Abstract:
A closure device includes an actuator movable between an initial extended position, a first position, and a second position with respect to a housing of the closure device, an inner seal configured to deploy from a distal end of the closure device when the actuator shifts from the initial extended position to the first position, a biasing mechanism configured to urge the actuator from the first position to the second position when a first pulling force is applied to the housing, and a locking member configured to deploy from the distal end of the closure device when the actuator shifts from the second position to the first position subsequent to deployment of the inner seal.

Description:
CROSS-REFERENCE TO RELATED PATENT APPLICATIONS 
     This application is a divisional of U.S. application Ser. No 10/756,764, filed Jan. 14, 2004, now U.S. Pat. No. 8,118,831, which claims benefit of priority to U.S. Provisional Application No. 60/439,800, filed on Jan. 14, 2003, the contents of which are hereby incorporated by reference. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates generally to a closure device for sealing a percutaneous puncture in the wall of a blood vessel, and more particularly to a closure device and a method by which an inner seal is deployed inside a vessel and a locking member is secured outside the vessel, such that bleeding from the percutaneous puncture is prevented. 
     BACKGROUND OF THE INVENTION 
     A system for sealing a percutaneous puncture in a blood vessel can comprise an inner seal which is adapted to be positioned against an inner surface of the vessel wall, and a locking member which is connected to the inner seal by, for example, a filament or a suture, and which is adapted to be positioned against an outer surface of the vessel wall such that the percutaneous puncture is sealed there between. During the phase of insertion, the inner seal is folded inside an introducer tube which is resting in the puncture to provide access to the interior of the blood vessel. Deployment of the inner seal inside the vessel takes place by pushing the inner seal through the tube, out from the distal end opening of the introducer. To ensure proper unfolding of the inner seal, the inner seal has to be deployed some distance away from the puncture hole in the vessel wall before the inner seal is positioned to be securely seated against the inner surface of the vessel wall. When the inner seal has been deployed inside the blood vessel, the introducer is retracted from the puncture to rest with its distal end outside the vessel, in close proximity to the puncture. When, during said retraction, the inner seal has been positioned against the vessel wall to cover the puncture, the locking member is pushed forward through the introducer tube until the locking member is tamped in contact with the outer surface of the vessel wall. To effectuate the different actions described above, inserter tools have been proposed which also accommodate the inner seal and the locking member before the sealing procedure. 
     The devices and procedures for sealing a percutaneous puncture in a blood vessel may be improved with respect to drawbacks connected with the prior art systems: 
     For example, existing systems unconditionally allow tamping of the locking member and provide no verification that the distal end of the introducer is retracted from the puncture before tamping, leading to a possibility of the locking member unintentionally being positioned inside the vessel in case of an incorrect maneuver. 
     Another drawback in existing systems is that two hands typically are required to handle existing tools for deployment of the inner seal, seating the inner seal against the vessel wall, and for tamping of the locking member. 
     SUMMARY OF THE INVENTION 
     The present invention aims to solve at least one of these and other problems. 
     An object of the present invention is to provide a closure device and method by which proper closure and ease of handling are both enhanced upon sealing of a percutaneous puncture in the wall of a blood vessel after a medical treatment or surgery. 
     In one aspect, the present invention aims to provide a closure device by which is eliminated the possibility of the locking member being unintentionally positioned inside the blood vessel. 
     In another aspect, the present invention aims to provide a closure device by which it is ensured that the inner seal is seated against the vessel wall before tamping of the locking member. 
     In a further aspect, the present invention aims to provide a closure device and method by which: deployment of an inner seal inside the vessel; seating the inner seal against the inner side of the vessel wall; and tamping of a locking member such that bleeding through the puncture is prevented, may all be performed in a one-hand operation. 
     Briefly, the present invention provides a closure device for sealing a percutaneous puncture in the wall of a blood vessel, comprising an insertion tool having an actuator which is operable in a first mode for deployment of an inner seal inside the vessel and operable in a second mode for tamping of a locking member outside the vessel, the actuator being arranged to be set into said second operable mode in response to a pulling force acting on a filament connecting the inner seal and the locking member. 
