to the closure element by way of the actuator such that a second portion of the closure element changes from a delivery configuration to a deployed configuration.
These and other advantages and features of the present invention will become more fully apparent from the following description and appended claims, or may be learned by the practice of the invention as set forth hereinafter.



BRIEF DESCRIPTION OF THE DRAWINGS
To further clarify the above and other advantages and features of the present invention, a more particular description of the invention will be rendered by reference to specific embodiments thereof which are illustrated in the appended drawings. It is appreciated that these drawings depict only typical embodiments of the invention and are therefore not to be considered limiting of its scope. The invention will be described and explained with additional specificity and detail through the use of the accompanying drawings in which:
FIG. 1 is a cross-sectional view of the closure device in accordance with one embodiment of the present invention;
FIG. 2A is a close-up cross-sectional view of an example embodiment of a closure device in accordance with the present invention;
FIG. 2B is a close-up cross-sectional view of an example embodiment of a closure device in accordance with the present invention and further illustrating a locking mechanism formed therewith;
FIG. 2C is a cross-section view of an example embodiment of a closure element in a deployed configuration;
FIGS. 3 through 6 illustrate the use of an example closure device in accordance with the present invention;
FIGS. 7A through 9B illustrate various embodiments of a closure element in accordance with the present invention;
FIGS. 10 and 11 are cross-sectional views of an alternative embodiment of a closure device including a charge of a hemostatic material;
FIG. 12 is a flow chart showing an example method of closing an opening in tissue in accordance with the present invention;
FIG. 13A is an exploded illustration of a delivery system of one embodiment of the present invention;
FIG. 13B is a top view of a portion of the delivery system of FIG. 13A according to one embodiment of the present invention;
FIG. 13C is another illustration of the delivery system of FIG. 13A according to one embodiment of the present invention;
FIG. 13D is a cross-section illustration of a portion of the delivery system of FIG. 13A;
FIG. 13E is a further illustration of the delivery system of FIG. 13A;
FIG. 13F is a yet further illustration of the delivery system of FIG. 13A; and
FIG. 13G is a perspective illustration of the delivery system of FIG. 13A in combination with an introducer sheath according to another embodiment of the present invention.



