Patent Publication Number: US-2023157679-A1

Title: Instrument and methods for surgically closing percutaneous punctures

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     The present application is a continuation of U.S. patent application Ser. No. 16/509,759, filed Jul. 12, 2019, which is a continuation of U.S. patent application Ser. No. 14/569,291, filed Dec. 12, 2014, now U.S. Pat. No. 10,383,611, which is a continuation of U.S. patent application Ser. No. 13/605,720 filed Sep. 6, 2012, now U.S. Pat. No. 10,485,524, which claims the benefit of U.S. Provisional Patent Application No. 61/551,251, filed on Oct. 25, 2011, entitled “LARGE BORE VASCULAR SEALING DEVICE AND METHOD,” now expired, and U.S. Provisional Patent Application No. 61/621,409, filed on Apr. 6, 2012, entitled “GUIDE WIRE THROUGH TOGGLE,” now expired, the entire contents of these applications are herein incorporated by reference into the application for all purposes. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates generally to closing percutaneous punctures. 
     BACKGROUND 
     U.S. Pat. No. 5,282,827 (hereinafter, the &#39;827 patent), entitled Hemostatic Puncture Closure System and Method of Use, discloses systems for sealing a percutaneous incision or puncture in a blood vessel. The systems of the &#39;827 patent comprise a closure device, an introducer, and a deployment instrument including a carrier for the closure device. The closure device has three basic components, namely, a sealing member, an intra-arterial anchor, and a positioning member. 
     The sealing member is in the form of an elongate, rod-like plug, e.g., a compressed hemostatic, resorbable collagen sponge or foam. This plug member is arranged for sealing the puncture. The anchor is an elongate, stiff, low-profile member which is arranged to be seated inside the artery against the artery wall contiguous with the puncture. The anchor is molded of non-hemostatic resorbable polymer similar to conventional resorbable sutures. 
     The positioning member comprises a filament, e.g., a resorbable suture. The filament connects the anchor and the collagen plug (sealing member) in a pulley-like arrangement, and includes a portion extending outside the patient&#39;s body. The outwardly located filament portion is arranged to be pulled, i.e., tension applied thereto, after the anchor is located within the interior of the artery and in engagement with the inner wall of the artery contiguous with the incision or puncture. The pulling on the filament causes its pulley arrangement to move the plug in the puncture tract toward the anchor. A tamper forming a portion of the deployment instrument is slid down the filament while the filament is maintained in tension to gently tamp the plug in the puncture tract to cause the plug to deform so that its diameter increases. Tension is maintained on the filament by use of an externally located spring during the tamping procedure. 
     The expansion of the plug within the tract is enhanced by the fact that it is formed of a compressed collagen so that it expands in the presence of blood within the puncture tract. The expansion of the plug within the puncture tract serves to hold it in place. Moreover, the closure device quickly becomes locked in place through the clotting of the hemostatic collagen plug within the puncture tract. The spring serves to hold the plug in its deformed state until such time that the plug is locked in place by the hemostatic clotting action. Once this has occurred, so that the plug is effectively locked within the puncture tract, the externally located spring can be removed. This typically occurs after approximately 30 minutes. After the spring is removed, the filament is severed at the top of the tamper. The tamper is then removed, and the remaining portion of the filament is cut subcutaneously prior to the discharge of the patient. The portion of the filament connecting the anchor to the plug remains in tension, thereby holding the closure device permanently in place until it is eventually absorbed by the patient&#39;s body. 
     U.S. Pat. No. 5,662,681 (hereinafter, the &#39;681 patent), entitled Self-locking Closure for Sealing Percutaneous Punctures, also teaches systems for sealing a percutaneous incision or puncture in a blood vessel. 
     SUMMARY 
     According to one aspect there is a method of sealing a puncture in a wall of an artery. The method includes inserting a guidewire into the puncture such that the guidewire extends from outside the artery, through the puncture and into the artery. The method further includes inserting a deployment instrument into the puncture via a toggle along the guidewire. The deployment instrument has a distal end section that a) rigidly supports the toggle and b) includes a first component and a second component being in actuatable relationship to one another. The method further includes actuating the deployment instrument to move the first component and the second component relative to each other such that the toggle abuts the wall of the artery proximate the puncture. 
     According to another aspect, there is a method of sealing a percutaneous puncture in a wall of an artery. The method includes inserting a deployment instrument along a guidewire through the puncture into the artery. The deployment instrument carries a tensioner assembly and a closure device including a toggle, a plug and a continuous elongate filament configured to draw the plug towards the toggle upon the application of tension to the filament in a direction away from the toggle. The method further includes positioning a distal end of the deployment instrument such that the toggle is positioned in the artery. The method further includes pulling the deployment instrument away from the puncture while the filament is connected to the tensioner assembly such that a mechanically induced tension force is applied to the filament causing the tensioner assembly to be withdrawn from an interior of the deployment instrument. The method further includes pulling the tensioner assembly away from the puncture while the filament is connected to the tensioner assembly such that the mechanically induced tension force is applied to the filament such that the tension force increases with increasing distance of the tensioner assembly away from the puncture to draw the toggle and the seal towards each other and into engagement with the wall of the artery at respectively opposite sides of the wall. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Embodiments of the present invention are described herein with reference to the attached drawing sheets in which: 
         FIG.  1    is a diagram showing the clinical setting of a large bore sheath and a guide wire; 
         FIG.  2 A  is a diagram depicting a closure device; 
         FIG.  2 B  is a cross-sectional view of the closure device of  FIG.  2 A ; 
         FIG.  3 A  is a diagram of an exemplary deployment instrument according to an exemplary embodiment; 
         FIGS.  3 B- 3 F  depicts additional details of the deployment instrument of  FIG.  3 A ; 
         3 G depicts an exemplary kit according to an exemplary embodiment; 
         FIGS.  4  and  4 A  are diagrams showing how an exemplary closure device is inserted into and removed from the artery; 
         FIG.  5    is a diagram showing how the sheath and the closure device are positioned in the large arteriotomy; 
         FIG.  6    a diagram showing how the toggle is released in preparation for deployment; 
         FIGS.  7 - 8 B  are diagrams showing how the device is deployed to seal the puncture; 
         FIGS.  9 A- 9 F  depict exemplary toggle-guide wire associations; 
         FIGS.  10 A-C  depict exemplary toggle-filament associations; 
         FIGS.  11 A-C  depict exemplary tampers; 
         FIG.  12 A-B  depict exemplary features of a tamper; 
         FIG.  13    depicts an alternate embodiment of a deployment instrument; 
         FIG.  14    depicts use of the embodiment of  FIG.  13   ; 
         FIGS.  15 - 18    depict features of an exemplary tensioner according to an embodiment; 
         FIG.  19    is a flowchart of an exemplary method; 
         FIGS.  20 A-B  depict an embodiment utilizing a plurality of plugs; 
         FIG.  21    depicts an embodiment utilizing a dual-lumen tamper; 
         FIG.  22 - 23    depict use of an occlusion balloon to hold a toggle against an artery wall; 
         FIGS.  24 A-D  depict an alternate embodiment of a toggle; 
         FIGS.  25 A-C  depict an end view of use of a balloon to hold a toggle against an artery; 
         FIGS.  26 A-B  depict an alternate embodiment of a toggle; 
         FIG.  27 A-D  depict an exemplary embodiment of a marker; and 
         FIGS.  28 - 30    depict exemplary embodiments of guide wire-plug association. 
     
    
    
     DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS 
     Some exemplary embodiments are directed towards wound (puncture) closure devices, systems and methods, and wound (puncture) closure device deployment instruments and methods and systems of utilization thereof, associated with closing a relatively large puncture (wound) of an artery, such as by way of example, a femoral artery. Such a large puncture may exist as a result of a balloon aortic valvulopasty (BAV) and/or percutaneous aortic valve replacement (PAVR) procedure and/or a related procedure, which utilize access sheaths from the 18 to 24 F size. Hereinafter, these procedures (BAV, PAVR and related procedures) may be referred to as the “referenced vascular treatment procedures.” 
     An exemplary embodiment of the wound closure system detailed below and some variations thereof interface with an intravascular guide wire. Accordingly, some exemplary embodiments of use of thereof will first be detailed, followed by a discussion of some specific features to the wound closure system of some exemplary embodiments. 
     In an exemplary embodiment, a needle cannula usable in a valvulopasty and/or percutaneous aortic valve replacement procedure is inserted into an artery. Such a needle may correspond to, by way of example and not by way of limitation, a needle usable in the Seldinger method. 
     While the needle cannula is in place (extending into the artery), a guide wire is passed through the cannula of the needle a desired distance into the artery (sufficient for the teachings detailed herein and/or variations thereof to be practiced, and/or other procedures to be practiced). In an exemplary embodiment, the guide wire is a so-called thirty-five thousandths of an inch guide wire. In an exemplary embodiment, the guide wire is an access guide wire. Once the guide wire is in place, the needle cannula is removed by pulling the needle away from the artery over the guide wire. This leaves the guide wire in place, with a portion thereof extending the desired distance (or thereabouts) into the artery. This further leaves an incision through which the guide wire extends. As will be detailed below, in an exemplary embodiment, the guide wire is part of a wound closure device deployment instrument, although in other exemplary embodiments, the guide wire is a separate element. 
     An introducer sheath, such as a large bore sheath, is passed over the guidewire, through the incision and into the artery, as depicted in  FIG.  1   , where element  10  is a large bore sheath, element  20  is a guide wire, element  1026  is a femoral artery (depicted in cross-sectional view), element  1024  is the puncture in the artery (wound in the artery), element  1025  is the tract leading to the puncture  1024  and element  1028  is the skin. By tract it is meant the passageway in the tissue located between the artery  1026  and the skin  1028  of the being, and which is formed when the artery is punctured percutaneously. 
     It is noted that the scene depicted in  FIG.  1    may be achieved through other steps than those just depicted by way of example. Any method or methods that result in the human tissue-medical device interface regime depicted in  FIG.  1    and/or variations thereof, which enable the teachings herein and/or variations thereof and/or result in the utility of the teachings detailed herein and/or variations thereof, may be used in some embodiments. Indeed, the aforementioned actions may be part of or be substituted by actions that are part of the referenced vascular treatment procedures. In any event, after executing such actions, a large bore sheath  10  remains in a vessel, such as the common femoral artery, as depicted by  FIG.  1    and/or a variation thereof. 
     As can be understood by the diagram of  FIG.  1    and attention to the sizing (unless otherwise noted, the drawings herein are drawn to scale), the sheath  10  is relatively large in relation to the inner diameter of the vessel (e.g., it has an inner diameter and/or an outer diameter of about 0.4, 0.5, 0.6, 0.7 and/or 0.8 or more times the size of the inner diameter of the artery, as measured on a plane lying normal to the longitudinal axes of these tubular structures). In this regard, the sheath  10 , as it is a large bore sheath, requires a transverse slit (i.e., a slit extending axially) in the artery which will be relatively large (sufficient to receive the sheath  10  therethrough, after the elastic nature of the artery is taken into account). 
     In an exemplary embodiment, the guidewire  20  is utilized for advancement of a wound closure device deployment instrument through the sheath  10  in general, and movement of a wound closure device in particular along the guide wire. It is noted that some exemplary details of the deployment instrument and closure device are provided below. However, in some embodiments, the deployment instrument and/or closure device may correspond to the deployment instrument and/or wound closure device of any of the above referenced applications as modified to interface with the large bore sheath  10  and/or closure device and/or deployment instrument detailed below, wherein the closure device may correspond to the closure device of any of the above referenced applications as modified to close such a large opening in the artery (e.g., an opening large enough to permit a sheath of 18 F to fit through as depicted in the FIGs.). 
     Also shown in  FIG.  1    is a PTA balloon  600  inserted proximally or from a contralateral puncture site. This balloon is utilized to block blood flow proximal to the large bore puncture site (i.e., the site depicted in  FIG.  1   ), and as an entry for contrast dye. Balloon  600  is depicted in an un-inflated or semi-inflated state coupled to guidewire  610 . In use, inflation fluid is pumped to the balloon, to inflate the balloon  600 . It is noted that some embodiments may not include the balloon  600 /may not utilize the balloon  600 . 
     An exemplary embodiment of a closure device will now be briefly described in the context of the environment of  FIG.  1   , with some additional details of the closure device being provided further below. 
     At some point during the aforementioned procedure, the incision in the artery is utilized for whatever medical purposes associated with the utility of the incision. After such utilization, there is utilitarian value in closing the incision. An exemplary embodiment of a closure device for closing the incision will now be described in the context of the artery  1026 . 
       FIG.  2 A  depicts an exemplary closure device  85  closing puncture  1024 . The closure device  85  includes toggle  30 , plug  50  (often referred to in the art and herein as a sealing member or collagen pad, or simply collagen), lock  60 , and suture (also referred to in the art and herein as filament)  80 , in the fully deployed state with the suture  80  cut below the skin level  1028  (the occlusion balloon is depicted in the un-inflated/deflated condition.  FIG.  2 B  depicts a cross-sectional view of the artery  1026 , which details the fit of the toggle  30  to the internal diameter of the artery, and also depicts the profile of the toggle  30  with respect to the longitudinal axis of the artery  1026 . 
       FIGS.  2 A and  2 B  depict by way of example the closure unit  85  (comprising toggle  30 , collagen  50 , lock  60 , and suture  80 ) in the fully deployed state with the suture  80  cut below the skin level, and the occlusion balloon deflated to re-establish blood flow in the vessel and depict the fit of the toggle  30  to the internal diameter of the vessel, highlighting the low profile of the toggle design, as seen along the longitudinal axis of the vessel. 