     Preferably, the actuator is controlled by an actuator mechanism that is adapted to disable the actuator until a pulling force acting on the filament causes the actuator to be reset into said second operable mode. 
     According to another preferred embodiment of the present invention, a method for sealing a percutaneous puncture in the wall of a blood vessel may comprise: providing an insertion tool having an actuator which is operable in a first mode for deployment of an inner seal inside the vessel and operable in a second mode for tamping a locking member on an outside of the vessel, the actuator being arranged to be set into the second mode in response to a pulling force acting on a filament connecting the inner seal and the locking member; operating the insertion tool in the first mode; pulling the filament so as to set the actuator in the second mode; and operating the insertion tool in the second mode. 
     Embodiments of the present invention further provide a closure device having an actuator movable between an initial extended position, a first position, and a second position with respect to a housing of the closure device, an inner seal configured to deploy from a distal end of the closure device when the actuator shifts from the initial extended position to the first position, a biasing mechanism configured to urge the actuator from the first position to the second position when a pulling force is applied to the housing, and a locking member configured to deploy from the distal end of the closure device when the actuator shifts from the second position to the first position subsequent to deployment of the inner seal. 
     According to another embodiment of the present invention, a closure device for sealing a blood vessel has an inner seal configured to deploy from the closure device into the blood vessel, a locking member configured to deploy from the closure device to abut an outer surface of the blood vessel, and a filament to connect the inner seal and the locking member. The closure device is configured such that application of a pulling force to the filament, subsequent to deployment of the inner seal, releases a latch mechanism to shift an actuator of the closure device from a first position to a second position and to enable deployment of the locking member. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention is more closely described below by reference to the drawings, diagrammatically illustrating the new insertion tool and method. In the drawings, 
         FIG. 1  illustrates a blood vessel in which a distal end of an introducer is positioned; 
         FIG. 2  illustrates a guide rod being inserted through the introducer of  FIG. 1 ; 
         FIG. 3  illustrates the vessel in which only the guide rod is in place; 
         FIG. 4  illustrates a closure device according to the present invention, the closure device being positioned over the guide rod of  FIG. 3 ; 
         FIG. 5  illustrates how the guide rod is removed from the closure device and from the vessel; 
         FIG. 6  is a diagrammatic, cross-sectional view of internal passageways that guide the seal assembly and the guide rod, respectively, in a housing of the closure device; 
         FIG. 7  illustrates how an actuator is pushed into the housing for deployment of an inner seal in a first mode of operation; 
         FIG. 8  illustrates how the closure device is retracted until the inner seal is in contact with the vessel wall; 
         FIG. 9  illustrates how the actuator is pushed into the housing for tamping of a locking member in a second mode of operation; 
         FIG. 10  illustrates the closure device after completion of the sealing operation; 
         FIG. 11  is an exploded view showing the major components of one embodiment of the closure device according to the present invention; 
         FIG. 12  is a partially broken away elevation view of a seal assembly and associated elements of the closure device; 
         FIG. 13   a  is a partially broken away elevation view of a slider, incorporated in the closure device; 
         FIG. 13   b  is a top view of the slider of  FIG. 13   a;    
         FIG. 13   c  shows the proximal end of the slider; 
         FIG. 13   d  shows the distal end of the slider; 
         FIG. 14   a  is a longitudinal section, part of which is laterally displaced, through section ( 14   a )-( 14   a ) of  FIG. 14   b  of an actuator incorporated in the closure device; 
         FIG. 14   b  is a sectional top view of the actuator of  FIG. 14   a  through section ( 14   b )-( 14   b ); 
         FIG. 14   c  is an elevation view showing the distal end of the actuator; 
         FIG. 14   d  is a partially broken away sectional view showing the slider and the actuator in a first relative position, realizing a first mode of operation; 
         FIG. 14   e  is a partially broken away sectional view showing the slider and the actuator in a second relative position, realizing a second mode of operation; 
         FIG. 15   a  is a longitudinal section through section ( 15   a )-( 15   a ) of  FIG. 15   c  of a sleeve, incorporated in the closure device; 
         FIG. 15   b  is a sectional top view through section ( 15   b )-( 15   b ) of  FIG. 15   c  of the sleeve; 
         FIG. 15   c  is an elevation view showing the proximal end of the sleeve. 