DETAILED DESCRIPTION
In accordance with the present invention there is provided a closure device configured to close an opening formed in tissue. The closure devices described herein may be formed of a bioabsorbable material or may be formed of a biocompatible material. It is further contemplated the closure device may be coated with a covering membrane and/or another biocompatible coating as will be described in greater detail below. In one embodiment, the closure device may be configured to be received within the lumen of a medical sheath, for example, in accessing the patient's femoral artery, the physician will typically utilize a 6 French sheath. The closure device may be configured to be received within the lumen of this 6 French sheath. However, it can be understood that embodiments of the closure device may be configured to be received within multiple sizes of sheaths and should not be limited to the example above.
FIG. 1 illustrates one example embodiment of a closure device 10. As shown in FIG. 1 the closure device 10 may include an elongate member 12 that has a proximal end 14 and a distal end 16. The elongate member 12 may also include a passage 18 that extends from the proximal end 14 towards the distal end 16. Within the passage 18 of the elongate member 12, a protrusion 20 extends into the passage 18, thus reducing the cross-sectional dimension of the passage 18 at a location that is between the proximal end 14 and the distal end 16 of the elongate member 12. The closure device 10 further includes an actuator 22 that extends through the passage 18 of the elongate member 12. A closure element 100 extends beyond the elongate member 12 and may be coupled to the actuator 22.
In operation, the closure device 10 may be inserted into a body lumen 30 as illustrated in FIG. 1. In one embodiment, the elongate member 12 and the closure element 100 pass through the proximal luminal wall 34 of the body lumen 30. While within the body lumen 30 the closure element 100 is changed from a delivery configuration, as illustrated in FIG. 1, to a deployed configuration as illustrated in FIG. 2C. While in the deployed configuration the closure element 100 is able to block or otherwise close a puncture in the proximal luminal wall 34.
Referring back to FIG. 1, the structure of the closure device 10 will be discussed in more detail. In particular, the closure device 10 may have configurations and characteristics that vary from one embodiment to the next. For example, the elongate member 12 is one aspect of the closure device 10 that may vary from one embodiment to the next. In particular, the elongate member 12 may have various geometric configurations. As illustrated in FIG. 1, the elongate member 12 may have a substantially circular cross-sectional geometric configuration. In other embodiments, however, the cross-sectional configuration of the elongate member 12 may vary and take various other configurations such as oval, square, triangular or any other configuration or combination of configurations.
Along with the various cross-sectional configurations of the elongate member 12, the passage 18 may also have various cross-sectional configurations. The cross-sectional configuration of the elongate member 12 may or may not match the cross-sectional configuration of the passage 18. Moreover, the cross-sectional configurations of the elongate member 12 and the passage 18 may vary from the proximal end to the distal end of the elongate member 12.
Notwithstanding variations in the geometric configuration, the elongate member 12 may be configured to retain the closure element 100 at the distal end 16 of the elongate member 12. In one example embodiment, illustrated in FIG. 1, the elongate member 12 further includes a protrusion 20 that protrudes inwardly into the passage 18 such that the closure element 100 is not permitted to pass the protrusion 20. The protrusion 20, as illustrated in FIG. 1, also may include a passage such that the actuator 22 may pass through the protrusion section 20 and contact or couple to the closure element 100.
In one example, and as illustrated in FIG. 1, the closure element 100 is generally allowed to be inserted only about halfway into the passage 18 of the elongate member 12 and thereafter is blocked from being inserted further into the elongate member 12 by the protrusion 20. The location of the protrusion 20 may vary from one embodiment to the next. In other example embodiments, the protrusion 20 may be positioned more proximally within the passage 18 of the elongate member 12, or alternatively, the protrusion 20 may be positioned more distally within the elongate member 12. Thus, the position of the protrusion 20 may allow the closure element 100 to either be further inserted into the elongate member or have more of the closure element 100 positioned outside the elongate member 12.
In addition to variations of the protrusion 20 within the passage 18 of the elongate member 12, the distal end 16 of the elongate member 12 may also vary. For example and as illustrated in FIG. 1, the distal end 16 of the elongate member 12 may have a radius. This radius, for instance, may assist when inserting the elongate member 12 into a tissue tract and subsequently into the body lumen 30 through the proximal luminal wall 34. In other example embodiments, the distal end 16 of the elongate member 12 may have various other configurations. For example, they may have various ranges of radii as well as various other geometric configurations, for example, square, triangular, or rectangular.
In addition to the geometric configuration variations, the elongate member 12 may also have various material characteristics. For example, in one embodiment the elongate member 12 may be formed of a rigid material such as a stainless steel or other biocompatible material that is rigid. Alternatively, the elongate member 12 may be formed of a flexible material such as those materials utilized to form catheter shafts, introducer sheaths, or other medical devices. Suitable materials include polyvinyl chloride (PVC), peak, PTFE, nylon, or any other similar materials.
As discussed, the actuator 22 may extend through the elongate member 12. The actuator 22 is another aspect of the closure device 10 that may vary from one embodiment to the next. As shown in FIG. 1, the actuator 22 extends through the passage 18 of the elongate member 12 and couples to or attaches to the closure element 100. One way in which the actuator 22 may vary is the cross-sectional geometric configuration of the actuator. FIG. 1 illustrates an actuator 22 that has a substantially circular cross-sectional configuration. In other example embodiments, the cross-sectional geometric configuration of the actuator 22 may vary and include configurations such as square, triangular, rectangular or any other geometric configuration. In one example embodiment, the geometric configuration of the actuator 22 may be configured to match the cross-sectional geometric configuration of the passage 18 within the elongate member 12.
Another way in which the actuator 22 may vary is the material from which the actuator 22 is made. For example, the actuator 22 may be made from a rigid material such as stainless steel or other biocompatible materials that are rigid. Alternatively, the actuator 22 may be formed of a flexible material, for example, if the elongate member 12 is made from a flexible material. Examples of flexible actuator 22 materials include polyvinyl chloride (PVC), peak, PTFE, nylon, or similar materials. Generally, the actuator 22 material may be made from any material that is able to have enough strength and structural properties to change the closure element 100 from a delivery configuration, as shown in FIG. 2A, to a deployed configuration, as shown in FIG. 2C.
Another way in which the actuator 22 may vary is the way in which it connects to or attaches to the closure element 100. FIG. 2B illustrates a cross-sectional view of the closure element 100 that shows one example of connecting the actuator 22 to the closure element 100. For example, actuator 22 may include a coupler element 24 that is configured to couple to the distal end 106 of the closure element 100. In one example embodiment, and as illustrated in FIG. 2B, the coupler element 24 includes a section that has a larger cross-sectional dimension than the actuator 22. In this example, the coupler element 24 may interface with the distal end 106 of the closure element 100 such that the coupler element 24 is held by the material of the closure element 100 (e.g., the closure element 100 material surrounds the coupler element 24. In other example embodiments, the coupler element may simply attach to or couple to the distal end 106 of the closure element 100 by an adhesive or other bonding means.