     In an exemplary embodiment, the closure device  85  can correspond to any of the above referenced applications as modified to close such a large opening in the artery (e.g., an opening large enough to permit a sheath of 18 F to fit through as depicted in the FIGs.) and/or to provide an alternate access pathway if needed during the procedure in which the method is executed. 
     For example, suture (filament)  80  can correspond to filament 34 of U.S. patent application Ser. No. 13/111,653 (hereinafter, the &#39;653 application) filed on May 19, 2011, entitled DEPLOYMENT INSTRUMENT FOR CLOSURE DEVICE FOR PERCUTANEOUSLY SEALING PUNCTURES, the teachings of the &#39;653 application relating to the construction and features of the filament being incorporated by reference herein for use in an embodiment herein. Lock  60  can correspond to lock 36 of the aforementioned &#39;653 application (or any other lock detailed therein and variations thereof), the teachings of the &#39;653 application relating to the construction and features of the lock being incorporated by reference herein for use in some embodiments herein. Collagen  50  can correspond to plug  30  of the aforementioned &#39;653 application, although it is noted that the size of plug  30  may vary from that disclosed in the &#39;653 application, the teachings of the &#39;653 application relating to the construction and features of the plug  30  being incorporated by reference herein for use in an embodiment herein. 
     While the toggle  30  is different in size and geometry from that explicitly disclosed in the &#39;653 application with respect to that anchor  32  detailed therein, in an exemplary embodiment, the toggle  30  corresponds to the anchor  32  of the &#39;653 application in a modified form in accordance with the teachings detailed herein and/or variations thereof, the applicable teachings of the &#39;653 application relating to the construction and features of the anchor  32  being incorporated by reference herein for use in an embodiment herein. 
     In an embodiment, the suture  80  is a braided multifilament size 2-0 PLLA suture. The suture  80  can be made from any synthetic absorbable plastic material that degrades as needed. 
     The plug  50  comprises a strip of a compressible, resorbable, collagen foam which includes one or more apertures through which portions of the suture  80  extend. In an embodiment, the plug  50  is a collagen pad made of a fibrous collagen mix of insoluble and soluble collagen that is cross linked for strength. In an embodiment, the collagen may be obtained from the connective tissue of animals. The collagen may be purified from the subdermal layer of cowhide. 
     The lock  60  comprises a cylindrical piece of resorbable iron and/or stainless steel crimped in a manner to provide a limited amount of resistance to movement along the suture  80 . 
     An embodiment of the toggle  30  is constructed of a 50/50 polylactic-cogycolic acid or other synthetic absorbable polymer that degrades in the presence of water into naturally occurring metabolites (e.g., water and CO2). In an embodiment, the toggle  30  is a monolithic structure formed by a bio-absorbable polymer. 
     It is noted that the aforementioned closure device  85  is an exemplary closure device, and alternate embodiments of such may be used in some embodiments. By way of example only and not by way of limitation, the aforementioned crimped lock may not be present, and instead, the filament is looped and/or suturing is utilized to hold the relative locations of the elements of the closure device  85  (e.g., plug  30  and toggle  30 ). By way of example and not by way of limitation, the closure device may correspond to, scaled for application with large bore application or unscaled, that detailed in U.S. Pat. No. 5,282,827 (hereinafter, the &#39;827 patent) and/or variations thereof, the contents of which are incorporated herein by reference in their entirety with respect to the closure device taught therein. Further by way of example and not by way of limitation, the closure device may correspond to, scaled for application with large bore application or unscaled, that detailed in U.S. Pat. No. 5,662,681 (hereinafter, the &#39;681 patent) and/or variations thereof, the contents of which are incorporated herein by reference in their entirety with respect to the closure device taught therein. Any device, system and/or method of closing the puncture that utilizes a component that fits into the artery to provide a reaction element (e.g., toggle  30 ) against a force applied thereto associated with closing the puncture and/or any device, system and/or method of closing the puncture that utilizes a plug (e.g., collagen plug  50 ) may be used in some embodiments. In some other embodiments, any device, system and/or method of closing the puncture may beutilized. 
     An exemplary puncture (wound) of which the teachings detailed herein and/or variations thereof can be utilized to close or otherwise be associated with is a puncture in an artery having a diameter (inner or outer) of about 10 mm, although such teachings can also be applicable to such having a diameter (inner or outer) of about 5, 6, 7, 8, 9, 10, 11, 12 and/or about 13 mm or more, or any value in between these values and/or any ranges encompassing some or all of these values (including ranges being bounded by the in between values). In an exemplary embodiment, the puncture extends over an arc, transverse to a longitudinal axis of the artery (about the circumference normal to the longitudinal axis) of about 90 degrees, although in some embodiments, the arc extends 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 105, 110, 115, 120, 125, 130, 135, 140, 145, 150, 155, 160, 165, 170, 175 and/or about 180 degrees, or any value in between these values and/or any ranges encompassing some or all of these values (including ranges being bounded by the in between values). By way of example, the puncture may extend along an arc having a length of 8 mm, although in some embodiments, the length is about 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 and/or about 15 mm or any value in between these values and/or any ranges encompassing some or all of these values (including ranges being bounded by the in between values). 
     As noted above, some additional exemplary features of the components that make up the closure device  85  are further detailed herein. Prior to that, however, a brief discussion of an exemplary deployment instrument is provided (with additional details pertaining to the deployment instrument being provided further below) for deploying a closure device such as closure device  85  and/or other equivalents thereof and/or variations thereof. 
       FIG.  3 A  depicts an exemplary deployment instrument  100  according to an exemplary embodiment, configured to deploy the closure device  85 . As described herein, deployment instrument  100  includes a closure device  85  and a guide wire  20 . However, in other embodiments, the deployment instrument may not include one or both of these elements. 
     Briefly, deployment instrument  100  is configured to be inserted into sheath  10 . Deployment instrument  100  includes a release tube  40  and a handle  110 . Release tube  40  is configured to move relative to handle  110  and release tube support  42  along longitudinal axis  101  via actuation of lever  90  clockwise or counter-clockwise relative to the handle, as depicted by arrow  102 . That is, movement of lever  90  moves release tube  40  (sometimes referred to herein as restraining tube  40 ) inward/proximal to release the toggle  30 . 
     More particularly,  FIG.  3 B  depicts a cross-sectional view of the distal end of the deployment instrument  100 , depicting additional components of the deployment instrument  100 . As may be seen, deployment instrument  100  includes a delivery tube  120  that is located within release tube  40 . The plug  50  of closure device  85  is located in the delivery tube  120 , with filament  80  extending past plug  50  to toggle  30 . It is noted that plug  50  may partially extend outside of tube  120 . In an exemplary embodiment, delivery tube  120  corresponds to a carrier assembly (which can include only the delivery tube or can include additional components). 
     As may be seen, toggle  30  is located such that it is at least partially located in the release tube  40 . In some embodiments, it may be fully located in the release tube  40  (i.e., no part of the toggle  30  extends past the distal tip of the tube  40 . Toggle  30  is held in place by filament  80 . As will be described in more detail below, guide wire  20  extends through delivery tube  120  and release tube  40 , as well as through toggle  30  and/or plug  50 . In this regard,  FIG.  3 C  depicts a top view of the distal end of deployment instrument  100 , with  FIG.  3 D  depicting a side view thereof for comparison purposes. As may be clearly seen in  FIG.  3 C , the guide wire  20  extends through toggle  30  (through the longitudinal center of the toggle  30 ). In an exemplary embodiment, the association of the guide wire  20  with the toggle  30  as detailed herein and/or variations thereof can have utility in that such may ensure or otherwise effectively and/or substantially increase the statistical probability (at least with respect to that in the absence of the guide wire association) that the toggle is at least generally if not substantially or about perfectly centered relative to the incision in the artery. 
     In an exemplary embodiment, irrespective of the presence or absence of the guide wire  20 , the plug  50  is held within delivery tube  120  in a manner that is similar to and/or a manner that is the same as that associated with the plug  30  tubular carrier  102  of the &#39;653 application, the teachings thereof relating to such being incorporated by reference herein for use in an embodiment herein. 
       FIG.  3 E  depicts an end view of the deployment instrument  100  looking at the distal end thereof. 
     In operation, movement of lever  90  on the delivery handle  110  of the deployment instrument  100  in the direction of arrow  102  moves the release tube  40  in the proximal direction to about the location depicted in  FIG.  3 F  (although the tube  40  may be moved to other locations in other embodiments, such as to a more distal location). As may be seen, the toggle  30  is now completely outside the release tube  40 , and is thus “released.” 
     In an exemplary embodiment, the deployment instrument  100  is a fully integrated system that includes the deployment device  85  and the guide wire  20 . In an exemplary embodiment, it is packaged (in, by way of example, a sterilized manner). In an exemplary embodiment, it is packaged in a hermetically sealed package. The guide wire  20  may be wound in a winding with a relatively large radius to avoid kinking the guide wire.  FIG.  3 G  depicts an exemplary closure device kit  1000 , including deployment instrument  100 , closure device  85  and guide wire  20  sterilized and hermetically sealed in package  900 . In an exemplary embodiment, kit  1000  may further include an insertion sheath  10  in package  900  and/or in a separate package attached thereto. 
     It is noted that in an alternate embodiment, the guide wire  20  is not part of the kit and/or the delivery instrument  100 . Instead, it is a separate component that is threaded through the toggle  30  and/or the plug  50  after access to the delivery instrument  100  (and thus the closure device  85 ) is obtained. Accordingly, an exemplary embodiment includes a method whereby a user, such as a physician or an operation room nurse or other professional passes an end of a guide wire through a hole in the toggle  30  or otherwise associates the toggle  30  with the guide wire, followed by deployment of the closure device  85 . 
     Use of the deployment instrument  100  will now be detailed with respect to an exemplary deployment method of deploying the closure device  85 . 
     With the sheath  10  in place as seen in  FIG.  1   , the deployment instrument  100  is inserted into a proximal end (not shown) of sheath  10 , and moved through the sheath  10  until the distal end of the instrument  100  end extends out of the distal end of the sheath  10 , approximately as shown in  FIG.  4   . In an exemplary embodiment, the guide wire  20  extends through the deployment instrument  100 , and the deployment instrument  100  slides along the guide wire  20  (guide wire  20  and sheath  10  are generally held stationary, relative to artery  1026 , while deployment instrument  100  is moved through the sheath  10 ). In an alternate embodiment, the guide wire  20  moves with the deployment instrument  100 , at least to a certain extent. 
     More particularly,  FIG.  4    depicts the relative locations of toggle  30 , the end of the delivery tube  120 , and the release tube  40  of the deployment instrument  100  with respect to the distal end of the sheath  10 . This positioning is achieved by driving the deployment instrument  100  through sheath  10 , over the guide wire  20  and/or with the guide wire  20 , until the release tube  40 , along with the closure device  85  in general and the toggle  30  in particular, as detailed herein and/or variations thereof (where toggle  30  and plug  50  and some of filament  80  is visible in  FIG.  4   ), is positioned as shown. The positioning can be determined via the use of one or more radiopaque markers  44  and/or  45  on the release tube  40 . The user, utilizing fluoroscopic methods, can determine the position of radiopaque marker  45 , and thus the release tube  40 , relative to the end of the sheath  10 . In an exemplary embodiment, the user stops driving the deployment instrument  100  into the sheath  10  upon the marker  45  emerging from the sheath  10  (imaged using fluoroscopic methods). It is noted that other devices, systems and/or methods may be utilized to determine or otherwise estimate the position of the end of the release tube  40  relative to the insertion sheath  10 . For example, a channel which permits blood to follow through/along the instrument  100  to a location that is visible by the user upon the instrument  100  being so positioned may be used in some embodiments. An exemplary embodiment utilizes some and/or all of the teachings associated with determining or otherwise positioning introducer sheath 28 and/or device 28 of U.S. Pat. No. 5,282,827, the contents of which associated with such teachings are incorporated herein by reference for use in some embodiments. Any device, system and/or method that will enable the position of the instrument  100  to be determined or otherwise estimated may be used in some embodiments. In an alternate embodiment, the sheath  10  is sized and dimensioned and/or the delivery instrument  100  is sized and dimensioned such that movement of the deployment instrument  100  through the sheath  10  stops at a certain point (e.g., a wall of the deployment instrument  10  abuts the sheath  10 ) such that the distal end of the deployment instrument  10  extends a distance past the distal end of the sheath  10  a distance having utilitarian value. 
     As may be seen in  FIG.  4   , the toggle  30 , which in this exemplary embodiment, is smoothly shaped, is partially covered by the release tube  40  upon its emergence from the sheath  10 . Because it is exposed, the smoothness has utility in that it can permit relatively smooth entry into the artery and can allow for rearward movement of the closure device within the artery without risk of the toggle  30  catching on any plaque or other obstruction. Given the anatomical nature of the access site and puncture, the release tube  40  (and the delivery tube  100 , sheath  10  and guidewire  20  will be slightly curved as may be seen in  FIG.  5   . This curvature provides a biasing force on the toggle  30  for the release actions. 
