Patent Publication Number: US-2022218322-A1

Title: Arteriotomy closure apparatus with slotted shoe for advantageous pressure distribution

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. Non-Provisional patent application Ser. No. 16/061,028 filed Jun. 11, 2018, which claims priority to International Application No. PCT/EP2016/081183 filed Dec. 15, 2016, which claims priority to and the benefit of U.S. Provisional Application No. 62/267,644 filed Dec. 15, 2015, the entire contents of each of which are hereby incorporated by reference. 
    
    
     BACKGROUND 
     During a surgical or endoscopic operation on a body lumen, e.g., a blood vessel, an aperture is formed (e.g., from an arteriotomy) in the tissue of the lumen. Following the procedure, the aperture has to be closed in order for the lumen to heal. One relatively new type of closure apparatus has a flexible disc that is delivered into the body lumen to seal the aperture. The disc maintains the tissue in apposition until the lumen is healed, allowing the wound to heal from the inside of the lumen. The disc may operate in conjunction with a rigid core, which prevents the disc from dislodging from the sealing position. 
     In certain patient groups, the area surrounding the tissue within the body lumen is diseased and/or has accumulation (e.g., plaque or calcified lesions on the tissue wall). Due to the irregular surface topology of such areas, the effectiveness of the seal made by certain closure apparatuses is reduced, as channels are formed between the disc and the tissue surface. 
     There are benefits of improving the seal formed by a closure apparatus when closing an aperture formed in the tissue of the body lumen. 
     SUMMARY 
     During a surgical or endoscopic or other minimally invasive operation on a body lumen, e.g., a blood vessel, an aperture is formed (e.g., from an arteriotomy or a veinotomy) in the tissue of the lumen. Closure and healing can be assisted by a closure apparatus, e.g., an apparatus that has a flexible disc that is delivered into the body lumen to seal the aperture, and/or a rigid core, which prevents the disc from dislodging from the sealing position. The disclosed technologies can improve the seal formed by a closure apparatus when closing an aperture formed in the tissue of the body lumen. In certain embodiments, the disclosed technologies assist the closure of an aperture, e.g., by providing a compressive force on the exterior surface of a vessel, e.g., using an extra-arterial cage or shoe. 
     In one aspect, the invention is directed to a device for fixating an implant, the device comprising a shoe comprising one or more engagement elements for engagement with a column or support member of the implant. In certain embodiments, the shoe has a caged structure. In certain embodiments, the shoe comprises one or more concave structural elements. In certain embodiments, at least one structural element of the shoe is selected from the group consisting of indentations, ridges, shoulders, planes, curved planes, cavities, notches, holes, slots surfaces, and grooves. In certain embodiments, the device comprises at least one hole and one shoulder. In certain embodiments, the device is bioabsorbable. In certain embodiments, the device comprises at least one material selected from the group consisting of Polydioxanone, Poly-L-lactide, Poly-D-lactide, Poly-DL-lactide, Polyglycolide, ε-Caprolactone, and Polyethylene glycol. In some embodiments, the material of the support member and/or sealable member is a co-polymer of, for example, but not limited to, Polydioxanone, Poly-L-lactide, Poly-D-lactide, Poly-DL-lactide, Polyglycolide, ε-Caprolactone, and Polyethylene glycol. 