     
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     A closure device for sealing a percutaneous puncture in a blood vessel is generally referred to by reference numeral  1  in the drawings. In  FIGS. 4-10 , the closure device  1  is diagrammatically shown in different operative positions illustrating the procedural steps of the sealing operation. In  FIGS. 11-15 , the structure and operation of an actuator mechanism in the closure device  1  is illustrated and explained, by way of example. 
       FIG. 1  illustrates an introducer  600  whose distal end portion is introduced into a blood vessel  2  and whose proximal portion extends out from the skin of a patient. Presumably, a medical operation has been performed via the introducer  600 , and the puncture hole through the wall  3  of the blood vessel is now to be closed. 
     In order to replace the introducer  600  with a closure device  1  according to the present invention, a guide rod  4  may be inserted through the introducer  600  as is shown in  FIG. 2 . 
     In  FIG. 3  the introducer  600  has been removed, leaving only the guide rod  4  in place. An advantage achieved by the use of a guide rod is that the diameter of the guide rod is larger than the diameter of a guide wire, e.g., which in the case of an artery results in less blood flowing from the artery, and the necessity for a manual external compression may thereby be avoided. 
       FIG. 4  shows a closure device  1  according to the present invention, threaded over the guide rod  4 . This is in contrast to insertion tools that are adapted to be connected to an existing introducer  600 . The present closure device  1  is therefore independent of the type, e.g., diameter or length, of the introducer  600  that was previously inserted into the vessel. 
     When the correct positioning of the closure device  1  has been established, the guide rod  4  is removed as is illustrated in  FIGS. 5 and 6 . 
       FIG. 6  shows, diagrammatically, a cross-section of a forward portion of the housing  100  of the closure device  1 . From the drawing it can be seen that a first passageway, in which seal assembly  500  is positioned, connects to a second passageway in which the guide rod  4  moves. Here it should be noted that it is possible to let the first and second passageways switch places, such that the guide rod  400 , which is flexible, is inserted through the first passageway. It is also conceivable to have two passageways that both are slightly bent. Two passageways can also connect to a straight passageway, which gives a configuration having the shape of the letter Y. 
     As illustrated in  FIG. 7 , an actuator  200  is depressed into the proximal end of the closure device housing  100 . When the distal end of the device  1  is positioned in the blood vessel, the guide rod  4  is removed, and the operator pushes the actuator  200  towards an end position provided in the housing  100 . The actuator  200  is operatively associated, in a first relative position, with a sliding member  300  that carries a tamping tube  505  and a pusher  506 , the latter detachably carrying an inner seal  501  by its distal end and pushing the inner seal  501  out from the closure device  1  to be deployed inside the vessel. This step completes a first mode of operation of the actuator mechanism. 
     One embodiment of the actuator mechanism, which is accommodated in the housing  100  of the closure device  1 , is diagrammatically illustrated and further explained below with reference to  FIGS. 11-15 . An important feature of the mechanism is that the locking member  502 , which is carried behind the inner seal  501  on a filament  503 , cannot be pushed out from the closure device  1  unintentionally when the actuator  200  has been pushed into its end position. An erroneous tamping of the locking member  502  inside the vessel is thereby prevented. The mechanism  200  comprises a spring member  207  generating a biasing force acting on the actuator as the actuator is pushed into the housing  100 . When the actuator  200  reaches its end position, a snap lock connection temporarily arrests the actuator in this end position. 
     Referring now to  FIG. 8 , in the next step of the sealing operation the housing  100  is manually retracted, i.e., the housing  100  is pulled in the proximal direction until the inner seal  501  is seated over the puncture in contact with the inner surface of the vessel wall  3 , while simultaneously the distal end of the closure device  1  is retracted from the puncture. 