     Upon positioning of the deployment instrument  100  at the desired position relative to the distal end of the sheath  10  (i.e., at the position depicted in  FIG.  4   ), the lever  90  is rotated relative to the rest of the instrument  100  in a direction and by a sufficient amount to retract the release tube  40  a utilitarian distance relative to delivery tube  120 , thereby entirely exposing the toggle  30 .  FIG.  5    depicts such an exemplary retraction. As may be seen, guide wire  20  extends through toggle  30  after retraction of the release tube  40 . 
     Next, sheath  10  is withdrawn from the approximate position depicted in  FIG.  5   . However, prior to this, balloon  600  optionally can be inflated as shown in  FIG.  5   . Because the sheath  10  may exit the puncture  1024  when the sheath  10  is withdrawn from the artery, the balloon is inflated under a low pressure to block blood flow from a proximal position at least prior to fully withdrawing the distal end of the sheath  10  from the artery (where blood flow flows from left to right with respect to the frame of reference of  FIG.  5   ). 
     As just noted, the insertion sheath  10  is withdrawn from its previous position, either partially and/or fully out of the artery  1026 .  FIG.  6    depicts withdrawal of the insertion sheath  10 . While the sheath  10  is withdrawn, the relative position of the deployment instrument  100  relative to the artery can change, either by the same amount or by a lesser or greater amount, although in other embodiments, its location relative to the artery may remain the same. Any movement or lack thereof of the instrument  100  relative to the artery may exist in some embodiments providing that it does not negate the utilitarian value of the embodiment. Some such movement may be seen by comparing  FIG.  6    to  FIG.  5   . In this regard,  FIG.  6    depicts the deployment instrument  100  in general, and the closure device  85  carried thereby, in a position relative to the puncture  1024  having utilitarian value. 
     It is noted that in an exemplary embodiment, plug  50  can be withdrawn from tube  120  without contacting the sheath  10  and/or at least without contacting the interior of the sheath  10 . This may, in some embodiments, eliminate the possibility that the plug  30  might become stuck in the sheath  10 —during the deployment procedure as it expands once leaving the tube  120 . 
     In an exemplary embodiment, a contrast agent is injected distal to the balloon  600 . Contrast agent can indicate any leakage at the puncture site and can additionally provide for an outline of the toggle  30  using fluoroscopic methods. 
       FIG.  4 A  shows the device including radiopaque marker  44  positioned near the puncture. Because the sheath  10  may exit the puncture during this step, balloon  60  is inflated under a low pressure to block blood flow from a proximal position. Contrast is injected distal to balloon  60 , which indicates any leakage at the puncture site and additional provides for an outline of toggle  30  on the fluoroscope. The sheath  10  and/or the tube  40 , are retracted (moved in the direction that would withdraw them from the patient) until the distal radiopaque marker aligns with the puncture, as will be seen fluoroscopically. Given the anatomical nature of the access site and puncture, release tube  40  and sheath  10  will be curved slightly, as may be seen in  FIG.  5   . This curvature provides a biasing force on the toggle  30  for the release step, discussed with respect to  FIG.  6   . 
     Still referring to  FIG.  6   ,  FIG.  6    depicts how the toggle  30  will be released from the biased state with retraction of the release tube  40 . The release orients the toggle  30  parallel to the vessel axis. Release is confirmed by the alignment of the distal radiopaque marker  44  with the end of the sheath  10  and/or markings on the handle (not shown). Note that vessel occlusion is maintained during this action, and an outline of the toggle will be visible to the user on the fluoroscope (as will be detailed below, the toggle  30  may include material that is readily apparent through fluoroscopy. Note further that, in an exemplary embodiment, the contact of the most distal portion of the toggle  30  with the artery wall forces the toggle  30  to rotate clockwise upon sufficient movement of the release tube  40 , thus aligning the toggle  30  in a manner that will statistically improve the chances that the toggle  30  will be sufficiently aligned so as to statistically reduce the likelihood (at least in comparison to the absence of such alignment), if not substantially eliminate or completely eliminate the likelihood that it will be pulled out of the artery during subsequent actions. It is noted that in some embodiments, radiopaque marker(s) may be located on the sheath  10 , such as, by way of example, at the distal end/tip of the sheath  10 . Such may be used, in some exemplary embodiments, to determine the position of the sheath  10 . For example, a sheath marker may be utilized to determine the position/estimate the position of the distal end of the sheath relative to the puncture. Such may have utility in determining whether or not to further retract the sheath  10  from the artery based on the location of the marker. Still further by example, such may be used to determine the location of certain components of the deployment instrument  100  (e.g., the release tube  40  and/or the deployment tube  120 , such as, by way of example, based on radiopaque markers thereon, etc.), relative to the sheath  10 . 
     Next, the delivery instrument  100  is moved proximally such that the distal tip thereof is moved from the location depicted in  FIG.  6    to at least about the location depicted in the functional schematic of  FIG.  7    (with sheath  10  not shown for clarity). This results in plug  50  being completely withdrawn from the artery and toggle  30  being drawn closer to the puncture  1024  and/or substantially or completely against the puncture  1024 . Guide wire  20  may move along with delivery instrument  100  partially and/or fully, or may remain stationary while the delivery instrument  100  is moved to the location of  FIG.  7    and locations thereabouts. Continued movement of the delivery instrument  100  away from the puncture, to a location such as that depicted by way of example in  FIG.  8 A , pulls toggle  30  closer to the puncture and/or completely against the puncture, and also pulls plug  50  out of the delivery tube  120  and, as a result of a pulley action/synching action/lassoing action between the filament  80 , the toggle  30  and the plug  50 , the plug is pulled towards the toggle  30  and thus the puncture  1024  (in some embodiments such that it contacts the artery wall), with guide wire  20  having the movements or lack of movements detailed above. Below, an exemplary device that has utilitarian value in moving the plug  50  relative to the toggle  30  is described. 
     Next, the delivery instrument  100  is moved further away from the puncture to expose some additional components therein, such as, for example, a tamper, the lock if not already exposed, and additional filament  80  (by exposed, it is meant that the delivery tube  120  (or other component of the delivery instrument  100 ) is pulled past these components such that the components emerge from the distal end of the tube  120  (or other component that carries these components)). It is noted that such exposure may be achieved by pulling the handle  110  of the delivery instrument  100 , which results in pulling of the delivery tube  120  (and the release tube  40 ), and other components. 
       FIG.  8 B  depicts an exemplary result of such movement of delivery instrument  10 , where tamper  70  has been exposed from the delivery tube  100  (not shown in  FIG.  8 B , as it is exemplary moved out of the field represented by  FIG.  8 B ). It is noted that the procedure for exposing the tamper  70  and the tamper  70  itself may correspond to the teachings of such exposure and the tamper detailed in the &#39;827 patent, the &#39;681 patent and/or the &#39;653 application, the contents of which related to such exposure and the tamper being incorporated by reference herein for use in some embodiments (although it is noted that below, an alternate tamper and an alternate method of exposure and an alternate device for achieving such exposure is detailed). 
     More particularly,  FIG.  8 A  represents by way of example how the retracting the sheath  10  and deployment instrument  100  can position the toggle  30  to cover the interior of the puncture.  FIG.  8 B  represents how further retraction of the deployment instrument  100  will deploy the contents of the delivery tube  100 , namely the collagen  50 , lock  60 , and tamper tube  70 , which will allow the user to compress the collagen  50  in place and deploy the lock  60  (in embodiments that utilize such a lock). In an exemplary embodiment, these components correspond to those disclosed in the &#39;827 patent, the &#39;681 patent and/or the &#39;653 application, and variations thereof, as might be scaled for use to procedures disclosed herein. Moreover, the steps of achieving the results depicted in these FIGS. may include some and or all of the method steps disclosed in any of the &#39;827 patent, the &#39;681 patent and/or the &#39;653. As noted above and is further detailed below, toggle  30  position can be confirmed fluoroscopically. 
     After utilitarian placement of the plug  50  relative to the toggle  30  and/or puncture  1024 , the plug  50  is locked in place by tamping lock  60  with tamper  70  in the distal direction (as represented by arrow  17 ) as described by way of example in the &#39;653 application. Again, an exemplary device that has utilitarian value in tamping lock  60  is described below. 
     It is noted that in an exemplary embodiment, some or all of the features associated with the methods of delivering the closure device  85  (including securing the closure device in place) can correspond to those variously taught in the &#39;681 patent, the &#39;827 patent and/or the &#39;653 application as implemented utilizing the teachings detailed herein in general and/or the teachings applicable to the delivery instrument  100  and sheath  10  in particular, the applicable teachings of those patents and applications being incorporated by reference herein for use in some embodiments. By way of example, the teachings of the &#39;653 application associated with pulling the plug towards the toggle prior to locking the plug in place may be used in some embodiments. 
     As detailed above, an exemplary embodiment utilizes a toggle that maintains an association with a guide wire. Some exemplary associations will now be described. 
       FIG.  9 A  depicts an exemplary embodiment of a toggle  30 A, which can be in some embodiments a large bore toggle, usable in at least some embodiments herein and methods herein. As may be seen, toggle  30 A includes two holes  31  through which filament  80  may extend, as described in greater detail below. (Additional features of the structural arrangement of the toggle are also described below.) Toggle  30 A may be utilized in an embodiment where there is no association between the toggle and the guide wire. 
     In an exemplary embodiment, toggle  30 A and/or the other toggles detailed herein and/or variations thereof are configured to utilitarianly fit to a 10 mm diameter (interior) artery. The toggle  30 A has a curved profile, as may be seen in  FIG.  9 A , which depicts both a top view and a side view of the toggle  30 A. In an exemplary embodiment, the top profile of the toggle  30 A has a generally circular profile having a radius of R1, which can be about 5 mm, in an unrestrained configuration, although in some embodiments, the profile may be a radius of about 4 mm, 5 mm, 6 mm, 7 mm, 8 mm, 9 mm, 10 mm, 11 mm and/or about 12 mm, or any value in between these values and/or any ranges encompassing some or all of these values (including ranges being bounded by the in between values). It is noted that in an exemplary embodiment, the aforementioned radii encompass a profile that is not exactly circular, but instead is elliptical (hence the use of the term “about”, which, as used herein with respect to any teaching herein, unless otherwise noted, does not exclude exact values and the use of about also includes embodiments not so qualified (i.e., includes exact numbers, tolerance as would be understood in the art). In an exemplary embodiment, the toggle has an unrestrained width W1 of about 6 mm, although in some embodiments, the width W1 may be about 2 mm, 3, 4, 5, 6, 7, 8, 9 and/or about 10 mm, or any value in between these values and/or any ranges encompassing some or all of these values (including ranges being bounded by the in between values). 
     In an exemplary embodiment, the radius R1 and/or the width W1 and/or other pertinent dimensions are such that when applied to a given artery, the wing tips  37 A and  37 B, as opposed to the longitudinal tips  38 A and  38 B, which run parallel to the longitudinal axis of the artery) contact the artery wall prior to the center  39  of the toggle  30 A. In an exemplary embodiment, the toggle  30 A is made of elastomeric material and/or is of a material such that, when sized and dimensioned for use, allows the toggle  30 A to flex (elastically and/or plastically) such that the radius R1 and/or width W1 decreases slightly (to about the interior diameter of the artery—with or without expansion of the artery (in some cases, the artery is about a zero elasticity tissue, such as may be the case for statistically very elderly patients for a population in the United States of America or Europe)) to conform to or about conform to the interior diameter, upon tensioning of the filament as detailed herein and/or variations thereof. In this regard, the upper surface may be characterized as being slightly less curved and/or slightly flatter than the interior surface of the artery (as taken on a plane normal to the longitudinal axis of the toggle and the artery, which in some embodiments, will be parallel or substantially parallel and/or effectively parallel during application). 
     In an exemplary embodiment, the longitudinal distance of the toggle  30 A (tip  38 A to tip  38 B) is about 16 mm, although in some embodiments, this distance may be about 6 mm, 7, 8, 9 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 and/or about 27 mm, or any value in between these values and/or any ranges encompassing some or all of these values (including ranges being bounded by the in between values). 
       FIG.  9 B  depicts an alternate toggle, toggle  30 B, which includes a hole  32 , as may be seen, which accommodates the guide wire  20 . Particularly, guide wire  20  extends through hold  32 , and hole  32  permits guide wire  20  to slide or otherwise move therethrough. As may be seen, Hole  32  is located at about the lateral center of the toggle  30 B (lateral center being on the lateral axis  301 B, as may be seen) as well as or in the alternative, centered along the axis of the suture holes  31 , which may be slightly offset from the lateral axis  301 B. 
     In an exemplary embodiment, the location of hole  32  is different than that depicted in  FIG.  9 B . For example,  FIG.  9 C  depicts hole  32  located in the longitudinal center of the toggle  30 C (longitudinal center being on the longitudinal axis  301 C, as may be seen), and/or, the hole  32  is longitudinally in between the holes  31  in the toggle. Any placement of hole  32  in the toggle that will enable the teachings detailed herein and/or variations thereof to be practiced or otherwise to have utilitarian value may be implemented in some embodiments. Also, in some embodiments, association of the toggle with the guide wire is achieved not by a hole through the toggle, but via a notch on the edge of the toggle, as may be seen in  FIG.  9 D , where toggle  30 D has a notch  33 . Such an embodiment can further include one or more holes through which the guide wire extends. An exemplary embodiment that achieves association with the guide wire and the toggle via a notch that has a C-Shaped cross-section (or other equivalent cross-section that achieves the following functional result) such that the guide wire is “trapped” or otherwise retained therein. For example, if the C-shaped interior of the notch is such that the distance between the ends of the C is less than the maximum diameter of the guide wire  20 , the guide wire should be retained therein. Alternatively, the notch exists, but the guide wire is not trapped or otherwise retained in the notch. Any device, system and or method of achieving and/or maintaining an association between the guide wire and the toggle may be practiced in some embodiments detailed herein and/or variations thereof. 