In addition to the coupler element 24, the actuator 22 may also include a locking element 26, as illustrated in FIG. 2B. The locking element 26 may vary from one embodiment to the next. For example, and as illustrated in FIG. 2B, the locking element 26 has a triangular configuration, however, in other example embodiments the geometric configuration of the locking element may take various forms such as square, rectangular, oval, circular or any other configuration.
In particular, the geometric configuration of the locking element 26 is configured such that the locking element 26 and the proximal end 104 of the closure element 100 cooperate to lock the closure element 100 in the deployed configuration. For example, and as illustrated in FIGS. 2B and 2C, the locking element 26 may be pulled through the proximal end 104 of the closure element 100. Once pulled through the proximal end 104 of the closure element 100, the locking element 26 and/or the proximal end 104 of the closure element 100 may be configured such that the locking element 26, in combination with the proximal end 104 of the closure element 100, restricts the actuator from moving distally with respect to the closure element 100. In other words the locking element 26 may be configured to facilitate removal of the locking element 26 from within the closure element 100, but after removal from the closure element 100, the locking element 26 may not be allowed to re-enter the closure element 100.
Notwithstanding the various configurations and characteristics of both the elongate member 12 and the actuator 22, the closure element 100 may be configured to be operatively associated with the elongate member 12 and the actuator 22 in order to be delivered and deployed in an opening within a body lumen. Continuing now with FIGS. 2A, 2B, and 2C, the closure element 100 will be discussed in more detail. As illustrated in FIG. 2A, the closure element 100 may include a body member 102 that has a proximal end 104 and a distal end 106. The body member 102 may also include a waist portion 108 that separates a plurality of proximal slits 110 from a plurality of distal slits 112. Moreover, the closure element 100 may have a delivery configuration, as illustrated in FIG. 2A, and a deployed configuration, as illustrated in FIG. 2C.
As with other aspects of the closure device 10, the closure element 100 may vary from one embodiment to the next. One way in which the closure element 100 may vary is the cross-sectional configuration of the closure element 100 body member 102. For example, and as illustrated in FIG. 2A, the body member 102 may have a generally cylindrical cross-sectional configuration. In other example embodiments, the cross-sectional configuration of the body member 102 may take various forms such as square, rectangular, triangular or any other cross-sectional configuration.
Another way in which the closure element 100 may vary is the geometric dimensions of the proximal slits 110 and/or distal slits 112. For example, the geometric configuration of the upper and lower slits 110 and 112, as shown in FIG. 2A, may be a generally rectangular configuration. However, in other example embodiments the geometric configuration of the proximal slits 110 and/or the distal slits 112 may take various other geometric configurations such as more square, triangular, oval or any other configuration or combination configurations. The slits may be formed within the wall of the body member 102 using known manufacturing techniques such as cutting, laser cutting, water jet cutting. Alternatively, the slits may be integrally formed within the body member 102 during manufacturing such as through the use of injection molding.
Furthermore, and as illustrated in the example embodiment in FIG. 2A, the proximal slits 110 may have substantially the same configuration and dimensions as the distal slits 112. In other example embodiments, however, the proximal slits may have a different geometric configuration and/or dimension compared to the distal slits 112. For example, in one embodiment, the proximal slits 110 may have a different length and width as the distal slits 112, or the proximal slits 110 may have a different geometric configuration relative to the distal slits 112.
In addition to variations between the proximal slits 110 and the distal slits 112, the geometric configuration and the dimensions of the proximal slits 110 and/or distal slits 112 may vary from one slit to the next. For instance, the upper slits 110 may have a variety of different sized and configured slits that make up the plurality of upper slits 110. Similarly, the lower slits 112 may be made up of a variety of different sized and configured individual slits.
Another way in which the proximal slits 110 and distal slits 112 may vary is the alignment configuration between the proximal slits 110 with respect to the distal slits 112. For example, as illustrated in FIG. 2A, the proximal slits 110 may be substantially aligned with the distal slits 112. However, in other example embodiments, the proximal slits 110 may be positioned such that the proximal slits are misaligned with the distal slits 112. In the same respect, the number of proximal slits 110 compared to the number of distal slits 112 may vary from one embodiment to the next. As shown in FIG. 2A, there are an equal number of proximal slits 110 relative to the number of distal slits 112. In other examples, however, the closure element 100 may have more proximal slits 110 compared to distal slits 112. For example, a closure element may be configured such that there are six distal slits equally spaced around the body member 102 of the closure element 100, while there are only four proximal slits 110 positioned and equally spaced around the body member 102 of the closure element 100.
As can be understood, the spacing between each individual slit may also vary from one embodiment to the next, as well as from one slit to the next. For example, and as previously mentioned, the upper and/or lower slits 110 and 112 may have the slits positioned and equally spaced around the body member 102. Alternatively, the slits may be positioned around the body member 102 such that the spacing between slits varies.
The distance between the proximal slits 110 and the distal slits 112 is another aspect of the closure element 100 that may vary from one embodiment to the next. In one example embodiment, the distance between the proximal slits 110 and the distal slits 112 is a distance that would be approximately equal to the width of a body lumen wall. For example, the distance between the upper and distal slits may be equal to the width of the proximal lumen wall 34, illustrated in FIG. 1. In this manner, the closure element 100, when in the deployed configuration, would assist in blocking an opening within the proximal lumen wall 34.
FIG. 2B illustrates various other aspects of the closure element 100 that may vary from one embodiment to the next. For example, FIG. 2B illustrates that the closure element 100 may include an aperture 105 located on the proximal end 104 of the body member 102. In one embodiment, the proximal end 104 of the body member 102 of the closure element 100 may be made of material that is flexible such that the locking element 26 of the actuator may be pulled in a proximal direction through the aperture 105 located on the proximal end 104 of the closure element 100. Moreover, the proximal end 104 of the body member 102 may have a geometric and/or material configuration that allows the locking element 26 or similar feature of the actuator to pass through in one direction (i.e. the proximal direction) but not pass through in the opposite direction (i.e. the distal direction).
For example, the proximal end 104 may be configured with a plurality of cuts that are arranged in a generally circular pattern around the aperture 105 such that each cut extends away from the aperture along a radius line. The cuts may be formed at an angle such that the material on the proximal end 104 between the cuts are allowed to flex in a direction that would allow the locking element 26 to pass through the aperture 105 of the closure element 100. However, once the locking element 26 has passed through the aperture 105, the proximal end 104 material between the cuts is not permitted to flex to allow the locking element 26 to again pass through the aperture 105. In other words, the material at the proximal end 104 of the closure element 100 may only flex in one direction and thus resist movement of the locking element 26 in the distal direction after the locking element 26 has passed through the aperture 105.