     During retraction of the closure device  1 , the pulling force is carried by the filament  503  which is arrested by its distal end being attached to the inner seal  501  and by its proximal end being connected to the sliding member  300 . The filament  503  thus prevents the sliding member  300  from moving in the proximal direction, causing the sliding member  300  to be displaced relative to the actuator  200 . By means of a cam surface provided on the sliding member  300 , the snap connection that arrests the actuator  200  is disengaged in response to the relative displacement between the retracting actuator  200  and the stationary sliding member  300 . As the snap connection is disengaged, the biasing spring  207  pushes the actuator  200  back to a tamping position wherein the actuator  200  is again operatively associated with the sliding member  300 , now in a second relative position. Furthermore, during this retraction of the housing  100 , the proximal end of the pusher is disconnected from engagement with the sliding member  300 , and a subsequent second forward motion of the actuator  200  will have no effect on the pusher  506 . In the tamping operation the actuator  200  acts on the sliding member  300 , the tamping tube  505  and the locking member. 
       FIG. 9  illustrates the actions caused by a second forward motion of the actuator  200 . When the actuator  200  this second time is pushed towards its end position in the housing  100 , the actuator  200  pushes on the sliding member  300  which, via the tamping tube  505 , pushes the locking member forward and into a locking position against the outer surface of the vessel wall  3 , as is illustrated in  FIG. 9 . This step completes the second mode of operation of the actuator mechanism. 
     The filament  503  runs through the locking member  502 . In the tamped position, the filament  503  secures the locking member  502  by means of frictional engagement provided from a distal portion of the filament  503 , the portion having an enlarged dimension or diameter. 
     The proximal end of the filament  503  is attached to the sliding member  300  through a sliding connection. In the first mode, when the actuator  200  and sliding member  300  are pushed forward for deployment of the inner seal  501 , the filament  503  is tensioned by the pusher  506  gripping the inner seal  501  by its distal end. In the second mode, as the actuator  200  and sliding member  300  are pushed forward for tamping the locking member  502 , the pusher  506  is inactive and the filament  503  is arrested by a member which is stationary relative to the sliding member  300  and which maintains a tension of the filament  503 . At the very end of the forward motion, the proximal end of the filament  503  is released from the sliding member  300  by the action of the stationary member. 
     Here it should be noted that one person can perform the closure using one hand only throughout the whole sealing procedure. 
     The housing  100  and its associated components can now be removed and disposed of, thereby leaving only the inner seal  501 , the locking member  502  and the filament  503  in place, as is illustrated in  FIG. 10 . Cutting the filament  503  completes the sealing operation. 
     As will be more fully understood from the following description of the device, the present invention discloses a method for sealing a percutaneous puncture in the wall of a blood vessel, comprising the step of providing an insertion tool having an actuator  200  which is operable in a first mode for deployment of an inner seal  501  inside the vessel  2  and operable in a second mode for tamping of a locking member  502  on the outside of the vessel  2 , wherein operation of the actuator  200  for tamping the locking member  502  is enabled through the step of applying a pulling force to act on a filament  503 , connecting the inner seal  501  and the locking member  502 , for setting the actuator  200  into the second operable mode. 
     Preferably, the step of operating the actuator  200  for deployment of the inner seal  501  disables operation of the actuator  200  for tamping the locking member  502 , until the step of applying a pulling force to act on the filament  503  resets the actuator  200  into the second operable mode. 
     In the present description of an illustrated embodiment, “distal” refers to the left hand side and “proximal” refers to the right hand side of the drawings of  FIGS. 11-15 . Also, the expressions “top”, “bottom”, “horizontal” and “vertical” refer entirely to the orientation shown in the drawings, and is no indication of the actual orientation of the closure device in practice. 
     With reference to  FIG. 11 , the closure device  1  comprises as its major components: a housing  100  (outlined in dash-dot lines), and an actuator  200 , a slider  300 , a sleeve  400  and a seal assembly  500 , all supported in the housing  100 . 
     Basically, the sleeve  400  is telescopically received in the housing  100 , the actuator  200  is telescopically received in the sleeve  400 , the seal assembly  500  is operatively connected to the slider  300 , and the slider  300  is operatively engaged by the actuator  200 . The slider  300  is guided for longitudinal displacement relative to the actuator  200  between first and second relative positions, in which the actuator  200  operatively engages the slider  300  to be brought into the movement of the actuator  200 . The actuator  200  is guided for longitudinal movement relative to the sleeve  400 , from an extended storage or idle position to a partially overlapping operable position from where the actuator  200  is further advanced to an end position for deployment of the inner seal  501  in the first mode, and for tamping the locking member  502  in the second mode of operation. The sleeve  400  is accommodated in the housing  100  and guided therein for longitudinal movement, from an extended idle position to a fully inserted operative position. Advantageously, the housing  100 , sleeve  400  and actuator  200  are arranged about a common longitudinal axis. The housing, the sleeve and the actuator, as well as the slider, may be of any suitable sectional profile, such as circular, or they may for example have an orthogonal section such as the illustrated embodiment of a closure device  1  according to the invention. As an assembly, these components provide a tool for insertion of the sealing components such as the inner seal  501 , the filament  503  and the locking member  502 . 