     In an alternate embodiment, a suture hole may be utilized as a hole to achieve association between the toggle and the guide wire/a hole for the guide wire may be utilized to pass a filament  80  therethrough.  FIG.  9 E  depicts such an exemplary toggle  30 E. Such may be achieved by making a suture hole with a larger diameter than that which is would otherwise be the case for association with a suture alone. 
       FIG.  9 F  depicts an alternate embodiment where two holes  32  are utilized to respectively associate two guide wires  20  with the toggle  30 F. Accordingly, such an exemplary embodiment may utilize two guide wires. In some embodiments, three or more guide wires and a corresponding number or different number of association devices (e.g., holes, notches, etc.) are utilized. 
       FIG.  10 A  depicts an exemplary filament  80  weave through holes  31  of an exemplary toggle  30 F, with element  81  corresponding to, for example, loop  50 A and winding  52  as detailed in the &#39;653 application, the contents of which related to the loop and winding thereof being incorporated herein by reference in an exemplary embodiment. It is noted that the exemplary embodiment of  FIG.  10 A  includes a suture hole  31  spacing width W2 that is wider than that depicted in the exemplary toggle of  FIG.  9 A . In an exemplary embodiment, the holes  31  are about 4 mm from one another (W2 equals about 4 mm), although in some embodiments, W2 is about 2 mm, 2.5, 3 mm, 3.5 mm, 4 mm, 4.5 mm, 5 mm, 5.5 mm, 6 mm, 6.5 mm, 7 mm, 7.5 mm, 8 mm, 8.5 mm, 9 mm, 9.5 mm and/or about 10 mm or any value in between these values and/or any ranges encompassing some or all of these values (including ranges being bounded by the in between values). It is noted that the spacing between the holes  31  of the toggle of  FIG.  9 A  correspond to about 1.5 mm. In an exemplary embodiment, the hole spacing is sized so as to provide sufficient structure that provides utilitarian value with respect to providing sufficient material to react against the tension applied to the filament (e.g., it will not break the toggle during tensioning). 
     It is noted that the weave depicted in  FIG.  10 A  is applicable to the toggles detailed above and/or below. In exemplary embodiment, element  81  is a collar as detailed in the &#39;653 application. Any device system and or method of achieving the utilitarian value of element  81  (e.g., its use as a collar), which can include permitting the loop  82  established by filament  80  to reduce in diameter (like a lasso or the like) can be used in some embodiments. 
       FIG.  10 B  depicts an alternate embodiment utilizing more than two toggle holes  31 . As may be seen, four holes  31  are used, through which filament  80  is threaded. Such an exemplary embodiment can have utility by improving pulley action for compressing the plug  50  (not shown in  FIGS.  10 A and  10 B ), as compared to that resulting from the configuration of  FIG.  10 A  and/or  FIG.  9 A . 
       FIG.  10 C  depicts an alternate embodiment including a washer (resorbable and/or non-resorbable washer)  500  interposed as seen in the loop  82  formed with toggle  30 A (or any other toggles described herein and/or variations thereof). Such may provide for utilitarian management of the wound/puncture at the access site. In an exemplary embodiment, washer  500 , upon deployment of the closure device  85 , becomes located between the vessel wall and the plug  50  (which is interposed in the loop between the toggle  30 A and washer  500 , but not shown in  FIG.  10 C ), or, alternatively, proximally of the plug  50 . In an exemplary embodiment, the distance between the holes of the washer  500  corresponds to the distance between the holes of the toggle  30 A, although in an alternate embodiment, the holes have a different spacing than that of the toggle. (It is noted that the aforementioned hole spacings for the toggle and/or the washer are centerline to centerline dimensions.) 
     In an exemplary embodiment, the holes of the washer are about 4 mm from one another (W2 equals about 4 mm), although in some embodiments, the distance is about 1 mm, about 2 mm, 2.5, 3 mm, 3.5 mm, 4 mm, 4.5 mm, 5 mm, 5.5 mm, 6 mm, 6.5 mm, 7 mm, 7.5 mm, 8 mm, 8.5 mm, 9 mm, 9.5 mm and/or about 10 mm or any value in between these values and/or any ranges encompassing some or all of these values (including ranges being bounded by the in between values). It is noted that the spacing between the holes  31  of the toggle of  FIG.  9 A  correspond to about 1.5 mm. In an exemplary embodiment, the hole spacing is sized so as to provide sufficient structure that provides utilitarian value with respect to providing sufficient material to react against the tension applied to the filament (e.g., it will not break the toggle during tensioning). 
     It is noted that an exemplary embodiment includes a toggle having three holes  81  or more holes. In an exemplary embodiment, the three holes are utilized with a threaded double suture. 
     As noted above, delivery instrument  100  includes a tamper  70  therein. While some embodiments include a tamper and are otherwise configured according to the tamper of the &#39;827 patent, the &#39;681 patent and/or the &#39;653 application, an exemplary embodiment includes a tamper  71  that provides association between the tamper and the guide wire  20 , as will now be described. 
     An exemplary embodiment of tamper  71  is depicted in  FIG.  11    and includes a double-lumen. Specifically, tamper  71  includes lumen  80 ′, through which filament  80  extends, and lumen  20 ′, through which guide wire  20  extends. Lumen  80 ′ is sized and dimensioned, relative to the guide wire  20  and the filament  80 , to permit movement of the tamper  71  relative to the filament  80 , and lumen  20 ′, in some embodiments, is sized and dimensioned to permit movement of the tamper relative to the guide wire  20 , while in other embodiments, it does not permit movement relative thereto. 
       FIG.  11 B  depicts an alternate embodiment of a tamper, tamper  72 , which achieves association with the guide wire via the use of guide wire carriers  20 ″, through which guide wire  20  extends, the functional features of tamper  72  being the same as and/or similar to that of tamper  71 .  FIG.  11 C  depicts another alternate embodiment of a tamper, tamper  73 , which includes guide wire slot  20 ′″, through which guide wire  20  extends, and is retained therein (slidably or otherwise) via bridges  21  attached to the body of the tamper, the functional features of tamper  73  being the same as and/or similar to that of tamper  71 . An exemplary embodiment that achieves association with the guide wire and the tamper does not include the bridges  21 , while including the slot. The slot may have a C-shaped cross-section (or other equivalent cross-section that achieves the following functional result) such that the guide wire is “trapped” or otherwise retained therein even in the absence of the bridges  21 . For example, if the C-shaped interior of the slot is such that the distance between the ends of the C is less than the maximum diameter of the guide wire  20 , the guide wire should be retained therein. Alternatively, the slot exists, but the guide wire is not trapped or otherwise retained in the slot. Any device, system and or method of achieving and/or maintaining an association between the guide wire and the tamper may be practiced in some embodiments detailed herein and/or variations thereof. It is noted that the embodiment of  FIG.  11 A  can have utility in that it provides a level of safeguard against a user inadvertently gripping the guide wire or the like during tamping, where in an exemplary embodiment, the tamper slides relative to the guidewire during tamping. 
       FIG.  12    functionally depicts the environment in which tamper  71  is utilized. More particularly, after the delivery instrument  100  is withdrawn as detailed above to expose the tamper and the other components, tamper  71  is exposed as depicted in  FIG.  12 A . In the exemplary embodiment depicted in  FIG.  12   , guide wire  20  and filament  80  extend through respective lumens  20 ′ and  80 ′. ( FIG.  12 B  depicts a cross-section of tamper  71  taken at line A-A- of  FIG.  12 B , where the guide wire  12  and the filament  80  have been removed for clarity.) 
     In an exemplary embodiment, the tamper  71  (or  72  or  73  or variations thereof) enables tamping action over/along the guide wire  20  and suture  80 , running through separate lumens  20 ′ and  80 ′ in the double lumen tamper, until the tamper  71  contacts the lock  60 . Upon contact, the user pushes down (continues to push down) on the lock  60  to compress the plug  50  in place/to lock the already compressed plug  50  in place (such as is done by way of example and not by way of limitation, as detailed in the &#39;827 patent, the &#39;681 patent, the &#39;653 application, at least with respect to movement along the filament thereof), without affecting the placement of the guide wire  20 . The double lumen tamper  71  enables utilitarian support of the guide wire  20 , as compared to the absence of the lumen for the guide wire (or the absence of the alternate components to achieve association with the guide wire) during the deployment of the device and/or can statistically improve user experience when tamping as compared to tamping without such an association feature. 
       FIG.  13    functionally depicts an alternate embodiment of a delivery instrument  200 . It is noted that some and/or all of the additional features (e.g., the tensioner apparatus, described below) described with respect to instrument  200  may be included in instrument  100 . It is further noted that an exemplary embodiment of deployment instrument  200  includes some or all of the features of instrument  100  detailed above. 
     Briefly, movement of the release tube  40  relative to the delivery tube  120  is achieved by applying force to section  214  of the release tube  40  in the proximal direction of the deployment instrument  200 , as indicated by arrow  201 , while applying a reaction force to the delivery tube  120  at section  212  in the direction of arrow  202 . Application of sufficient force thereto drives the release tube  40  towards the proximal end of the instrument  200 , and moves it relative to the deployment tube  120 , until section  214  abuts section  212  or until the force is reduced/eliminated. In this regard, the exemplary embodiment of  FIG.  13    is such that there is a slight friction fit between the tubes  40  and  120 , although in an alternate exemplary embodiment, the fit is a slip fit. Alternatively, or in addition to this, additional components, such as an O ring or the like, may be interposed between the tubes to generate a modicum of friction. Any device system and/or method of moving the tubes relative to one another may be practiced in some embodiments. 
     In an exemplary embodiment, aside from the different mechanisms utilized to move the tubes relative to one another, the functionality of the deployment instrument  200  corresponds to that of the deployment instrument  100 , as well as its use. 
     An exemplary embodiment includes a device, system and/or method of gauging or controlling the application of tension on filament  80  while deploying the closure device  85  described herein. Specifically, the application of high tension on filament  80  may result in the toggle pulling out. Alternatively, insufficient tension will not compress the plug  50  onto the exterior vessel wall. 
     Prior to describing an exemplary embodiment of a tensioner assembly of the delivery instrument  100 , some actions associated with deployment of the closure device  85  by the deployment instrument  100  will be briefly described (some of which includes redescription and/or variations of the description above) in the context of the function of the tensioner assembly. 
     As detailed above, movement of the deployment instrument  100  in the proximal direction causes toggle  30  to engage the artery wall. As the toggle  30  catches/engages, resistance will be felt by the user with increased movement of the deployment instrument  100  in the proximal direction. 
     With increased movement of the deployment instrument  100  away from the puncture, the plug  50  is deployed into the puncture tract with the toggle  30  engaging or catching the inner surface of the artery wall contiguous with the puncture. The instrument  100  is then pulled further outward. Inasmuch as the toggle  30  trapped against the interior of the artery wall, the continued retraction of the deployment instrument  100  causes the filament  80  to pull the plug  50  out of the delivery tube  120  of the deployment instrument  100  and into the puncture tract. As the deployment instrument comes out of and/or is moved further away from the puncture tract, continuous steady resistance will be felt as the tensioner assembly of the deployment instrument controls the force on the filament  80  during the retraction procedure. 
     Continued retraction of the instrument  100  brings the tamper  70  out of the distal end of the deployment instrument  100  (thus exposing the tamper  70 ). 
     The retraction of the deployment instrument  100  carries the plug  50  into engagement with the exterior of the artery wall immediately adjacent the puncture. Continued retraction causes the filament  80  to deform the plug  50 , i.e., cause it to deform radially outward, in an exemplary embodiment, as detailed by way of example in the &#39;827 patent, the &#39;681 patent and/or the &#39;653 application, the contents of which relating to such deployment/expansion/positioning of the plug incorporated by reference herein for use in embodiments associated with deployment of the closure device  85 . In an embodiment, the plug  50  (which may be a collagen pad, as noted above) is forced to fold down after exiting the delivery tube  120  (in some embodiments, it begins to fold down immediately upon exiting the delivery tube  120 ). The existence of blood within the puncture tract can further contribute to the deformation of the plug  50 , because, in some embodiments, it is collagen foam that expands and softens in the presence of blood. The retraction procedure continues to pull the deployment instrument  100  up the filament  80  until the user stops pulling. At this point the plug  50  should be located in the puncture tract contiguous with the opening in the artery, and the lock  60  (if utilized) located immediately proximally of the plug. 
     The plug  50  is now ready to be positioned in the tract. To achieve that end, the user compacts the plug  50  by gently tensioning the filament by, for example, pulling on the handle  110  of the delivery instrument  100  in the proximal direction with one hand. This moves loop element  81  down along the filament as a result of tension on filament. Here, toggle  30  acts in an analogous manner to a pulley as described in, for example, the &#39;653 application, the contents of which associated with that pulley action being incorporated herein by reference for use in an exemplary embodiment utilizing such pulley action. This has the effect of tightening the loop  82 . As element  81  moves down filament section to tighten loop  81 , it compacts plug  50 . This forces plug  50  to conform to the artery contiguous with the puncture in the artery. 