The locking element 26, along with the configuration of the closure element 100 assist to change the closure element 100 from a delivery configuration, shown in FIGS. 1 and 2A, to a deployed configuration shown in FIG. 2C. In one embodiment, the actuator 22 cooperates with the closure element 100 to collapse the body member 102 of the closure element such that the proximal slits 110 and the distal slits 112 allow the portions of the body member 102 between the proximal slits 110 and distal slits 112 to collapse and flex radially outwardly. Moreover, when in the deployed configuration, the actuator 22, with the locking element 26 and the coupler element 24 may cooperate with the closure element 100 such that the body member 102 of the closure element 100 may be changed into, and held locked in, the deployed configuration. Specifically, the locking element 26 cooperates with the coupler element 24 such that the body member 102 of the closure element 100 is held in place in the deployed configuration between the locking element 26 and the coupler element 24.
The deployed configuration of the closure element 100 may have various configurations. For example, in one embodiment, the deployed configuration of the closure element 100 may provide a clamping force upon the body lumen wall, thus holding the closure element 100 in place within the opening in the body lumen. Additional characteristics and configurations of the closure element 100 in the deployed configuration will be discussed with respect to FIGS. 6 through 9B.
Another way in which the closure element 100 may vary is the type of material used to make the closure element 100. In one embodiment the closure element 100 is manufactured from a bioabsorbable, bioresorbable, bioerodible, and/or biodegradable material. Examples of suitable materials for use are metals, metal alloys, polymers or combinations thereof that decompose or biodegrade in a biological environment such as within a body lumen. For example, and not by limitation, suitable bioabsorbable materials may include magnesium, zinc, silicon, lithium, zinc titanium, magnesium lithium, polyglocic acid (PGA), polyhydroxybutyric acid, polyL-Lactic acid (PLLA), polydilactidel glycolide acid, polydilactid acid, PolyDL Lactide-co-gycolide, Polylactic acid, Polylicolic acid, Polyhydroxyalkanoates or derivatives thereof and any combination thereof.
In addition to the various types of materials that may be used to manufacture the closure element 100, the closure element 100 may include additional material properties that may be useful. For example, the closure element 100 may be covered with a flexible membrane to aid in sealing the opening. The flexible membrane may be formed of a flexible bio-compatible or bioabsorbable material such as any of those that were described above. Moreover, the closure element 100 may further include a beneficial agent either disposed thereon as a coating or integrally formed within the absorbable material wherein the beneficial agent would be configured to aid in healing and/or reduce the potential for infection.
Moreover, material properties may be included in the closure element 100 to help a user place the closure element 100. For example, the closure component 100 may further include a radiopaque marker or radiopaque coating in order to aid the user in positioning the closure element 100 within the puncture site of the body lumen. The radiopaque marker may be formed within the wall of the body member 102 in the form of a rivet. Alternatively, a radiopaque coating may be disposed on the body member 102 as a thin coating of radiopaque metal such as gold, tantalum, alydium, platinum, uridium or similar metals.
Referring now to FIGS. 3 through 6, the operation of the closure device 10 will be explained in more detail. Initially, the closure device 10 is inserted in a tissue tract and disposed through an opening or puncture within a body lumen. For example and as shown in FIG. 1, the closure device 10 may be disposed through the proximal lumen wall 34 of the body lumen 30. After disposing the closure device 10 through the opening in the proximal lumen wall 34 the closure element 100 may be changed from a delivery configuration to a deployed configuration.
In one embodiment, the process of changing the closure element 10 from a delivery configuration to a deployed configuration begins with positioning the closure element 100 within the elongate member 12 such that the distal slits 112 are located outside of the elongate member 12 and the proximal slits 110 are located within the elongate member 12. In one example, this position of the closure element 100 may correspond to the protrusion 20 located within the elongate member 12 as discussed above and as illustrated in FIG. 3.
With the distal slits 112 positioned outside of the elongate member 12, the actuator 22 may be moved in the proximal direction (as indicated by the arrow in FIG. 3) such that the portions of the body member 102 located in-between the distal slits 112 are forced to collapse, bend, and/or buckle and extend in an outward direction as shown in FIG. 3. In particular, the actuator 22 may pull the distal end 106 of the closure element 100 in a proximal direction by way of the coupler element 24 that is coupled to the distal end 106 of the closure element 100. The distal slits 112 may weaken the body member 102 such that upon experiencing the force associated with pulling the distal end 106 of the closure element 100 in the proximal direction, the portions of the body member 102 in-between the distal slits 112 collapse, the collapsing portions of the body member 102 extending out from the closure element 100. On the other hand, because the proximal slits 110 are positioned within and stabilized by the elongate member 12, the portions of the body member 102 in-between the proximal slits 110 may not collapse.
Once the portions of the body member 102 in-between the distal slits 112 have collapsed, the closure device 10 may be moved in the proximal direction such that the deployed lower section of the closure element 100 is generally in contact with the inside portion of the proximal lumen wall 34, as illustrated in FIG. 4. At this position, the deployed section of the closure element 100 is within the body lumen 30, the waist portion 108 of the closure element 100 extends through the opening in the proximal lumen wall 34, and the proximal slits 110 are located outside the body lumen 30.
When in this position, the elongate member 12 may be moved in a proximal direction relative to the closure element 100 such as to reveal or release the proximal slits 110 from the elongate member 12. In one example embodiment, the actuator 22 is held in substantially a constant position, while the elongate member 12 is pulled or otherwise moved in a proximal direction with respect to the closure element 100. Moreover, the distal end 16 of the elongate member 12 may be configured with a bias that applies a radially compressive force on the closure element 100. Thus, once the closure element is released from the elongate member 12, the user may sense the release and/or feel that the resistance to the movement of the elongate member 12 has changed indicating that the proximal slits 110 have been released from the elongate member 12.
At this point the proximal slits 110 are now in position for the proximal portion of the closure element 100 to be deployed. As illustrated in FIG. 5, the proximal portion of the closure element 100 is deployed by having the portions of the body member 102 in-between the proximal slits 110 collapse such that the portions of the body member 102 in-between the proximal slits 110 extend radially outwardly as illustrated in FIG. 5. In order to deploy the upper portion of the closure element 100, the actuator 22 may be moved in a proximal direction (as illustrated by the arrow in FIG. 5) thus applying a force to the closure element 100 that causes the portions of the body member 102 in-between the proximal slits 110 to collapse and extend outwardly.
Moreover, and as illustrated in FIG. 5, during or after the deployment of the proximal portion of the closure element 100, the locking element 26 located on the actuator 22 may be pulled through the aperture 105 in the proximal end 104 of the closure element 100. The locking element 26 is then allowed to rest or push on the proximal end 104 of the closure element 100 such that the closure element is held in the deployed configuration between the locking element 26 and the coupler element 24 of the actuator.