     In another aspect, the invention is directed to a device for sealing an aperture in a tissue of a body lumen, the device comprising: (i) a flexible support member comprising a base and a sealable member; (ii) a column comprising a centering tab and/or one or more locking tabs; and (iii) an extra-arterial shoe comprising one or more engagement elements for engagement with the flexible support member. In certain embodiments, the extra-arterial shoe comprises a shoulder. In certain embodiments, the one or more locking tabs engage with the extra-arterial shoe by snap fitting with the shoe. In certain embodiments, the one or more locking tabs engage with the extra-arterial shoe by engaging the shoulder of the shoe. In certain embodiments, the column comprises two locking tabs. In certain embodiments, the locking tabs are positioned opposite to each other along the circumference of a cylindrical portion of the flexible support member. In certain embodiments, the centering tab reversibly engages one or more features of the extra-arterial shoe. In certain embodiments, the one or more features are a notch, a hole, surface, or a groove. In certain embodiments, the device comprises a delivery system comprising an external shaft. In certain embodiments, the extra-arterial shoe is mounted on the external shaft and is slideably moveable along a longitudinal axis of the external shaft. In certain embodiments, the device comprises a shoe pusher. In certain embodiments, the shoe pusher is mounted on the external shaft and is slideably moveable along a longitudinal axis of the external shaft. 
     In another aspect, the invention is directed to a device for sealing an aperture in a tissue of a body lumen, the device comprising: (i) a flexible support member comprising a base and a sealable member; (ii) a column comprising a centering tab and/or one or more locking tabs; (iii) an extra-arterial shoe comprising one or more engagement elements for engagement with the flexible support member; (iv) a delivery system comprising an external shaft having a longitudinal axis; and (v) a shoe pusher. In certain embodiments, the extra-arterial shoe is mounted on the external shaft and is slideably moveable along a longitudinal axis of the external shaft, and the shoe pusher is mounted on the external shaft and is slideably moveable along a longitudinal axis of the external shaft. In certain embodiments, the shoe pusher is reversibly engageable to the external shoe. In certain embodiments, the shoe pusher and the extra-arterial shoe are moveable between a first, proximal position and a second, distal position, such that in the first position, the shoe pusher and the extra-arterial shoe are reversibly engaged and slideably moveable along the longitudinal axis, and such that in the second position, the extra-arterial shoe engages the flexible support member. In certain embodiments, the shoe pusher is moveable to a third, proximal position. In certain embodiments, the extra-arterial shoe, upon deployment and engagement, is capable of exerting pressure on an exterior surface of the tissue. In certain embodiments, the aperture in a tissue of a body lumen is a surgical or endoscopic perforation in a body cavity. 
     In another aspect, the invention is directed to a device for sealing an aperture in a tissue of a body lumen, the device comprising: (i) a flexible support member comprising a base and a sealable member; (ii) a column comprising a locking neck; and (iii) an extra-arterial shoe comprising one or more engagement elements for engagement with the flexible support member. In certain embodiments, the extra-arterial shoe comprises an engagement slot. In certain embodiments, the locking neck engages with the extra-arterial shoe by snap fitting with the shoe. In certain embodiments, the locking neck engages with the extra-arterial shoe by engaging the engagement slot. In certain embodiments, the device comprises a delivery system comprising an external shaft. In certain embodiments, the extra-arterial shoe is mounted on the external shaft and is slideably moveable along a longitudinal axis of the external shaft. In certain embodiments, the device comprises a shoe pusher. In certain embodiments, the shoe pusher is mounted on the external shaft and is slideably moveable along a longitudinal axis of the external shaft. 
     In certain embodiments, the body lumen is the inside space of a biological structure selected from the group consisting of gastrointestinal tract, heart, peritoneal cavity, esophagus, vagina, rectum, trachea, bronchi, and blood vessel, e.g., the femoral artery, iliac artery, subclavian artery, ascending and descending aorta, auxiliary and brachial arteries, femoral vein, iliac vein, subclavian vein, and vena cava. 
     Further features and aspects of example embodiments of the present invention are described in more detail below with reference to the appended Figures. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWING 
         FIGS. 1A and 1B  are diagrams showing a perspective view and a cross-sectional view of an exemplary closure device deployed at a sealing position in a body lumen. 
         FIG. 2A  is a diagram of the closure device in a stowed position, according to an illustrative embodiment. 
         FIG. 2B  is a diagram of the closure device in a deployed state at the sealing position, according to an illustrative embodiment. 