     Next, the tamper  71  is manually slid down the filament  80  by the user&#39;s other hand so that it enters the puncture tract and engages the proximal side of the lock  60 , if present. A force is applied to tamper  71  sufficient to overcome the resistance to movement of the lock  71  relative to the filament, at least if the lock  60  corresponds to the lock of the &#39;653 application. This causes the lock  60  to slide down filament section until it abuts element  81 . An exemplary embodiment of the lock  60  is configured, when used in conjunction with filament  80 , to provide a certain amount of resistance to movement along filament  80 . This locks element  81  in place, as, for example, taught in the &#39;653 application, thus preventing loop  82  from expanding. This feature causes the plug  50  to be secured in the compact position until hemostasis occurs (which happens relatively very quickly, thereby locking the closure device in place). That is, because the plug  50  is compressed between the toggle  30  and the lock  60 , plug  50  is retained or locked in position within the puncture tract and cannot move away from the toggle, even before the blood clots in the plug. 
     In an exemplary instrument the deployment instruments detailed herein and/or variations thereof include a tensioner assembly. Such a tensioner assembly will be described in terms of deployment instrument  200 , but are readily applicable to deployment instrument  100 , as will now be described. 
       FIG.  13    depicts a cross-sectional view of deployment instrument  200 , including tensioner assembly  140  in the form of a tensioner cartridge  160 . Tensioner cartridge  160  configured to gauge/measure and/or to control the forces (e.g., tension in filament  80 ) resulting from deployment of closure device  85 . The tensioner cartridge  160  provides the user with visual and/or tactile and/or auditory feedback during deployment. The construction of the tensioning cartridge includes a spring  150  located inside a retractable tube  162  that allows for the passage of filament  80  therethrough. The cartridge  160  includes a retractable member  170 . In an exemplary embodiment, the retractable member  170  is fixedly attached to the filament  80 , such that tension on the filament  80  imparts a force onto the retractable member  170 , and thus spring  150 . In an alternate embodiment, the filament  80  is attached to one or more of the coils of spring  150  (e.g., the most proximal coil/last coil), such that tension on the filament  80  imparts a force onto the spring  150 . In an alternate embodiment, the retractable member  170  may include a soft tensioning member  172  through which the filament  80  extends. The tensioner assembly  140  one or more utilitarian functions. For example, it controls the force applied to the filament  80  (and thus the tension) by holding the filament taut during pull back of the instrument  200  (or  100 ) while providing a system for allowing the user to guard against the application of too much force. By utilizing the tensioner assembly  140  as detailed below, a user may apply adequate filament tension for compressing the plug  50  and/or during tamping the lock  60  or other component. 
     The tensioner assembly may also provide tactile and/or visual and/or auditory indication for the user to stop pulling back and/or to stop applying additional (increasing) force to the deployment instrument in the distal direction when the end of suture length has been reached through change in color, shape, etc., visible on the instrument. In an exemplary embodiment, this can prevent or otherwise enable safeguarding against excessive force being applied to the toggle, preventing the toggle from pulling out of the blood vessel. 
     During use, application of a force onto deployment instrument  100  that results in a first tension on the filament is sufficient to withdraw the cartridge  160  out of the delivery tube  120 , exposing the cartridge  160  such that the user may handle the cartridge  160  with his or her hand. In particular, cartridge  160  is carried within delivery tube  120  such that there is a slight friction fit between the two components. This may be achieved, by way of example, via, elastomeric O-ring  174 , as may be seen. Application of the first tension (by applying a sufficient withdrawal force on the instrument  200  in the proximal direction) is sufficient to overcome the friction forces and pull the cartridge  160  out of the tube  120 . Alternatively, or in addition to this, a snap fit is utilized to retain the cartridge, and a sufficient force applied to the instrument resulting in sufficient tension on the filament is sufficient to release the snap fit. In yet another alternative embodiment, a positive retention mechanism, such as an actuating cylinder or box beam, etc., that extends into the tube  120 , and thus blocks the cartridge  160  until it is moved out of the tube  120 , or at least from in front of the cartridge  160 , may be utilized to retain and then release the cartridge. Any device, system and/or method that can provide the modicum of friction between the cartridge  160  and the delivery tube  120  and/or that provides the modicum of securement so as to releasably retain the cartridge  160  in the delivery tube  120  until it should be exposed can be utilized in some embodiments. In this regard, it is noted that the first tension may vary between embodiments. By way of example, the tension associated with overcoming the friction fit utilizing, for example, the O-ring, may be different from that associated with overcoming the snap-fit. Moreover, the tension may be variable or generally constant. For example, the tension during withdrawal of the cartridge  160  from the delivery tube  120  will be generally constant during the withdrawal process with respect to the friction fit utilizing the O-ring, whereas the tension may vary during withdrawal with respect to the snap-fit or the like. Embodiments where the tension is relatively constant, or at least moderately increases within a range that does not result in damage to the artery wall and/or dislodgement of the toggle, can have utility in that this results in a tension that generally maintains the toggle in place against the puncture on the interior of the artery. 
     With respect to the embodiment of  FIG.  13   , where the O-ring results in a friction fit between the tube  120  and the cartridge  160 , application of the first tension results in the ejectment/exposure of the cartridge  160 . This is schematically represented by way of example in  FIG.  14   . Upon sufficient exposure of the cartridge  160 , the user grips the cartridge  160  with a free hand and gradually or abruptly begins to apply force to the cartridge in the proximal direction at a level that is in equilibrium, in an exemplary embodiment, to that applied to the instrument  200 , until the cartridge  160  is completely free of the delivery tube  120 , at which point the tension in the filament  80  is a result of force applied to the cartridge  160  in the proximal direction. 
     An exemplary embodiment of the present invention includes a deployment instrument  100  including an exemplary tensioner assembly  1110  as may be seen conceptually in  FIG.  15   . In an exemplary embodiment, the tensioner assembly  1110  conceptually corresponds to the cartridge  160  detailed above, although as will be detailed below, in an exemplary embodiment of the cartridge  160 , there are different features between the two. 
     A portion of the procedure involving deployment of the closure device  80  in a recipient using the exemplary tensioner assembly  1110  of  FIG.  15    will now be described. As may be seen in  FIGS.  15  and  16   , the tensioner assembly  1110  includes a frame  1120  in which a hub assembly  1140  is slidably retained. Frame  1120  includes protrusions  1121  that interact with O-ring  174 . In this regard, frame  1120  corresponds to element  161  of  FIG.  13   . The frame  1120  serves as a handle that the user may grasp during application of the closure device  85  to the recipient. In some embodiments, the handle is provided with knurling or tread grips or the like to facilitate grasping by the user. The hub assembly  1140  includes a hub  1180  and a tensioner insert  1200  (and silicone tension block  1210 , which provides friction to the filament as it uncoils). The hub assembly is spring loaded by spring  1220  (which corresponds to spring  150  of the device of  FIG.  13   ) in the proximal direction of the deployment instrument  200 . That is, with respect to  FIG.  15   , the spring  1220  forces the hub assembly  1140  upward, relative to the frame  1120 . Another way of describing this is that the spring  1220  forces the frame  1120  downward, relative to the hub assembly  1140 . 
     It is noted that alternate embodiments include structure that is different from that detailed herein. Indeed, a visual comparison between the embodiment of  FIG.  13    and that of  FIG.  15    reveals that there are differences. It is thus again noted that the structure detailed herein is exemplary and conceptual and can, and/or will vary in implementation. In this regard, while the embodiment of  FIG.  15    depicts a hub  1140  that extends into the interior of spring  1220 , the embodiment of  FIG.  13   . Hub  1140  corresponds to retractable member  170  of  FIG.  13   . However, retractable member  170  does not so extend into the spring  150 , as may be seen. 
     In an exemplary embodiment, the spring  1220  permits the tension on filament  80  to be controlled/ensures that sufficient tensioning and not too much tensioning is applied to the filament during deployment of the closure device  85 , as will now be detailed. 
     Referring to  FIG.  15   , the tensioner assembly  1110  includes a filament recess between the tensioner insert  1200  and a filament cap  1240  in which filament  85  is wound in a coil section  80 E, from which the filament  80  travels to the closure device  85 . The end of the filament  80 E is threaded through a hole  1240 A in the filament cap  1240  and is trapped between the filament cap  1240  and a filament lock  1260  to hold the end of the filament  80  in place. Filament lock  1260  may be held to filament cap  1240  via a screw fit or a snap fit or through the use of an adhesive or a weld, etc. That said, in an alternate embodiment, the filament  80  extends completely from one side of the hub  1140  (or the retractable member  170 ) to the other side thereof, and further proximally out of the frame  1120  (or element  161 ). 
     As may be seen in  FIG.  15   , a friction block  1210  is located in a cut-out section of the tensioner insert  1200 . In an exemplary embodiment, the friction block  1210  is a silicon block that is dimensioned such that when inserted in the hub  1180  along with tensioner insert  1200 , a compressive force on filament  80  is applied by the friction block  1210  and the hub  1140 . In some exemplary embodiments, as will be described in greater detail below, as the filament  80  (filament from section  80 E) is drawn from the spool of the tensioner assembly  1110 , the user feels a relatively constant resistance and/or a relatively consistent resistance as compared to other deployment instruments  100  (i.e., the resistance felt with one deployment instrument  100  used during a given procedure will be about the same as that felt during a prior procedure with another deployment instrument  100 ). That is, the friction block  1210  in combination with the tensioner insert  1200  and hub  1140  function to control the force required to at least initially withdraw the filament  80  from the spool. 
     In an exemplary embodiment, friction block  1210  corresponds to soft tensioning member  172  detailed above with respect to  FIG.  13   . As has been noted above, the specific structure of various embodiments can vary, while utilizing the principles detailed herein. 
     As noted above, a force applied to deployment instrument  200  sufficient to result in a first tension in the filament can result in the cartridge  160  (or tensioner assembly  1110 ) being exposed (withdrawn/released from inside delivery tube  120 ). As noted above, inasmuch as the toggle  30  is trapped (anchored) against the interior of the artery wall, the continued retraction of the deployment instrument  200  causes the filament  80  to pull the plug  50  out of the deployment tube  120  of the deployment instrument  200 . Also, once the toggle  30  catches on the wall of the artery, the filament  80  (filament from section  80 E or other location where the filament is stored) will be drawn from the spool of the tensioner assembly  1110 . Some resistance will be felt, at least in embodiments utilizing the friction block  1210  (or its corresponding structure  172 ) described above (as opposed to other embodiments where no drag force is applied to the filament as a result of compression of the filament by the friction block, such as in the case where no friction block  1210 /structure  172  is used and a bore or other space of the tension insert  1200  through which the filament  80  passes is oversized relative to the filament  80 ). This resistance may require the user to apply about ¾ths of a pound of force to the deployment instrument  200  to pull the filament  80  out of/through hub  1180 /structure  170 . The user continues to pull the deployment instrument  200  away from the recipient with a force sufficient to overcome the friction resulting from the compressive force applied to the filament  80  by the friction block  1210 . At a given distance of the deployment instrument  200  from the recipient/from the puncture, the filament  80  will be completely unwound from the spool (or otherwise withdrawn through structure  172  until stop  176  strikes structure  172  in the case of cartridge  160 ).  FIG.  16    depicts the tensioner assembly  1110  in the state where the filament  80  is about ½ way unwound from the spool and  FIG.  17    depicts the tensioner assembly  1110  in the state where all of the filament  80  has been unwound from the spool. The tension on filament  80  is high enough to unwind the filament from the spool, and potentially compresses spring  1220  by a corresponding amount. 
     At this point, with increasing force applied to the deployment instrument  200 , the tension in filament  80  reaches a high enough value (the first amount detailed above) to overcome the friction forces between the O-ring and delivery tube  120 , and thus the cartridge  160  (or tensioner assembly  1110 ) becomes exposed (withdrawn/released from inside delivery tube  120 ). 
     At this point, the user grips the cartridge  160  or frame  1120 , and continues to withdraw the cartridge  160  or frame  1120  away from the recipient with a steady or increasing force. When the tensioner assembly  140   1110  is located a first linear distance from the vessel wall, because the end of the filament  80  (or other part of the filament  80 ) is trapped between filament cap  1240  and the filament lock  1260  (or element  176  abuts structure  172 ), continued pulling of the tensioner assembly away from the recipient (past the first distance), when the user holds the frame  1120  (or element  162 ) causes the filament  80  to become more tensioned because the “unwinding” of the filament  80  from the spool has stopped (there is no more filament from section  80 E to be unwound) and the end of the filament  80  is held in place as it is attached to the tensioner assembly. Accordingly, this increase in tension as the user moves the deployment tensioner assembly from the first distance from the vessel wall causes frame  1120  (or element  162 ) to move relative to hub assembly  1140  and thus causes spring  1220  (or spring  150 ) to compress or further compress. The force compressing the spring is substantially equal to the tension in the filament  80 . As the tension of the filament  80  progressively increases as the user continues to pull the tensioner assembly  200  away from the recipient (via pulling on the frame  1120  or element  162 ), the spring  1220  continues to be compressed, thus resulting in a gradual increase in the tension of the filament  80  as the tensioner assembly is continued to be pulled away from the recipient. This as compared to the relatively sudden increase in tension that would exist if the hub assembly  1140  were instead rigidly fixed to the tensioner assembly  1110  and/or the spring  1220  were not present (or if structure  170  were instead rigidly fixed to the tensioner assembly  140  and/or the spring  150  were not present. In this regard, the spring  1220 /spring  150  provides a dampening or cushioning effect with respect to the force applied to the inner wall of the blood vessel or other body passageway which reacts against the toggle  30  at the time that the filament  80  is fully unwound from the spool. Thus, there should be no sudden increase in the force/pressure on the wall at the location of the toggle  30 . Instead, there should be a gradual increase in the force/pressure on the wall at the location of the toggle  30 . In an exemplary embodiment, the hub assembly  1140  may travel about eight (8) millimeters upon the application of about two (2) pounds of tension force in the filament  80  before bottoming out (i.e., the hub assembly  1140  cannot move further downward/frame  1120  cannot move further to the upward with respect to  FIG.  15   ). Thus, an embodiment provides a mechanically induced increasing tension force applied to the filament that increases with increasing distance of the tensioner assembly away from the puncture at a rate of less than about 1.5 pounds per 4 mm of increased distance of the deployment instrument away from the puncture. Accordingly, in an exemplary embodiment, pulling the tensioner assembly away from the puncture while the filament is connected thereto results in an initial contact of the anchor to the wall of the body passageway followed by a gradual increase in pressure applied to the wall by the anchor while tension in the filament is less than about two (2) pounds. Thus, via a mechanical device of the deployment instrument  200 , a sudden increase in pressure applied to the wall of a body passageway by the toggle  30  is avoided. 