FIG. 6 shows a close-up view of a deployed closure element 100 within an opening of a body lumen 30. As shown in FIG. 6, the proximal slits 110 and distal slits 112 have allowed the proximal and distal portions of the body member 102 to collapse, and thus the portions of the body member 102 in-between the slits have extended outwardly such that the proximal lumen wall 34 is located between the collapsed proximal portion and the collapsed distal portion of the closure element 100. The waist portion 108 of the body member 102 may be located at least partially within the opening in the proximal lumen wall 34 of the body lumen 30.
FIG. 6 further illustrates that the deployed closure element 100 may be held in a deployed configuration by the coupler element 24 and the locking element 26. In particular, the locking element 26 cooperates with the coupler element 24 such that the closure element 100 is squeezed or otherwise restricted between the coupler element 24 and the locking element 26. In this way, the portions of the body member 102 that have collapsed are held in the collapsed or deployed configuration and are not permitted to return to the pre-collapsed or delivery configuration.
Once the closure element 100 is locked in the deployed configuration, the actuator 22 portion proximal to the locking element 26 may be severed or cut using a secondary cutting device or, alternatively, the actuator 22 may be configured such that upon application of another proximal force a weakened portion of the actuator 22 allows the actuator to break free at a location on the actuator 22 that is proximal to the locking element 26. The severed actuator 22 and the elongate member 12 are then removed from the tissue tract leaving the deployed closure element 100 within the puncture or opening within the body lumen 30.
FIGS. 7A through 8B illustrate various additional example embodiments of the closure element 100. For example, FIG. 7A illustrates a closure element 100 that includes a body member 102 with a proximal end 104 and a distal end 106. The body member 102 has proximal slits 110 and distal slits 112 formed within the body member 102 of the closure element 100. The proximal slits 110 and the distal slits 112 may have various arrangements and alignments with respect to one another. The arrangement and alignment of the proximal slits 110 and the distal slits 112 may affect the deployed configuration of the closure element 100. Thus, the proximal slits 110 and the distal slits 112 may have almost any arrangement and alignment configurations that subsequently determine the deployed configuration of the closure element 100.
For example, and as illustrated in FIGS. 7A through 7B, the closure element 100 may take various forms. In particular, the example closure element 100, illustrated in FIG. 7A, includes proximal slits 110 that are offset from the distal slits 112. In other words, the proximal slits 110 are not vertically aligned with the distal slits 112. This example offset arrangement of the proximal and distal slits 110 and 112 may result in the closure element 100 having a deployed configuration as illustrated in FIG. 7B.
Specifically, when in the deployed configuration, the closure element 100 has upper extensions 114 and lower extensions 116. As illustrated in FIG. 7B, the upper extensions 114 may be offset from the lower extensions 116 such that the upper extensions 114 and lower extensions 116 alternate as viewed from the distal end 106 of the closure element 100. In other example embodiments, the upper extensions 114 and lower extensions 116 may be configured such to have any pattern of alignment or arrangement with respect to one another or with respect to other portions of the closure element 100 depending on the alignment or arrangement of the proximal slits 110 with respect to the distal slits 112.
FIG. 8A shows another alternative embodiment of the closure element 100 that varies the configuration of the proximal slits 110 and the lower slits 112 to produce another example of the deployed configuration of the closure element 100. As illustrated in FIG. 8A, the closure element 100 has a body member 102 that has a proximal end 104 and distal end 106 and also includes a waist portion 108. The waist portion 108 is positioned between proximal slits 110 and distal slits 112. In this example embodiment, the proximal and distal slits 110 and 112 are curved or have a radius, as illustrated in FIG. 8A. The curved proximal slits 110 and curved distal slits 112 produce curved upper and lower extensions 114 and 116 when the closure element 100 is changed into the deployed configuration. Moreover, and as illustrated in FIG. 8B, the curved upper and lower extensions 114 and 116 may alternate one from another. As with the embodiment shown in FIG. 7A, the curved upper and lower extensions 114 and 116 may have any alignment or arrangement configuration with respect to one another.
In addition to the two embodiments of the closure element 100, illustrated in FIG. 7A through FIG. 8B, the upper and distal slits 110 and 112 may have various other configurations such as a zigzag pattern, an oval pattern or any other pattern or configuration that would produce various arrangement and alignment configurations of the upper extensions 114 and/or lower extensions 116. Moreover, there can be any combination between the proximal slits 110 and the distal slits 112. For example, the proximal slits may take on a more rectangular configuration, as shown in FIG. 7A, and the distal slits 112 may take on a curved configuration as shown in 8A. Thus, the deployed configuration of the closure element 100 may have upper extensions 114 that are rectangular, as shown in 7B, and lower extensions 116 that are curved, as shown in FIG. 8B.
Although FIGS. 7A through 8B addresses various example configurations of the closure element 100 that have proximal and distal slits 110 and 112, the closure element 100 may be configured to not contain any slits. For example, FIGS. 9A and 9B show an example embodiment of a closure element 100 that does not include any proximal or distal slits; however, the closure element 100 is still able to collapse such to form the deployed configuration of the closure element 100. In particular, the sidewall of the closure element 100, as illustrated in FIG. 9B, may include indentations 118 or other areas within the wall that create natural weaknesses or breaking points. The indentations 118 within the closure element wall 120 may be configured such that when a compressive force is applied from the actuator 22, the closure element 100 collapses around the weakened portions of the indentation 118.
The indentations 118, shown in FIG. 9B, may vary from one embodiment to the next. For example, the number of indentations that are located on the sidewall 120 of the closure element 100 may vary. In one example embodiment illustrated in FIG. 9B, the sidewall 120 of the closure element 100 includes two indentations 118. Each indentation 118 would produce extensions when the closure device is changed to the deployed configuration, thus two extensions (for example an upper and lower extension) would be made from the example embodiment shown in FIG. 9B. However, in other example embodiments, more or less indentations may be used in order to create various or multiple sections of that collapse to form a barrier within an opening of a body lumen.
FIGS. 10 and 11 show another optional embodiment of a closure device 200. As illustrated in FIG. 10, closure device 200 may include an elongate member 12 that has a passage 18 extending through from a proximal end to a distal end. The elongate member 12 may be configured to accept and retain a closure element 100. The closure element may include a proximal end 104, a distal end 106, and a waist portion 108 that is located between the proximal end 104 and the distal end 106. In one embodiment, the closure element 100 may contain proximal slits 110 and distal slits 112, as previously discussed. Closure device 200 further includes an actuator 22 that is connected to the closure element 100. The actuator 22 is associated with a second actuator 40. Located within the passage 18 within the elongate member 12 may be a hemostatic agent 50.
In one example embodiment of the closure device 200, the second actuator 40 has a slightly larger cross-sectional dimension than the cross-sectional dimension of the actuator 22. In this way a space is located in the passage 18 between the elongate member 12 and the actuator 22 such that a hemostatic agent 50 may be placed next to the actuator 22. Moreover, the second actuator 40 may be configured and sized appropriately such that the clearance between the second actuator 40 and the elongate member 12 through the passage 18 is minimal, allowing the second actuator 40 to press or move the hemostatic agent 50 through the passage 18 of the elongate member 12.