     The housing  100  is associated with an insertion tube  101 , connecting to the distal end of the housing via a forward house portion  102  (as seen in the direction of insertion). Insertion tube  101  and house portion  102  may be integral parts of the housing  100 . When inserted by its distal end through the puncture, the insertion tube  101  communicates the blood vessel with first and second passageways formed in the forward house portion  102  (as shown in  FIG. 6 ), one of which is designed to receive a guide rod  4  that controls the insertion tube  101  during location in the blood vessel, and the other passageway designed for insertion of the inner seal  501  and locking member  502  upon sealing of the puncture. These passageways converge into the insertion tube  101 . Advantageously, the housing  100  is formed with indication means providing a verification that a flow communication has been established with the blood vessel, via the distal end of housing  100 /insertion tube  101 . Such a means will be known to one of ordinary skill in the art. 
     With reference to  FIG. 12 , the seal assembly  500  comprises the inner seal  501  and the locking member  502 , the inner seal  501  being anchored in the distal end of the suture or filament  503  running through the locking member  502 . The locking member  502  is spaced behind the inner seal  501 , on the proximal side of an end portion  504  of the filament  503  having increased cross-sectional dimension, providing a frictional engagement with the locking member  502  in its tamped (advanced) position on the filament  503 . In a ready-to-use condition, the inner seal  501  and locking member  502  both lie encapsulated in the forward house portion  102  (diagrammatically illustrated in  FIG. 11 ). 
     The filament  503  runs through the tamping tube  505 , together with the pusher  506 . The filament  503  and the pusher  506  both reach out beyond the distal end of the tamping tube  505 , the pusher  506  by its distal end detachably gripping the inner seal  501 , and the locking member  502  freely supported on the filament  503  outside the distal end of the tamping tube  505 . Also, the filament and the pusher both reach out from the proximal end of the tamping tube  505 . The proximal ends of the filament  503 , the pusher  506  and the tamping tube  505  are all supported in the slider  300 , as will be explained below with reference also to  FIGS. 13   a - 13   d.    
     Referring now to  FIGS. 13   a  and  13   b , the slider  300  is an elongate four-sided body having an orthogonal section, dimensioned to be accommodated in the actuator  200  for longitudinal movement therewith, and guided in the actuator  200  for longitudinal displacement relative thereto. In  FIGS. 13   c - 13   d , the slider  300  has opposed, vertical side walls  301 ,  302  connecting a horizontal top plane  303  with a horizontal bottom plane  304 . Preferably, the longitudinal margins connecting the walls are chamfered in order to facilitate a sliding displacement free from jamming in the actuator  200 . 
     The tamping tube  505  connects to the distal end of the slider  300 , the proximal end of the tamping tube  505  being received in a recess  305 , mouthing in the distal end of the slider  300 . 
     In one side wall  301  of the slider  300 , the recess  305  opens laterally towards the exterior, the opening forming a slot  306  that connects the recess  305  with a clearance  307  through the side wall  301 . On the interior of side wall  301 , the slot  306  proceeds rectilinearly from the clearance  307  to the proximal end of slider  300 . A corresponding slot  306 ′ is formed on the interior of the opposite side wall  302 . The slots  306 ,  306 ′ are dimensioned to receive and to guide the pusher  506 , the proximal end  507  of the pusher being bent transversely to reach across the interior of slider  300  for a sliding engagement with the two slots  306 ,  306 ′. 