       FIG.  18    depicts spring  1120  fully compressed upon the application of two (2) pounds of tension force in the filament  80  by the user while filament  80  is connected to toggle  30  (which, as noted above, is lodged in the artery). By bottoming out the hub assembly  1140 , and not pulling on the tensioner assembly too much more after that, the user can ensure that he or she has applied about two (2) pounds of tension force on the filament  80 , and not too much more. This ensures that sufficient tension has been applied to the filament to properly deploy the closure device  85 , and not too much more. Also, the spring  1220 /spring  150  at least partially reduces what otherwise might be a spike in the force applied to the wall of the artery upon the filament  80  becoming completely unwound from the spool and becoming unslackened due to movement of the tensioner assembly away from the recipient. 
     In an exemplary embodiment, the user feels/senses the gradual increase in tension as the spring  1220 /spring  150  is compressed (as compared to the relatively static tension resulting from friction block  1210 /element  174 ), and thus is provided an indication that the tensioner assembly will soon reach the mechanical limits of its withdrawal away from the recipient, after which any further withdrawal will be due to the plastic and/or elastic nature of the filament and the recipient. In some embodiments, the spring  1220  is a linearly compressible spring, and thus the gradual increase in tension as the spring  1220  is compressed is linear. Non-linear compressible springs may also be used, in which case the gradual progressive increase in tension is not linear. In an exemplary scenario of use, the user continues pulling the tensioner assembly away from the recipient until the spring  1220 /spring  150  bottoms out, and then halts further movement of the tensioner assembly away from the recipient. Alternatively, the user can continue to pull the tensioner assembly away from the recipient, thereby further increasing the tension in the filament  80 . Even with respect to this latter scenario, the indication afforded to the user by the spring  1220 /spring  150  provides the user with an opportunity to adjust the deployment procedure to avoid injury to the recipient and/or damage to the closure device, etc. 
     It is noted that as the tensioner assembly  100  is pulled away from the recipient, and by the time that the spring  1220  has bottomed out, the pulley arrangement of the filament  80  connecting toggle  30  and the plug  50  causes the plug  50  to be moved into engagement with the exterior of the artery wall contiguous with the puncture. The tension in the filament  80  resulting from pulling the tensioner assembly away from the recipient causes the filament  80  to somewhat deform the plug, i.e., cause it to deform radially outward and, in some embodiments, twist. Because the spring  1220 /spring  150  permits the tension on filament  80  to be controlled/ensures that sufficient tensioning and not too much tensioning is applied to the filament during deployment of the closure device  20 , the user is provided with some reassurance that the proper amount of tensioning has been applied to the filament  80  to deform the plug and properly deploy the closure device  20 . 
     It is noted that in an exemplary embodiment, plug  50  can be withdrawn from tube  120  without contacting the sheath  10  and/or at least without contacting the interior of the sheath  10 . This may, in some embodiments, eliminate the possibility that the plug  30  might become stuck in the sheath  10 —during the deployment procedure as it expands once leaving the tube  120 . 
     It is noted that an exemplary embodiment includes an indicator that provides an indication to the user that the hub assembly  1140  has bottomed out within the frame  1120  (or corresponding structure). In an exemplary embodiment, the indicator corresponds to, at least conceptually and/or functionally, to the indicator taught in the &#39;653 application, the contents of which pertaining to the indicator being incorporated herein by reference in their entirety for use in an embodiment. 
     Accordingly, in an exemplary embodiment, referring to the flowchart of  FIG.  19   , there is a method of sealing a percutaneous puncture in a wall of a body passageway, comprising, at step  1 , providing a deployment instrument  100  including a tensioner assembly  1110 / 140  and carrying a closure device  80 , the closure device  80  including a toggle, a plug  50  and a contiguous elongate filament  80  configured to draw the plug  50  towards the toggle  30  upon the application of tension to the filament  80  in a direction away from the toggle  30 . At step  2 , the distal end of the deployment instrument  100  is positioned through the puncture into the body passageway such that the toggle  30  is located in the body passageway. At step  3  the deployment instrument  100  is pulled away from the puncture while the filament  80  is connected to the deployment instrument. This results in the application of a mechanically induced increasing tension force to the filament  80  that increases with increasing distance of the deployment instrument  100  away from the puncture, thereby drawing the toggle  30  and the plug  50  towards each other and into engagement with the wall of the body passageway at respectively opposite sides of the wall. In an exemplary embodiment, the mechanically induced increasing tension force is a result of spring, as detailed above. 
       FIG.  20 A  depicts an embodiment that utilizes two plugs  50  and  50 ′, each located on a portion of loop  82 , with a single toggle  30 . An exemplary embodiment of such a configuration provides utility in that two plugs may better seal a relatively large puncture. In this regard, some punctures will extend a relatively great distance about the artery wall in a direction normal to the longitudinal axis thereof. For example, the puncture may extend over an arc that extends about 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160 170 and/or about 180 degrees or more and/or angles in between these in one degree increments. A single plug may bunch at the apex of the puncture, thus leaving portions of the large puncture exposed on either side of the plug. The use of two plugs covers more area, and thus can cover more of the puncture. By way of example, a single plug may cover a puncture extending over an arc of 10 or 20 degrees, whereas two plugs may cover a puncture extending over an arc of about 25, or 35 or 40 or more degrees. Along these lines, the use of two holes  31  for the filament spread relatively far apart can space the plugs over the full area of the puncture. 
     It is noted that the washer  500  detailed above can be used to spread out the filament  80  so as to avoid or otherwise reduce the tendency of the plug to bunch at the apex of the puncture in a manner the same as or similar to the manner by which the more widely spaced holes  31  prevents or otherwise reduces the bunching tendency. 
       FIG.  20 B  depicts a cross-sectional view of a closure device according to the embodiment of  FIG.  20 A  after delivery. 
     As can be seen in  FIG.  20 A , the exemplary embodiment utilizing two plugs  50  and  50 ′ can include two tampers  70  and  70 ′ to tamp locks  60  and  60 ′. Use of these additional components may correspond to the teachings detailed above, albeit sequentially (tamping lock  60  first with tamper  70 , and then tamping lock  60 ′ with tamper  70 ′). 
     Still referring to  FIG.  20 A , an exemplary embodiment includes an alternate embodiment of a tensioner apparatus. Specifically,  FIG.  20 A  depicts a tensioning apparatus  400 . In an exemplary embodiment, tensioning apparatus  400  corresponds to a spring that is biased such that the ends  401  and  402  of the spring are separated as shown in  FIG.  20 A . Specifically, ends  401  and  402  can be wrapped about filament  80  as conceptually shown, or otherwise may include devices at the ends that permits the filament  80  to slide relative therethrough while holding the filament  80 . Upon tensioning the filament  80  as detailed herein, the two portions of filament  80  between element  81  and the toggle  30  will tend to move towards each other. The tensioning apparatus  400  will resist this movement owing to the spring bias just mentioned. The more tension applied to the filament  80 , the greater the tendency for these portions of filament  80  to move towards each other, thus compressing the spring/moving the ends  401  and  402  closer together. Accordingly, a user can view the degree of closure of the spring/movement of ends  401  and  402  closer to one another, and thereby determine or otherwise estimate/gauge how much tension is being applied. In an exemplary embodiment, a gauge may be included with tensioning apparatus  400  that permits the user to read the tension on the filament  80  owing to the location of the ends  401  and  402  (or the arms that support the ends) relative to the gauge. In yet an alternate embodiment, a spacer element may be present between the ends (or arms) that functionally permits the spring to bottom out in a manner akin to that detailed above with respect to spring  1120 / 150 , and thus having the functionality/utilitarian value of that configuration. 
       FIG.  21    depicts a variation of the embodiment of  FIG.  20 A , where instead of two separate tampers, a single tamper  75  is present that includes two lumens through which the two sides of the filament that forms loop  82  extends the same embodiment with a double lumen tamper used to include the double sutures. 
     In another embodiment, the occlusion balloon  600  is moved distally from the occlusive position to the puncture site, whereby the occlusive balloon  600  is utilized to assist with positioning the toggle  30  and/or the plug  50  and sealing the puncture. Such is depicted by way of example and not by way of limitation in  FIG.  22   . Exemplary actions associated with such a procedure can include first position toggle intra-arterially as detailed herein and/or variations thereof in general, and, in particular, with respect to  FIG.  6   . Once the toggle  30  is positioned proximate the puncture, the occlusion balloon is deflated. Next, the occlusion balloon  600  is moved from its occlusion position to a location corresponding to a longitudinally proximate position of the puncture. After this, the occlusion balloon  600  is re-inflated to occluding pressure and/or another pressure that will enable the teachings detailed herein and/or variations thereof to be practiced. This can push the toggle  30  against the interior of the artery as shown in  FIG.  22   . The user can then double check the final position of the toggle  30  (using fluoroscopy or the like) and/or make adjustments to the tension or positioning of the plug  50  before deflating the balloon  600 . (Before deflating the balloon, the closure device  20  may be secured in place according to the teachings detailed herein and/or variations thereof, or such may be done after deflating the balloon.)  FIG.  22    depicts an action of this method, where it can be seen how the balloon  600  covers the toggle  30  and puncture site. This the action associated with  FIG.  22    can allow for full compaction of the plug  50  without any risk of or otherwise significantly statistically reducing the chances of reinsertion of the plug within the artery as compared to that which would exist without use of the balloon  600 . 
     An exemplary embodiment includes the use of a double balloon catheter, where the proximal balloon serves to occlude flow, while the second, and moveable (slideable) balloon is utilized to assist with toggle and collagen placement as above.  FIG.  23    depicts an action associated with a method of such an embodiment, where balloon  600 ′ is the occluding balloon and balloon  600  is the balloon that is used to position the toggle  30 . 
       FIGS.  24 A,  24 B and  24 C  depict an alternate embodiment of a toggle. Specifically, these FIGS. depict a toggle  135  having hinged wings or flaps  136  and  137  via hinge features  136 A and  137 A. Hinge features may be barrel hinges or may be areas of relative weakness that enables the wings to hingedly move (or flap). Toggle  135  has a width W1 that is larger than the maximum internal diameter of the sheath  10  on a plane normal to the longitudinal axis thereof. In this regard, wings  136  and  137  of the toggle  135  (e.g., portions outboard of the dashed lines seen in  FIGS.  24 A- 24 C ), are located outboard of the inboard portion of the toggle represented by main body  138 . In an exemplary embodiment, the outboard portions are flexibly connected or otherwise hingedly connected to the rest of the toggle  135 . 
     In an exemplary embodiment, the toggle  135  is configured to elastically deform at the areas of the hinges and/or thereabouts. By way of example, width W1 of  FIG.  24 A  is a first value, corresponding to any of the values detailed above with respect to the tip to tip distance and/or variations thereof, and this value corresponds to the value when the toggle  135  is in the relaxed state. Upon the application of a force to the wings, the value of W1 increases, by about 4 mm (about 2 mm for each wing), although in alternate embodiments, the value W1 increases by about 0.5 mm, 0.75, 1, 1.25, 1.5, 1.75, 2, 2.25, 2.5, 2.75, 3, 3.25, 3.5, 3.75, 4, 4.25, 2.4, 4.75, 5, 5.25, 5.5, 5.75, 6, 6.25, 6.5, 6.75 and/or any value in between these values and/or any ranges encompassing some or all of these values (including ranges being bounded by the in between values). 
     This increase in value of W1, or at least a portion thereof, elastically deforms the toggle  135 , such that it retains the new value of W1 or something close to that or something in between, depending on the elastic properties that come into play associated with the plastic properties. 
       FIG.  24 D  depicts a cross-sectional view of toggle  135  through section A-A of  FIG.  24 C . As can be seen, hinge features  136 A and  137 A are notched sections in the top surface of the toggle  135 . In an alternate embodiment, the notches are located in the bottom surface. In an alternative embodiment, the notches are located both above and below. In an exemplary embodiment, hinge feature  136 A is a notch located on the top and hinge feature  137 A is a notch located on the bottom, or visa-versa. (The holes  31  are not depicted in the cross-sectional view of  FIG.  24 D .) 
     Any device, system and/or method that enables the folding functions detailed herein and/or variations thereof with respect to the wings may be utilized in some embodiments. 