As shown in FIG. 11, the basic operation of the closure device 200 may be similar to the basic operation previously discussed with closure device 10. However, in this embodiment after the closure element 100 is secured in the deployed configuration about the proximal lumen wall 34, the second actuator 40 will then be positioned to press the hemostatic agent 50 out of the elongate member 12. Specifically, once the closure element 100 is in the deployed configuration, the elongate member 12 may be moved in the proximal direction and the second actuator 40 may be pressed in the distal direction such that the hemostatic agent 50 is forced out of the elongate member 12 and onto the surface of the deployed closure element 100, and thus the hemostatic agent may be deposited onto the portion of the proximal lumen wall 34 that is in the general area of the deployed closure element 100.
The hemostatic agent 50 may be any material configured to aid in the healing of the body lumen wall as well as to cause the cessation of bleeding. Moreover, the hemostatic agent 50 may contain any material or agent that may be used to avoid infection. Suitable hemostatic materials for any of the embodiments described above may include chitosan, collagen, thrombin, PEG or other biocompatible materials. In one embodiment, chitosan may be utilized. The chitosan hemostatic composition may provide a strong clotting action to seal a hole, puncture, incision, or any other bleeding site to promote enhanced healing of the bleeding site and reduce opportunities for infection. Additionally, the chitosan hemostatic composition can be configured to swell in the presence of blood to form a hemostatic barrier that covers or otherwise plugs the bleeding site.
Chitosan is a polycationic polymer derived from chitin, which can also be used as described herein. Chitosan has a positive charge from primary amine groups that can interact with the negative charge of the lipids present on cell surfaces, such as blood cells. This electrostatic interaction has been identified as an aspect of the hemostatic properties of chitosan. Dry chitosan compositions can have increased hemostatic properties by increasing surface area, and thereby the contact area with blood. Processing methods, such as freeze drying, puffing, foaming, sponging, ballooning, combinations thereof, or the like, can be used to provide a porous, open cellular, or closed cellular structure with increased surface area. In addition to chitosan and/or chitin, other polymers having N-acetylglucosamines and N-glucosamines, such as poly-beta-1→4-N-acetylglucosamines with or without one or more monosaccharides being deacetylated and poly-beta-1→4-N-glucosamines, and derivatives thereof.
The chitosan or other similar polymer used in various embodiments of the present invention may be purified to facilitate use in a medical device and or used within the body of a subject. This may include being purified to remove proteins, other organic or inorganic contaminants. Such purification and processing of chitosan is well known in the art. Accordingly, the chitosan or other similar polymer can be considered to be biocompatible, immunoneutral, and/or generally recognized as safe for use with or within a subject, such as a human or other animal.
Once the hemostatic agent 50 has been deployed next to the deployed closure element 100, the elongate member 12 along with the associated actuator 22 and second actuator 40 may be removed from the patient.
The closure device discussed with the various example embodiments of the present invention may include various other configurations. For example, any configuration of the closure device that includes a closure element that is able to anchor on the inside surface of the body lumen wall as well as on the outside surface of the body lumen wall (i.e. sandwich the wall of the body lumen between two closure elements or two closure element portions) may be used with the closure device contemplated with the present invention.
Accordingly, the previous figures and the corresponding text provide a number of different components and systems that may be used to close an opening in a body lumen. In addition to the foregoing, other example embodiments may also be described in terms of flowcharts comprising one or more acts in a method for accomplishing a particular result. For example, FIG. 12 illustrates a method 600 of closing an opening in tissue. The acts of method 600 are discussed more fully below with respect to the disclosures of FIGS. 1 through 11.
For example, FIG. 12 shows that a method in accordance with an example implementation of the invention may include inserting 602 a closure device into an opening in a body lumen wall. Inserting a closure device may involve inserting a closure device into an opening formed in tissue, the closure device including a delivery tube, an actuator, and a closure element, the closure element defined by a body having a proximal portion, a distal portion and a waist. For example, as shown in FIG. 3, the closure element 100 may be inserted through the proximal lumen wall 34.
After the closure device is inserted into an opening, a force may be applied 604 to the actuator to move a first portion of a closure element from a first configuration to a second configuration. Applying a force may involve applying a force to the actuator to move the distal portion of the closure element from a first configuration toward a second configuration, wherein in the second configuration, portions of the closure element protrude from the body. For example, as shown in FIG. 3, the actuator 22 may be moved in a proximal direction (as indicated by the arrow) such that the portions of the body member 102 located in-between the distal slits 112 are forced to collapse, bend, and/or buckle and extend in an outward direction thus causing the distal portion of the closure element 100 to change from a delivery configuration to a deployed configuration.
Next, a second force may be applied 606 to an actuator to move a second portion of the closure element from a first configuration towards a second configuration. Applying a second force may involve applying a second force to the actuator to move the proximal portion of the closure element from a first configuration toward a second configuration. For example, and as illustrated in FIG. 5, the actuator 22 may be moved in a proximal direction, thus causing the portions of the body member 102 in-between the proximal slits 110 to collapse and extend outwardly.
FIGS. 13A through 13G illustrate an example embodiment of a closure device that uses a handle assembly 400. In particular, FIG. 13A illustrates a closure device that includes a handle assembly 400 that has a handle element 402 and a hub member 404. The handle element 402 has a proximal end 406, a distal end 408, a grip portion 410, and an extended portion 412. Projections 414 may extend from the extended portion 412. Moreover, the handle element 402 includes a port 416 through which an actuator 22 may extend.
The handle element 402 is operatively associated with a hub member 404. The hub member 404 includes a hub body 418 that has a proximal end 420 and a distal end 422. A channel 424 is formed within the hub body 418 of the hub member 404, the channel 424 configured to cooperate with the projections 414 located on the handle element 402. An elongate member 12 may be connected to the hub member 404. The elongate member 12 may be configured such that an actuator 22 may extend through the elongate member 12. Attached to a distal end of the actuator 22 is a closure element 100, as illustrated in FIG. 13A.
Briefly, in operation, the handle assembly 400 assists a user in deploying the closure element 100 within an opening in a body lumen. For example, after the closure element 100 is positioned appropriately within the opening in the body lumen, as discussed above, the user may turn the handle element 402, which in turn assists to deploy the closure element 100. Specifically, the handle element 402 may be coupled to the actuator 22 such that as the handle element 402 is rotated, the actuator applies a force upon the closure element 100 that causes the closure element 100 to change from a delivery configuration to a deployed configuration, as discussed above.
The handle assembly 400, shown in FIG. 13A, may vary from one embodiment to the next. For example, the handle element 402 is one example aspect of the handle assembly 400 that may vary. FIG. 13B shows a bottom view of the handle element 402. The bottom view of the handle element 402 illustrates the grip portion 410, the extended portion 412, and the projections 414 that extend from or project out from the extended portion 412. Moreover, FIG. 13B illustrates the port 416 through which the actuator 22 may extend.