         FIGS. 3A and 3B  are diagrams showing a perspective view and a bottom view of a support member of the closure device, according to an illustrative embodiment. 
         FIGS. 4A and 4B  are diagrams showing a perspective view and a bottom view of a support member of the closure device with directionally-induced rigidity, according to an illustrative embodiment. 
         FIG. 4C  is a diagram showing a bottom view of a support member of the closure device with directionally-induced rigidity, according to an illustrative embodiment. 
         FIGS. 4D and 4E  are diagrams showing a perspective view and a bottom view of a support member of the closure device with directionally-induced rigidity, according to an illustrative embodiment. 
         FIG. 5  is a diagram of an example closure device (e.g., of  FIG. 7 ) secured to a delivery apparatus. 
         FIG. 6  is a diagram showing a perspective view of an alternative embodiment of a support member. 
         FIG. 7  is a diagram showing a perspective view of an alternative embodiment of a support member. 
         FIG. 8  is a diagram showing a perspective view of an alternative embodiment of a support member. 
         FIG. 9  is a diagram showing a perspective view of an alternative embodiment of a support member. 
         FIG. 10  is a diagram showing a perspective view of an alternative embodiment of a support member. 
         FIG. 11  is a diagram showing a perspective view of an alternative embodiment of a support member. 
         FIG. 12  is a diagram showing a perspective view of an alternative embodiment of a support member. 
         FIG. 13  is a diagram showing a perspective view of an alternative embodiment of a support member. 
         FIG. 14  is a diagram showing a perspective view of an alternative embodiment of a support member. 
         FIG. 15  is a diagram showing a perspective view of an alternative embodiment of a support member. 
         FIG. 16  is a diagram showing a perspective view of an alternative embodiment of a support member. 
         FIGS. 17A, 18A and 18B  are diagrams showing a perspective view and a cross-sectional view of an assembled closure device. 
         FIG. 17B  is diagram showing a perspective view of a locking feature. 
         FIGS. 19A, 19B, and 19C  are diagrams of a perspective view, a side view, and a front view of a closure device with a threaded portion to allow assembly of the sealable member to the support member without distortion and/or deformation of the sealable member. 
         FIGS. 20A, 20B, 20C, and 20D  are diagrams showing a sequence for assembling the sealing member to a support member configured with a threaded portion. 
         FIGS. 21A, 21B, and 21C  are diagrams showing a sequence of the transition of the sealable member and the support member from a stowed state to a delivery state when the closure apparatus is loaded in a delivery cannula. 
         FIG. 22  is a diagram of the sealable member and the support member in the delivery configuration. 
         FIGS. 23A, 23B, 23C, and 23D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 24A, 24B, 24C, and 24D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 25A, 25B, 25C, and 25D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 26A, 26B, 26C, and 26D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 27A, 27B, 27C, and 27D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 28A, 28B, 28C, and 28D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 29A, 29B, 29C, and 29D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 30A, 30B, 30C, and 30D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 31A, 31B, 31C, and 31D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 32A, 32B, 32C, and 32D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 33A, 33B, 33C, and 33D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 34A, 34B, 34C, and 34D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 35A, 35B, 35C, and 35D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 36A, 36B, 36C, and 36D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 37A, 37B, 37C, and 37D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 38A, 38B, 38C, and 38D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 39A, 39B, 39C, and 39D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 40A, 40B, 40C, and 40D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 41A, 41B, 41C, and 41D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 42A, 42B, 42C, and 42D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 43A, 43B, 43C, and 43D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 44A, 44B, 44C, and 44D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 45A, 45B, 45C, and 45D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 46A, 46B, 46C, and 46D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 47A, 47B, 47C, and 47D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 48A, 48B, 48C, and 48D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 49A, 49B, 49C, and 49D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 50A, 50B, 50C, and 50D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 51A, 51B, 51C, and 51D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 52A, 52B, 52C, and 52D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 53A, 53B, 53C, and 53D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 54A, 54B, 54C, and 54D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 55A, 55B, 55C, and 55D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 56A, 56B, 56C, and 56D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 57A, 57B, 57C, and 57D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 58A, 58B, 58C, and 58D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 59A, 59B, 59C, and 59D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 60A, 60B, 60C, and 60D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 61A, 61B, 61C, and 61D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 62A, 62B, 62C, and 62D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 63A, 63B, 63C, and 63D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 64A, 64B, 64C, and 64D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 65A, 65B, 65C, and 65D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 66A, 66B, 66C, and 66D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 67A, 67B, 67C, and 67D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 68A, 68B, 68C, and 68D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 69A, 69B, 69C, and 69D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 70A, 70B, 70C, and 70D  are diagrams of perspective, top, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 71A, 71B, and 71C  are diagrams of perspective, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 72A, 72B, and 72C  are diagrams of perspective, front, and side views of an illustrative embodiment of a closure apparatus. 