     In an exemplary embodiment, the toggle  135  is such that the resistance to flexture of the toggle along lines  136 A and/or  137 A is substantially and/or effectively less than resistance to flexture of the toggle at locations generally proximately inboard and outboard thereof. In an exemplary embodiment, the toggle  135  is such that the elastic modulus of the toggle along lines  136 A and/or  137 A is substantially and/or effectively less than that of the toggle at locations generally proximately inboard and outboard thereof. 
     As noted above, the wings may expand upon the application of sufficient force thereto. In this regard, an exemplary embodiment of the toggle  135  is utilized in conjunction with a balloon  600  in a manner similar to and/or the same as that detailed above with respect to  FIG.  22   . More particularly,  FIGS.  25 A,  25 B and  25 C  schematically illustrate a sequence according to an exemplary embodiment combining the above teachings.  FIG.  25 A  depicts the toggle  135  positioned at the puncture, with the wings  136  and  137  drooping downward prior to applying tension to the filament beyond about that which is used to hold the toggle  135  against the puncture (e.g., prior to cinching the loop  80 , etc.) Balloon  600  is depicted in a deflated or semi-deflated state and is located longitudinally proximally to the puncture (and toggle  135 ). 
       FIG.  25 B  depicts inflation of the balloon  600 . As the balloon expands outward, wings  136  and  137  are forced outward towards the wall of the artery  1026 .  FIG.  25 C  depicts the balloon  600  inflated to at least about its maximum inflation dimensions. As can be seen, the wings  136  and  137  are trapped against the wall of the artery between the wall and the balloon  600 . At this time, additional tension is applied to the filament  80  to move the plug  50  (not shown) towards the toggle  135 , etc. More particularly,  FIG.  25 C  depicts how balloon  600  (single or double embodiment) may be used to orient the wings  136  and  137  of the toggle  135  to assist with internal closure. 
     Exemplary embodiments of  FIGS.  24 A-D  and/or  25 A-C can be used to substantially and/or effectively statistically reduce the chances of the toggle  135  dislodging and/or passing through the puncture and into the tract relative to the other embodiments detailed herein and/or variations thereof. This statistical phenomenon may be, for example, because the additional area of the toggle  135  owing to the wings because the wings can be folded for insertion into the sheath  10 . This as compared to a toggle without folding wings, where the maximum size of the toggle is limited by the internal diameter of the sheath  10 . 
     Exemplary embodiments of  FIGS.  24 A-D  and/or  25 A-C can be used in applications where the puncture extends over a larger arcuate distance as compared to toggles having smaller widths. For example, the puncture may extend over an arc that extends about 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160 170 and/or about 180 degrees or more and/or angles in between these in one degree increments. The embodiments of  FIGS.  24 A-C  and/or  25 A-C can substantially and/or effectively statistically reduce the chances of the toggle  135  dislodging and/or passing through such punctures puncture and into the tract relative to the other embodiments detailed herein and/or variations thereof. 
       FIGS.  26 A and  26 B  depict another embodiment, where the filament is utilized to apply the above-mentioned force to the wings to expand the wings. In this regard,  FIG.  26 B  is a cross-sectional view of section AA of the toggle  300  depicted in  FIG.  26 A . In this embodiment, the holes  311  of the toggle  300  for the filament  80  are angled relative to the lateral axis  301  or positioned so as to aid in the support of the widened portion, or ‘wings’. In an exemplary embodiment, this can aid in opening the toggle  300 , which has hinge sections  300 A and  300 B extending along the midline. In an exemplary embodiment, loop  82  extends through holes  311  as may be seen. The angle of the holes relative to axis  301  has utility in that as the loop  82  is closed due to the tensioning of filament  80 , the filament  80  applies a force onto wings  302 A and  302 B, lifting the wings upward and against the artery. It is noted that such utility can also be achieved without the angling of the holes  311  relative to axis  301 . In this regard, because the holes  311  are outboard of the hinge sections  300 A and  300 B, the force resulting from the tensioning of the filament  80  is applied to the wings, thus forcing the wings upward and against the artery. 
     In addition to radiopaque marking schemes mentioned above, some embodiments detailed herein and/or variations thereof may include additional markers to ensure or otherwise substantially and/or effectively statistically improve the chances of utilitarianly deploying the toggles. Radiopaque markings on the tubes can aid in enabling the user to estimate the amount of delivery tube and/or release tube that has been pushed into the vessel. This can help the user avoid unutilitarian advancement of the toggle into the vessel (e.g., too much advancement), thereby obviating any adverse situations during deployment such as catching of the toggle on the inner wall downstream. The delivery tube and/or the release tube may have radiopaque strips or rings at fixed distances. It may also have rings with increasing thicknesses. The gradient may be designed in proportion to a qualitative assessment of distance advanced. The tube(s) may also have dots in place of rings to differentiate between the radiopaque sheath tip and the delivery tube. 
     In a similar vein, an exemplary embodiment includes a toggle or other degradable intraluminal sealing member that includes a radiopaque marker. In an exemplary embodiment, one or more or all of the embodiments of toggles detailed herein and/or variations thereof may include therein a relatively thin stainless steel radiopaque marker (thickness of 0.005″-0.010″). In some exemplary embodiments, the marker may have hollow features.  FIGS.  27 A-D  depict such an exemplary embodiment of a marker  2700 , having hollow holes  2701  in arms  2702  extending from a core  2703 . Embedded in or otherwise attached to a toggle, the hollow features can be utilized to indicate toggle orientation during deployment. By way of example, depending on the orientation of the toggle relative to a viewing perspective, the holes will appear anywhere from circular to highly elliptical. More particularly, under fluoroscopic guidance, the holes appear circular at 0.degree. relative to the viewing perspective ( FIG.  27 A ), elliptical at 15.degree. relative to the viewing perspective ( FIG.  27 B ), more elliptical at 30.degree. relative to the viewing perspective ( FIG.  27 C ) and highly-elliptical and/or closed off completely (i.e., one cannot see through the hole as the wall of the hole blocks the view) at 45.degree. ( FIG.  27 D ). Accordingly, there is a method of fluoroscopically confirming the orientation of the toggle relative to a viewing perspective based on how the holes look relative to a viewing perspective prior to initiating any of the actions detailed herein and/or variations thereof associated with deployment of the toggle. 
     More particularly, in an exemplary embodiment, during deployment of the toggle, the holes may appear closed (or highly elliptical) as the toggle is released from the delivery instrument and hangs in the intraluminal space. As the toggle is brought closer to the vessel wall as detailed herein, the varying degrees of circularity of the holes relative to a viewing perspective via fluoroscopy can provide the user with a visual confirmation of accurate positioning and/or utilitarian positioning of the toggle. 
     In an exemplary embodiment, the marker can also be used as a reinforcing element that reinforces the toggle and improves resistance to the tensioning of the filament as detailed above. This can have utilitarian value in that it can substantially and/or effectively statistically increase the likelihood that the toggle stays in contact with the inner wall of the vessel throughout the period of resorption. This as compared to that which would be the case in a similarly situated toggle without the marker. In an exemplary embodiment, the “marker” need never be used as a marker, but instead simply only as a reinforcing device. 
     As noted above, an exemplary embodiment includes a guide wire  20  that passes through holes in the plug  50 .  FIGS.  28 ,  29  and  30    depict exemplary embodiments, of such a configuration. In a further embodiment, there is an extra luminal sealing component  550 , as depicted in  FIG.  30   , that is in the form of a stainless steel plate or bar about 0.5″ long or less and about 0.010″ thick or less placed between the hemostatic pad  50  and the lock  60 . The plate  550  can have utilitarian value in that it can increase or otherwise result in utilitarian distribution of compression forces on the plug  50  more evenly in order to achieve statistically and/or effective reliable hemostasis. 
     Embodiments disclosed herein and variations thereof include various interventional cardiology procedures which utilize large access sheaths to accommodate large devices. Non-exhaustive examples may include methods that include steps of balloon aortic valvuloplasty (BAV) and percutaneous aortic valve replacement (PAVR), both of which are utilized with sheaths ranging from 12-24 F. Closure of access sites involving sheaths this large are accomplished with the closure devices and deployment instruments disclosed herein and variations thereof, as well as methods for closing such access sites disclosed herein (which includes those disclosed in the above referenced applications, scaled for such closure) instead of and/or in addition to surgical closure procedures and/or the use of multiple traditional vascular closure devices. In an exemplary embodiment, the devices and methods disclosed herein and variations thereof reduce by 50%, 75%, 90%, 95%, and/or 99% or more the failure rates associated with closure of access sites of the just-mentioned procedures (i) such as those disclosed by, for example, Herrmann et al, discusses the successful use of multiple 8 F Angio-Seal devices (St Jude Medical, Minnetonka, Minn.) to close the arterial access site from BAV procedures, combating historical vascular complication rates from various studies ranging from 11-23%, (ii) and/or such as those disclosed by the Ramy et a12 report on the use three Perclose devices utilized for the closure of PAVR arterial access sites, suggesting deployment of the devices at 60 degree offsets to completely close the arteriotomy around the periphery. 
     It is noted that some embodiments include methods of utilizing the devices and/or systems and/or components detailed herein and/or variations thereof. Such methods can include individual method actions associated with/corresponding to the movement, positioning, use, etc., of the devices and systems and components detailed herein and/or variations thereof. 
     In an exemplary embodiment, there is a closure device for sealing a percutaneous puncture in a wall of a body passageway, the closure device comprising: 
     at least one of an: 
     anchor configured to engage an interior surface of the body passageway, and a plug configured to engage an exterior surface of the body passageway; and 
     a guide wire configured to extend from an outside of the body to inside the body passageway, 
     wherein the at least one of the anchor and the plug is associated with the guide wire. 
     In an exemplary embodiment, there is a closure device as described above and/or below, wherein the anchor is associated with the guide wire such that the anchor is slidingly coupled to the guide wire. In an exemplary embodiment, there is a closure device as described above and/or below, wherein the anchor includes a cavity, and the guide wire extends through the cavity. In an exemplary embodiment, there is a closure device as described above and/or below, wherein the cavity is an orifice through the anchor. In an exemplary embodiment, there is a closure device as described above and/or below, wherein the cavity is a notch on a periphery of the anchor. 
     In an exemplary embodiment, there is a closure device as described above and/or below, wherein the plug is associated with the guide wire such that the plug is slidingly coupled to the guide wire. 
     In an exemplary embodiment, there is a deployment instrument for deploying a closure device for sealing a percutaneous puncture in a wall of a body passageway, the deployment instrument comprising: 
     the closure device; 
     a carrier device, wherein the carrier device is configured to hold the closure device in a pre-deployment state; and 
     a guide wire, the guide wire passing through at least a portion of the closure device. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein the closure device includes a toggle, wherein the guide wire passes through the toggle. In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein the closure device includes a plug, wherein the guide wire passes through the plug. In an exemplary embodiment, there is a deployment instrument as described above and/or below, further comprising:
         a tamper, wherein the guide wire is associated with the tamper.       

     In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein the tamper includes a plurality of lumens, wherein the guide wire extends through one of the lumens. In an exemplary embodiment, there is a deployment instrument for deploying a closure device for sealing a percutaneous puncture in a wall of an artery, the deployment instrument comprising: 
     the closure device, wherein the closure device includes a toggle and a plug connected to the toggle; and 
     an actuatable assembly having an actuatable portion configured to extend into the artery such that the toggle is located in the artery while, in a first state, effectively maintaining a relative position of the toggle with respect to the actuatable portion. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein the actuatable assembly is configured to, upon actuation from the first state to a second state, permit the toggle to move relatively freely relative to the actuatable portion while connected to the plug and while the toggle is in the artery. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein the actuatable assembly is configured to extend into the artery such that at least a portion of the plug is located in the artery; and actuatable assembly is configured to, upon actuation from the first state to a second state, permit the toggle to move relatively freely relative to the plug while connected to the plug and while the toggle and at least a portion of the plug is in the artery. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein the actuatable assembly includes a first lumened component in which the plug is located and a second lumened component in which the first lumened component is located; and 
     wherein the instrument is configured to, upon actuation of the actuatable assembly, move the second lumened component relative to the first lumened component and/or visa-versa, thereby actuating from the first state to the second state and thereby permitting the toggle to move relatively freely relative to the actuatable portion while connected to the plug. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein at least a portion of the toggle is located within the lumen of the second lumened component; and 
     wherein movement of the second lumened component relative to the first lumened component and/or visa-versa, upon actuation from the first state to the second state, results in the toggle being fully exposed outside the second lumen component. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, further comprising: 
     a knob configured to turn relative to at least one of the first lumened component or the second lumened component to actuate the actuatable assembly. 