     The filament  503  is detachably connected to the slider  300  through a sliding connection. The proximal end of the filament  503  is arrested in the slider  300  by being looped around a longitudinal bar  308 , cut out from the opposite side wall  302 . The bar  308  extends from a distal portion of the slider  300 , and terminates with a free end in a proximal portion of the slider  300 . The filament  503  runs, under a slight tension, from the bar  308  across the interior of slider  300 , via the clearance  307  into the slot  306  and further through the tamping tube  505  to the inner seal  501  which is supported in the distal end of the pusher  506 . 
     The tension of the filament  503  is provided by the pusher  506 , the transverse portion in the proximal end  507  of the pusher being arrested in a seat  309  formed in a latch  310  that rises from the bottom  304  of slider  300 , and the distal end of the pusher  506  being detachably connected to the inner seal  501  which is attached to the distal end of the filament  503 . The length of the pusher  506  is determined with respect to the length of the filament  503  to provide a slight bias of the pusher  506 , sufficient for tensioning the filament  503  as long as the proximal end of the pusher  506  is arrested by the latch  310 , and the proximal end of the filament  503  is looped around the bar  308 . 
     The seat  309  provides a snap lock connection with the pusher  506 , by the latch  310  being depressible towards the bottom  304  of slider  300 . Depression of the latch  310  causes the pusher  506  to be released from the seat  309  and free to slide in the slots  306 ,  306 ′, towards the proximal end of the slider  300 . 
     A heel  311 , facing the proximal end of slider  300 , is formed in the terminal end of an arm  312  rising from the bottom  304  of the slider  300 . Similar to the latch  310 , the arm  312  is depressible towards the bottom  304  of slider  300 . However, for reasons that will be explained further on, the arm  312  is flexible and able to return to an operative position shown in the drawings. Advantageously, the latch  310  and the arm  312  are both flexible and formed integrally with the slider  300 , made for example of a synthetic material such as a polymer material. 
     The latch  310  and the arm  312  are both formed with ramp surfaces  313 ,  314  interacting with a cam  210  which is stationary in the actuator  200 . When assembled, the cam  210  reaches through the open top plane  303  to be received in the interior of slider  300  as will be further explained with reference to  FIGS. 14   a - e.    
     In the illustrated embodiment of  FIGS. 14   a - e , the actuator  200  is an elongate, hollow, four-sided body having an orthogonal section, dimensioned to receive the slider  300  for longitudinal movement therewith, and guiding the slider  300  for longitudinal displacement relative thereto. The actuator  200  is formed with opposed, vertical side walls  201 ,  202  connecting a horizontal top plane  203  with a horizontal bottom plane  204 . Preferably, the longitudinal margins connecting the walls are chamfered in order to facilitate a sliding movement free from jamming in the sleeve  400 . 
     With reference to  FIGS. 14   a - 14   c , the actuator  200  is a two-piece element hinged together along one side thereof. A snap lock engagement may be formed on the opposite side for closing the actuator body. The interior of actuator  200  is divided into a first longitudinal chamber  205  formed to receive the slider  300 , and a second longitudinal chamber  206  formed to receive a compressible spring  207  (shown diagrammatically through dash-dot lines in  FIGS. 14   b ,  14   c ). Both chambers, separated by a longitudinal partition wall  208 , open in the distal end of actuator  200 . The proximal end thereof is closed, carrying a push-button  209 . 
     Depending from the interior of top plane  203 , a cam  210  reaches down into the chamber  205 . In the assembled position, the cam  210  is received through the open top plane  303  of the slider  300  to a depth wherein the cam  210  is operative to engage and depress the ramp surfaces  313  and  314  in succession, i.e., first depressing the latch  310  and then the arm  312 , when the slider  300  is displaced relative to the actuator  200 . 
     In the first mode of operation for deployment of the inner seal  501 , such as in  FIGS. 7 and 14   d , the proximal end of the slider  300  abuts the proximal push-button end of actuator  200 , the actuator  200  thus pushing the slider  300  forward (towards the distal end) in a first relative position between slider and actuator. 
     In the second mode of operation for tamping the locking member  502 , such as in  FIGS. 9 and 14   e , the cam  210  engages the heel  311  and the actuator  200  thus pushes the slider  200  in a second, advanced position relative to the actuator  200 . 