The geometric configuration is one way in which the handle element 402 may vary. As illustrated in FIG. 13B, the geometric configuration of the handle element 402 may have a substantially circular cross-sectional configuration. However, in other example embodiments, the cross-sectional configuration of the handle element including the extended portion 412 and the grip portion 410 may have various other geometric configurations such as square, rectangle, triangle or any other configuration or combination of configurations.
Moreover, and as shown in FIGS. 13A and 13D, the handle element 402 may include a set screw 428. The set screw 428 may be positioned in the grip portion 410 such that a set screw may be used to secure the position of the actuator 22. FIG. 13D illustrates how the set screw 428 may be positioned such to enter from the side of the grip portion 410 and into the port 416, and thus, secure the actuator 22.
Another way in which the handle element 402 may vary is the characteristics of the projections 414. As shown in FIG. 13D, the projections 414 may be made from a different piece of material than the extended portion 412. In alternate embodiments, the projections 414 may be manufactured out of the same piece of material as the extended portion 412.
Not only can the manufacture method vary with respect to the projections 414, but the location of the projections 414 on the extended portion 412 may vary from one embodiment to the next. As illustrated in FIGS. 13A and 13D, the projections 414 may be located on the distal end 408 of the handle element 402. However, in alternative embodiments, the projections 414 may be located at various other locations or almost any location on the extended portion 412.
Another aspect of the handle element 402 that may vary from one embodiment to the next is the grip portion 410. The grip portion 410 may be sized such that a human finger or a human hand would be able to easily turn and twist the grip portion 410. In order to help with the twisting of the handle element 402, the grip portion 410 may include a friction provider such as a piece of rubber or a pattern within the sidewall of the grip portion to aid in helping a human hand grip the grip portion 410 and turn the handle element 402.
In addition to various geometric characteristics, the handle element 402 may vary in material composition. For example, in one example embodiment the handle element 402 may be made from a metal such as stainless steel. Other materials may be used to make the handle element 402 such as plastics, ceramics or any other material that would have structurally suitable properties.
Just as the handle element 402 may vary from one embodiment to the next, so too may the hub member 404. For example, the cross-sectional configuration of the hub member 404 may vary from one embodiment to the next. The hub member, as illustrated in FIG. 13A, has a substantially circular cross-sectional geometric configuration. Alternatively, in other example embodiments, the hub member 404 may have a cross-sectional geometric configuration that is square, rectangular, hexagonal, or any other configuration or combination of configurations.
Notwithstanding the cross-sectional configuration of the hub member 404, the way in which the channel 424 is located throughout the hub member 404 may vary. For example, and as illustrated in FIG. 13A, the channel 424 is configured such that the handle element 402 is allowed to rotate one full turn within the hub member 404. Alternatively, the channel 424 may be configured to allow more or less rotation of the handle element 402. In one example embodiment, the channel 424 may only allow for a half turn of the handle element 402. Alternatively, in other embodiments of the invention, the channel 424 may allow for multiple rotations of the handle element 402.
In addition to the number of rotations in which the channel 424 allows the handle element 402 to make, the channel 424 may also be configured with various pathways. For example, and as illustrated in FIG. 13A, the pathway of the channel 424 is relatively smooth from the bottom portion of the channel 424 around to the top portion of the channel 424. However, in alternative embodiments, the channel 424 may have step sections such that the projections 414 on the handle element 402 move within the channel at various steps from one depth to the next. In another example embodiment, the channel 424 may direct the handle element 402 to move with a combination of relatively smooth movements and stepped movements.
The operation of the handle assembly 400 will be discussed in further detail with reference to FIGS. 13C through 13G. The handle element 402 is inserted within a receiving area 426 located within the hub member 404, as illustrated in FIG. 13D. The projections 414 located on the extended portion 412 of the handle element 402 interact with the channel 424 on the hub member 404 such that as the handle element 402 is turned, the position of the handle element relative to the hub member 404 changes.
For example, and as illustrated in FIG. 13C, the handle element 402 is located towards the distal end of the hub member 404. When the handle element 402 is rotated, the projections 414 follow the channels 424 such that the handle element 402 moves in the proximal direction with respect to the hub member 404, as illustrated in more detail in FIGS. 13E and 13F. Moreover, if the actuator 22 is secured to the handle element 402 by way of the set screw 428, then as the handle element 402 moves in the proximal direction with respect to hub member 404, the handle element 402 also pulls the actuator 22 in the proximal direction. Thus, as the handle element 402 is rotated, the actuator 22 is pulled in a proximal direction and the closure element 100 may be deployed, as previously described with relation to FIGS. 3 through 6.
In one specific embodiment, the closure element 100 with the handle assembly 400 cooperates with an introducer sheath 500, as illustrated in FIG. 13G. The introducer sheath 500 may include an introducer elongate member 502. The elongate member 12 and the closure element 100 are passed through the introducer sheath 500 and extend through the introducer elongate member 502 such that the closure element 100 protrudes from the distal end of the introducer elongate member 502. In one example embodiment, the closure element 100 has the distal slits protruding from the introducer elongate member 502.
In operation, the introducer sheath 500 may already be positioned such that the introducer elongate member 502 is located at least partially within the body lumen or extended through an opening in a body lumen wall. The closure element 100, along with the elongate member 12, may then be introduced into the introducer sheath 500 and positioned within the opening in the body lumen. With the closure device located within the introducer sheath 500, the handle element 402 may be rotated such that the actuator 22 is pulled in the proximal direction and the lower or distal region of the closure element 100 changes from a delivery configuration to a deployed configuration, as shown in FIG. 13E.
After the first portion of the closure element has been deployed, the introducer sheath 500 and the introducer elongate member 502 may be moved in the proximal direction such as to uncover the proximal slits 110. At this point, the handle element 402 may be again twisted or rotated such that the actuator 22 is moved or pulled in the proximal direction, thus deploying the upper portion of the closure element 100, as shown in FIG. 13F.
The amount of rotation that may be needed to deploy the closure element 100 or change the closure element 100 from a delivery configuration to a deployed configuration may vary. In one example embodiment, the handle element 402 may be turned one half of a turn to deploy the first portion of the closure element 100 and then turned another half of a turn to deploy the second portion of the closure element 100. However, in other example embodiments it is understood that larger or smaller rotation may be used to deploy the closure element 100.
Once the closure element 100 is deployed and in place within the body lumen wall, the remainder of the closure device and the introducer sheath can be removed in a similar manner as described with respect to FIGS. 3-6.
The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope. It shall be further understood that although the present invention has been described in relation to vessel closure, it is contemplated that the closure component of the present invention may be utilized to close other openings in the body such as PFO openings, or openings formed in organs such as the stomach for certain surgical procedures.