     In an exemplary embodiment, there is a deployment instrument for deploying a closure device for sealing a percutaneous puncture in a wall of a body passageway, the closure device including an anchor, a plug and a contiguous elongate filament configured to draw the plug towards the anchor upon the application of tension to the filament in a direction away from the anchor, the deployment instrument comprising: 
     a carrier assembly, wherein the carrier assembly is configured to hold the closure device in a pre-deployment state; and 
     a tensioner assembly located inside the carrier assembly. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein the carrier assembly includes a first lumened component, wherein the first lumened component is configured to hold the closure device in a lumen thereof, and 
     wherein the tensioner assembly is located in the lumen. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein the tensioner assembly includes a cartridge comprising a handle, a spring, and a suture interface that moves relative to the handle, movement relative to the handle causing at least one of compression or extension of the spring; and 
     wherein the handle, the spring and the suture interface are located within the lumen. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein the tensioner assembly is configured to increase the tension in the filament upon linear movement of the tensioner assembly away from the wall of the body passageway when the closure device is anchored to the wall via the anchor such that the tension is gradually increased as the tensioner assembly is moved between a first linear distance and a second linear distance greater than the first linear distance from the wall of the body passageway. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein the deployment instrument is configured such that movement of the carrier assembly away from the wall of the body passageway when the closure device is anchored to the wall via the anchor with the cartridge in the carrier assembly while the filament is under tension withdraws the cartridge from the carrier assembly; and 
     wherein the deployment instrument is configured such that the movement withdrawing the carrier assembly results in movement of the tensioner assembly from a first location that is a linear distance from the wall of the body passageway less than the first linear distance to a second location that is greater than the linear distance from the wall to the first location and less than or about equal to the first linear distance from the wall of the body passageway. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein the deployment instrument is configured such that movement of the carrier assembly away from the wall of the body passageway when the closure device is anchored to the wall via the anchor between a first linear distance from the wall to a second linear distance from the wall greater than the first linear distance while the filament is under tension results in withdrawal of the cartridge out of the first lumen; and 
     wherein the tensioner assembly is configured to increase the tension in the filament upon linear movement of the handle away from the wall of the body passageway when the closure device is anchored to the wall via the anchor such that the tension is gradually increased as the tensioner assembly is moved between a third linear distance and a fourth linear distance greater than the third linear distance from the wall of the body passageway, wherein the third linear distance is greater than or about equal to the second linear distance. 
     A closure device for sealing a percutaneous puncture in a wall of a body passageway, the closure device comprising: 
     a toggle configured to engage an interior surface of the body passageway; and 
     a filament threaded through three or more orifices in the toggle. 
     In an exemplary embodiment, there is a closure device as described above and/or below, wherein the filament is threaded through four orifices in the toggle. In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein in the following order: 
     the filament enters a first orifice at a first side of the toggle and exits the first orifice at a second side opposite the first side of the toggle; 
     the filament enters a second orifice at a second side of the toggle and exits the second orifice at the first side of the toggle; 
     the filament enters a third orifice at the first side of the toggle and exits the third orifice at the second side opposite the first side of the toggle; and 
     the filament enters a fourth orifice at the second side of the toggle and exits the fourth orifice at the first side of the toggle. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, wherein the four orifices are generally linearly arranged across the toggle in an order of the first orifice, the second orifice, the third orifice and the fourth orifice. In an exemplary embodiment, there is a closure device for sealing a percutaneous puncture in a wall of a body passageway, the closure device comprising: 
     a toggle configured to engage an interior surface of the body passageway; 
     a looped filament extending through the toggle; and 
     a washer spanning across the loop and associated with the filament at two locations such that the filament of the look cannot constrict on itself proximate the washer. 
     In an exemplary embodiment, there is a closure device as described above and/or below, further comprising: 
     a first plug, wherein the filament is threaded through the first plug between the washer and the toggle on a first side of the loop; and 
     a second plug, wherein the filament is threaded through the second plug between the washer and the toggle on a second side of the loop opposite the first side. 
     In an exemplary embodiment, there is a closure device for sealing a percutaneous puncture in a wall of a body passageway, the closure device comprising: a toggle configured to engage an interior surface of the body passageway; a looped filament extending through the toggle; 
     a first plug, wherein the filament is threaded through the first plug on a first side of the loop; and 
     a second plug, wherein the filament is threaded through the second plug on a second side of the loop opposite the first side. 
     In an exemplary embodiment, there is a deployment instrument for deploying a closure device for sealing a percutaneous puncture in a wall of a body passageway, the closure device including an anchor, a plug and a contiguous elongate filament configured to draw the plug towards the anchor upon the application of tension to the filament in a direction away from the anchor, the deployment instrument comprising: 
     a closure device including an anchor and a pad connected to the anchor via a looped filament; 
     a first tamper lumen, the filament extending through the first tamper lumen on a first side of the loop; and 
     a second tamper lumen, the filament extending through the second tamper lumen on a second side of the loop. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, further comprising: 
     a first tamper, the first tamper including the first tamper lumen; and 
     a second tamper, the second tamper including the second tamper lumen. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below, further comprising: 
     a tamper, wherein the first and second tamper lumens extend through the tamper. 
     In an exemplary embodiment, there is a deployment instrument for deploying a closure device for sealing a percutaneous puncture in a wall of a body passageway, the closure device including an anchor, a plug and a contiguous elongate filament configured to draw the plug towards the anchor upon the application of tension to the filament in a direction away from the anchor, the deployment instrument comprising: 
     a closure device, the closure device including a toggle and a plug connected to the toggle via a looped filament; and 
     a tensioner assembly, the tensioner assembly spanning the loop and being spring biased to resist closure of the loop. 
     In an exemplary embodiment, there is a deployment instrument as described above and/or below wherein the tensioner assembly includes a first and second arm, the arms being spring biased away from one another, the arms being respectively connected to sides of the loop, such that closure of the loop imparts a force onto the arms that drives the arms towards one another. In an exemplary embodiment, there is a method of closing a puncture in an artery wall, comprising: 
     inserting an anchor through the puncture into the artery; 
     moving an expandable device along the longitudinal direction of the artery to a location longitudinally proximate the puncture and longitudinally proximate the anchor; and 
     expanding the expandable device, thereby applying a compressive force to the anchor. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein the compressive force compresses the anchor against the artery wall. In an exemplary embodiment, there is a method as described above and/or below, wherein the expandable device is an occlusion balloon. In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     moving a second occlusion balloon along the longitudinal direction of the artery; and 
     occluding the artery. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     while the expandable device is applying the compressive force, moving a plug against the artery wall proximate the anchor. 
     In an exemplary embodiment, there is a closure device for sealing a percutaneous puncture in a wall of a body passageway, the closure device comprising: 
     an anchor configured to engage an interior surface of the body passageway, wherein the anchor includes a first portion and a second portion, the first portion extending away from the second portion, and wherein at least one of the first portion and the second portion is hinged. 
     In an exemplary embodiment, there is a closure device as described above and/or below, 
     wherein the anchor includes a main body between the first portion and the second portion, wherein the hinge is between the first portion and the main body. 
     In an exemplary embodiment, there is a closure device as described above and/or below, 
     wherein the anchor includes a main body between the first portion and the second portion; the first portion and the second portion are hinged; the hinge of the first portion is between the first portion and the main body; and 
     wherein the hinge of the second portion is between the second portion and the main body. 
     In an exemplary embodiment, there is a closure device as described above and/or below, 
     wherein the hinge comprises a notch in the anchor. 
     In an exemplary embodiment, there is a closure device as described above and/or below, 
     wherein the anchor includes a plurality of orifices through which a filament is looped, one side of the loop extending through one orifice and the other side of the loop extending through the other orifice; and 
     wherein the hinge is between the orifices. 
     In an exemplary embodiment, there is a closure device for sealing a percutaneous puncture in a wall of a body passageway, the closure device comprising: 
     an anchor configured to engage an interior surface of the body passageway, wherein the anchor includes a fluoroscopic marker, the marker including a hole having a circular cross-sectional area extending therethrough. 
     In an exemplary embodiment, there is a closure device as described above and/or below, 
     wherein the marker includes a plurality of holes having respective circular cross-sectional areas extending therethrough. 
     In an exemplary embodiment, there is a closure device as described above and/or below, wherein the marker includes arms extending from one another, the respective arms having respective holes. In an exemplary embodiment, there is a method of sealing a percutaneous puncture in a body passageway of a living being, the method comprising: 
     inserting an anchor into the body passageway; 
     inserting at least a portion of a plug coupled to the anchor into the body passageway; 
     and closing the puncture by moving the plug towards the anchor. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     inserting in its entirety the plug into the body passageway. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein: 
     the anchor is held effectively rigidly relative to the plug while inserting at least a portion of the plug into the body passageway. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein: 
     at least a portion of the anchor is enclosed within a delivery apparatus while inserting at least a portion of the plug into the body passageway. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein: 
     the delivery apparatus is a delivery tube. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     releasing the anchor after it is held effectively rigidly relative to the plug such that the anchor is effectively movably connected to the plug while at least a portion of the plug is in the body passageway. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein: 
     the action of inserting the anchor into the body passageway is executed while the anchor is associated with a guidewire extending into the body passageway through the puncture from outside the body passageway. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     passing the anchor completely through an insertion sheath while at least a portion of the anchor is enclosed within the delivery apparatus. 
     In an exemplary embodiment, there is a method of sealing a percutaneous puncture in a body passageway of a living being, the method comprising: 
     inserting a guidewire into the body passageway such that the guidewire extends from outside the body passageway, through the puncture and into the body passageway; and 
     inserting an anchor into the body passageway while the anchor is associated with the guidewire extending from outside the body passageway, through the puncture and into the body passageway. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein: 
     the guidewire extends through the anchor, and the anchor slides along the guidewire while inserting the anchor into the body passageway. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein: 
     the guidewire extends through a plug that is coupled to the anchor, and the plug slides along the guidewire while inserting the anchor into the body passageway. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     associating the guidewire with the anchor prior to inserting the anchor into the body passageway. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein: 
     the action of associating the guidewire is executed while the puncture is open. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein: 
     the action of associating the guidewire is executed in relatively close temporal proximity to at least one of forming the puncture and closing the puncture. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     obtaining access to a deployment instrument including a closure device including the anchor and the guidewire while the anchor is associated with the guidewire. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein: 
     the action of obtaining access includes opening a package containing the deployment instrument including the closure device including the anchor and the guidewire while the anchor is associated with the guidewire. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein: 
     the package is at least one of a hermetically sealed. 
     In an exemplary embodiment, there is method of sealing a percutaneous puncture in a body passageway of a living being, the method comprising: 
     inserting a distal end section of a deployment instrument into the puncture from outside of the passageway, wherein the distal end section of the deployment instrument rigidly supports an anchor, the distal end section including a first component and a second component being in actuatable relationship to one another. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     actuating the deployment instrument to move the first component relative to the second component and/or visa-versa, wherein the actuation relieves the rigid support of the anchor, thereby enabling the anchor to effectively move relative to the distal end section. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     inserting the distal end section into an insertion sheath extending through the puncture from outside of the passageway to inside of the passageway while the distal end section of the deployment instrument rigidly supports the anchor. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     inserting the insertion sheath into the puncture. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein: 
     the insertion sheath is inserted into the puncture such that the insertion sheath substantially deforms from a linear configuration. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     after inserting the insertion sheath into the puncture such that the insertion sheath substantially deforms from the linear configuration, moving the insertion sheath relative to the deployment instrument and/or visa-versa so that the anchor is exposed from the insertion sheath and in the passageway. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     actuating the deployment instrument to move the first component relative to the second component and/or visa-versa, wherein the actuation relieves the rigid support of the anchor, thereby enabling the anchor to effectively move relative to the distal end section. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     after actuating the deployment instrument, moving the deployment instrument in a distal direction so that the anchor abuts a wall of the passageway proximate the puncture. 
     In an exemplary embodiment, there is a method as described above and/or below, further comprising: 
     after actuating the deployment instrument, moving the deployment instrument in a distal direction so that the anchor abuts a wall of the passageway proximate the puncture and so that a plug contained in the deployment instrument moves towards the anchor and towards the puncture. 
     In an exemplary embodiment, there is method of sealing a percutaneous puncture in a wall of a body passageway, comprising: 
     providing a deployment instrument carrying a tensioner assembly and a closure device within the deployment instrument, the closure device including an anchor, a plug and a contiguous elongate filament configured to draw the plug towards the anchor upon the application of tension to the filament in a direction away from the anchor; 
     positioning a distal end of the deployment instrument through the puncture into the body passageway such that the anchor is positioned in the body passageway; 
     pulling the deployment instrument away from the puncture while the filament is connected to the tensioner assembly such that a mechanically induced tension force is applied to the filament causing the tensioner assembly to be withdrawn from an interior of the deployment instrument; and 
     pulling the tensioner assembly away from the puncture while the filament is connected to the tensioner assembly such that the mechanically induced tension force is applied to the filament such that the tension force increases with increasing distance of the tensioner assembly away from the puncture to draw the anchor and the seal towards each other and into engagement with the wall of the body passageway at respectively opposite sides of the wall. 
     In an exemplary embodiment, there is a method as described above and/or below, wherein pulling the tensioner assembly away from the puncture while the filament is connected to the tensioner assembly results in the application of a linearly increasing mechanically induced tension force to the filament. In an exemplary embodiment, there is a method as described above and/or below, wherein the mechanically induced increasing tension force is produced via compression of a spring. In an exemplary embodiment, there is a method as described above and/or below, wherein the tensioner assembly includes a handle that is movable relative to a first location on the tensioner assembly to which the filament is connected, the method further comprising continuing to pull the tensioner assembly away from the puncture by pulling on the handle until the handle no longer moves relative to the first location on the tensioner assembly. 
     While various embodiments of the present invention have been described above, it should be understood that they have been presented by way of example only, and not limitation. It will be apparent to persons skilled in the relevant art that various changes in form and detail can be made therein without departing from the spirit and scope of the invention. Thus, the breadth and scope of the present invention should not be limited by any of the above-described exemplary embodiments but should be defined only in accordance with any future claims and their equivalents.