     The displacement of the slider  300 , from said first to said second position relative to the actuator  200 , is caused by applying a pulling force upon retraction of the housing  100  in order to position the inner seal  501  over the puncture and in order to retract the distal end of the housing/insertion tube (see  FIG. 8 ). During retraction, the slider  300  will remain stationary relative to the inner seal  501 , connected therewith through the filament  503 . A pulling force, applied to the actuator  200  via the housing  100  and the sleeve  400 , and thus acting on/carried by the filament  503 , causes ejection of the spring biased actuator  200 , and brings the cam  210  to engage the ramp on latch  310  which is depressed by the moving cam to release the pusher  506  from the seat  309 . Further motion of the actuator cam  210  will bring the pusher  506  along, the transverse portion  507  of the pusher being caught by a hook  211  that is formed on the cam  210 . Next, the cam  210  engages the ramp  314  on arm  312 , which is depressed to let the cam  210  pass to the proximal side of the heel  311 . Due to the flexibility of arm  312 , the arm returns to its original position wherein the heel  311  projects into the path of the cam  210 , thus arresting the slider  300  in a second and advanced position relative to the actuator  200 . Simultaneously, the proximal end of the pusher  506  leaves the guiding slots  306 ,  306 ′ formed on the interior of the slider walls. As the pusher  506  is released from engagement with the seat  309  and pulled backwards by the cam-and-hook formation  210 ,  211 , the distal end of the pusher  506  is concurrently disconnected from the inner seal  501 . When the proximal end of the pusher  506  leaves the slots  306 ,  306 ′ in the slider walls, the distal end of the pusher  506  is also fully retracted into the distal end of the tamping tube  505 . 
     The relative displacement between the actuator  200  and the slider  300  is thus initiated by the pulling force acting on the filament  503 , and is then driven by the compressible spring  207  as will be explained below. 
     With reference to  FIGS. 15   a - c , the sleeve  400  is an elongate, hollow, four-sided body having an orthogonal section, dimensioned to receive and guide the actuator  200  for longitudinal movement relative to the sleeve  400 . The sleeve  400  is formed with opposed, vertical side walls  401 ,  402  connecting a horizontal top plane  403  with a horizontal bottom plane  404 . Preferably, the longitudinal margins connecting the walls are chamfered in order to facilitate a jam free movement relative to the housing  100 , accommodating the sleeve  400 . 
     The sleeve  400  has an open proximal end receiving the actuator  200 , and the distal end of the sleeve  400  being closed by an end wall  405 . An opening  406  through the end wall  405  communicates with the passage through the forward portion  102  of the housing  100 , guiding the seal assembly  500  into the insertion tube  101  of the closure device  1 . 
     A rod  407  projects longitudinally through the sleeve  400 , from the end wall  405  towards the proximal end. In the assembly, the rod  407  projects into the chamber  206  of the actuator  200  to support the spring  207 , in this case a coiled spring  207 , acting between the end wall  405  of the sleeve and the proximal or push-button end  209  of the actuator  200 , and being compressed when the actuator  200  is depressed into the sleeve  400 . 
     Also projecting from the end wall  405  is a beam  408 , running in parallel with the rod  407  and aligned with the open interior of the slider  300  in the assembled position. The beam  408  runs with a clearance from the interior of top plane  403 , substantially corresponding to a wall thickness in the top plane  203  of actuator  200 . The beam  408  carries a latch  409  which is depressible towards the bottom plane  404  of the sleeve  400 . The latch  409  is flexible to engage a slot  212  (see  FIG. 14   a ), provided in the top plane  203  of the actuator  200  when the actuator is fully depressed into the sleeve  400  for deployment of the inner seal  501 . The slot  212  and latch  409  provide a snap lock connection, the latch  409  being operative for retaining, temporarily as will be explained below, the actuator  200  with its distal end abutting the end wall  405  of the sleeve  400 . In this end position of the actuator  200 , which terminates the first mode of operation in a definite stop from where the actuator  200  is prevented from further movement in the distal direction, the proximal end  410  of the beam  408  is received in the distal end of the slider  300  which is engaged by the actuator  200  in said first relative position. 