## Claims

1. A method of closing an opening in a blood vessel, the method comprising:
inserting a closure device at least partially through the opening and into the blood vessel, the closure device including a delivery tube, an actuator, and a closure element, the closure element comprising a body having a proximal portion, a distal portion, and a waist portion, a distal end of the delivery tube being configured with a bias and applies a radial compressive force to the closure element;
reconfiguring the distal portion of the closure element from a pre-deployed configuration to a deployed configuration, by pulling a distal end of the closure element in a proximal direction, while maintaining the proximal portion of the closure device in a pre-deployed configuration, wherein in the deployed configuration, one or more extensions of the distal portion protrude outward from the body beyond an outer edge of the opening in the blood vessel;
engaging an inside portion of the blood vessel distally from the opening in the blood vessel with the distal portion of the closure device by moving the closure device in a proximal direction;
following engaging the inside portion of the opening in the blood vessel, deploying the proximal portion of the closure element from the delivery tube;
reconfiguring the proximal portion of the closure element from the pre-deployed configuration to a deployed configuration by collapsing a collapsible portion of the body in an outward direction, wherein in the deployed configuration, one or more extensions of the proximal portion protrude outward from the body to engage an outside portion of the blood vessel proximally from the opening in the blood vessel; and
locking the proximal portion and the distal portion of the closure element in the deployed configuration by advancing a locking element formed on the actuator through a lumen of the proximal portion.

2. The method recited in claim 1, wherein the locking element is tapered from a proximal end to a distal end.

3. The method according to claim 1, further comprising deploying a hemostatic material on or adjacent to the opening in the blood vessel.

4. The method recited in claim 1, further comprising disengaging the delivery tube and actuator from the closure element and removing the delivery tube and actuator.

5. The method recited in claim 1, further comprising holding the proximal end of the closure device between the locking element and a coupler element, the coupler element being coupled to or incorporated with the actuator.

6. The method recited in claim 1, further comprising severing the actuator proximally to the locking element.

7. The method recited in claim 1, wherein reconfiguring the proximal portion of the closure element from the pre-deployed configuration to the deployed configuration further comprises:
compressively restraining the proximal portion of the closure device within the delivery tube, thereby preventing the collapsible portion of the body from collapsing in the outward direction after the locking element is pulled out of the proximal portion of the closure device; and
releasing the proximal portion of the closure device from the delivery tube, thereby collapsing the collapsible portion of the body and reconfiguring the proximal portion of the closure device to the deployed configuration.

8. The method of claim 1, further comprising positioning the closure device at a predetermined depth within the delivery tube with at least a portion of the closure device extending beyond the distal end of the delivery tube.

9. The method of claim 8, wherein the predetermined depth is set by a protrusion that limits the insertion of the closure device within the delivery tube.

10. A method of closing an opening in a blood vessel, the method comprising:
inserting a closure device at least partially through the opening, the closure device including a delivery tube, an actuator, and a closure element, the closure element comprising a body having a proximal portion, a distal portion, and a waist portion, a portion of the distal portion of the closure element extending distally from a delivery tube distalmost end prior to inserting the closure device at least partially through the opening, and the proximal portion of the closure element being disposed, within the delivery tube prior to inserting the closure device at least partially through the opening, adjacent a blocking protrusion disposed within a lumen of the delivery tube that prevents proximal movement of the closure device within the lumen of the delivery tube;
reconfiguring the distal portion of the closure element from a pre-deployed configuration to a deployed configuration, by pulling the distal end of the closure element in a proximal direction, while maintaining the proximal portion of the closure device in a pre-deployed configuration, wherein in the deployed configuration, one or more extensions of the distal portion protrude outward from the body;
engaging the inside portion of the opening in the blood vessel with the distal portion of the closure device by moving the closure device in a proximal direction; and
reconfiguring the proximal portion of the closure element from the pre-deployed configuration to a deployed configuration by collapsing a collapsible portion of the body in an outward direction, wherein in the deployed configuration, one or more extensions of the proximal portion protrude outward from the body.

11. The method recited in claim 10, further comprising locking the distal portion and the proximal portion of the closure element in their respective deployed configurations.

12. The method according to claim 10, further comprising deploying a hemostatic material on or adjacent to the opening in the blood vessel.

13. The method recited in claim 10, further comprising disengaging the delivery tube and actuator from the closure element and removing the delivery tube and actuator.

14. The method recited in claim 10, wherein collapsing a portion of the body comprises pulling a locking element through and out of the proximal portion of the closure device, the locking element being coupled to or incorporated with the actuator and being configured to collapse the collapsible portion of the body in the outward direction.

15. The method recited in claim 14, further comprising holding the proximal end of the closure device between the locking element and a coupler element, the coupler element being coupled to or incorporated with the actuator.

16. The method recited in claim 14, further comprising severing the actuator proximally to the locking element.

17. The method recited in claim 14, wherein reconfiguring the proximal portion of the closure element from the pre-deployed configuration to the deployed configuration further comprises:
compressively restraining the proximal portion of the closure device within the delivery tube, thereby preventing the collapsible portion of the body from collapsing in the outward direction after the locking element is pulled out of the proximal portion of the closure device; and
releasing the proximal portion of the closure device from the delivery tube, thereby collapsing the collapsible portion of the body and reconfiguring the proximal portion of the closure device to the deployed configuration.

18. The method of claim 10, further comprising positioning the closure device at a predetermined depth within the delivery tube.

19. The method of claim 18, wherein the predetermined depth is set by a protrusion that limits the insertion of the closure device within the delivery tube.