     Reset of the actuator  200  will be described as follows. The latch  409  is associated with a ramp surface  411  which is laterally and vertically offset from the latch  409  and aligned to be operatively engaged by a cam  315 , provided in the distal end of the slider  300  (see  FIGS. 13   a - d ). Upon retraction of the insertion tool, the cam  315  on the slider  300  (which remains stationary) acts on the ramp surface  411  to depress the latch  409 , which is then disengaged from the slot  212 . The actuator  200  is thus disengaged from the snap lock connection  212 ,  409  to be ejected by action of the spring  207 , the spring driving the actuator  200  in the proximal direction relative to the sleeve  400  and relative to the stationary slider  300 . 
     The action of the spring  207  causes the release of the pusher  506 , and resets the actuator  200  into a position from where the actuator  200  is operable and enabled for tamping the locking member  502 . The spring actuated ejection of the actuator  200  is limited through a flexible latch  213 , provided in a distal end portion of the actuator ( FIG. 14   c ), snapping into engagement with a slot  412  provided on the sleeve  400 . The latch  213  is formed with a ramp surface facing a distal margin of the slot  412 , and a transverse surface engaging a proximal margin of the slot  412 . From this arrested position the actuator  200  is operable to be depressed in the distal direction, but is however prevented from further movement in the proximal direction. Depression of the actuator  200  into the sleeve  400  will bring the slider  300  in the movement of the actuator  200 , the cam  210  of the actuator engaging the heel  311  of the slider  300  in the second, advanced position relative to the actuator  200 . 
     Release of the filament  503  will be described as follows. When the actuator  200  from this position is depressed into the sleeve  400  in the second mode of operation, the slider  300  is advanced in a forward or distal portion of the actuator  200 . In this movement, the beam  408  which is stationary on the sleeve  400 , moves longitudinally through the interior of the slider  300 . The filament  503  which is looped around the bar  308  and crossing the interior of the slider  300 , is then captured by the proximal end  410  of the beam  408  and caused thereby to slide towards the proximal end of the bar  308 . Accordingly, the filament  503  remains stationary while the actuator  200 , slider  300  and tamping tube  505  are advanced for slipping the locking member  502  into frictional engagement with the distal portion  504  of the filament  503 . At the end of the tamping operation the filament loop has reached the proximal end of the bar  308 , from where it is slipped off by action of the beam  408 , the filament  503  thus being released from the slider  300 . Obviously, all structures involved in the tamping operation are dimensioned with respect to structural lengths and lengths of movement to allow release of the filament  503  as the locking member has reached its final position on the filament  503 , tamped against the outside of the vessel wall  3 . Release of the filament  503  terminates the tamping operation, and the insertion tool can be removed from the patient. 
     The illustrated embodiment is one example of realization of the invention. Modifications to the detailed structure and design of components are possible without changing the basic solution, defined by the claims. 
     Instead of one integral actuator, e.g., a first actuator may be adapted for deployment of the inner seal  501  and a second actuator being adapted for tamping the locking member  502 . In such case the slider  300  would be arranged to be disengaged from the first actuator and brought into engagement with the second actuator in response to a pulling force acting through the filament  503 , while simultaneously the second actuator is set into an operable condition. Also, instead of being arranged about a common longitudinal axis as illustrated, the actuator  200 , sleeve  400  and slider  300  may be of any conceivable shape as long as it is ensured that the first mode of operation terminates in a definite stop from where the tamping tube  505  and locking member  502  are prevented from further movement in the distal direction until the second mode of operation is enabled in response to a pulling force being applied to act on the filament  503 . 
     A central feature of the new closure device  1  is, accordingly, that an actuator  200  in a first mode is operable for deployment of an inner seal  501 , and is then reset into a second mode wherein the actuator  200  is operable for tamping a locking member  502 . Reset of the actuator  200  is accomplished by applying a pulling force to act on the filament  503  that connects the inner seal  501  and the locking member  502 . Thus, deployment of the inner seal  501 , enabling of a second operable mode and tamping of the locking member  502  may all be performed in a one-hand operation. Also, an erroneous positioning of the locking member  502  inside the blood vessel is prevented by the actuator  200  preferably being disabled until a pulling force acting on the filament  503  causes the actuator  200  to be reset into an operable condition. A proper closure of the percutaneous puncture and ease of handling are thus both conceivably enhanced through a closure device as disclosed by the present invention.