         FIGS. 73A and 73B  are diagrams showing perspective views of an exemplary extra-arterial shoe. 
         FIGS. 74A, 74B, and 74C  are diagrams showing a perspective view, a front view, and a side view of a support member of the closure device, according to an illustrative embodiment. 
         FIG. 75  is a diagram of an exemplary extra-arterial shoe engaged with a support member of the closure device, according to an illustrative embodiment. 
         FIGS. 76A, 76B, and 76C  are diagrams showing a perspective view and a rear view of a support member of the closure device, according to an illustrative embodiment. 
         FIG. 77  is a diagram of an exemplary shoe connected to an exemplary delivery system in an initial position, according to an illustrative embodiment. 
         FIG. 78  is a diagram of an exemplary shoe connected to an exemplary delivery system in a second position, according to an illustrative embodiment. 
         FIG. 79  is a diagram of an exemplary shoe connected to an exemplary delivery system in a second position, with the shoe pusher in a retracted position according to an illustrative embodiment. 
         FIG. 80  is a diagram of an exemplary shoe deployed and engaged with a tabbed support member, according to an illustrative embodiment. 
         FIGS. 81A and 81B  are diagrams showing perspective views of an exemplary extra-arterial shoe according to an illustrative embodiment. 
         FIG. 82  is a diagram of an exemplary shoe connected to an exemplary delivery system in an initial position, according to an illustrative embodiment. 
         FIG. 83  is a diagram of an exemplary shoe connected to an exemplary delivery system in a second position, according to an illustrative embodiment. 
         FIG. 84  is a diagram of an exemplary shoe deployed and engaged with a tabbed support member, according to an illustrative embodiment. 
         FIG. 85  is a diagram of an exemplary shoe deployed and engaged with a tabbed support member, according to an illustrative embodiment. 
         FIGS. 86A and 86B  are diagrams showing perspective views of an exemplary extra-arterial shoe. 
         FIGS. 87A, 87B, 87C, and 87D  are diagrams showing a perspective view, a bottom view, a front view, and a side view of a support member of the closure device, according to an illustrative embodiment. 
         FIGS. 88A, 88B, 88C, and 88D  are diagrams showing a bottom view, a rear view, a perspective view, and a side view of an exemplary extra-arterial shoe. 
         FIGS. 89A, 89B, 89C, and 89D  are diagrams showing a perspective view, a bottom view, a rear view, and a side view of an exemplary extra-arterial shoe deployed and engaged with a support member, according to an illustrative embodiment. 
         FIGS. 90A, 90B, 90C, and 90D  are diagrams showing front, top, perspective and side views of an alternative embodiment of an extra-arterial shoe. 
         FIGS. 91A, 91B, 91C, and 91D  are diagrams showing front, top, perspective and side views of an alternative embodiment of an extra-arterial shoe. 
         FIGS. 92A, 92B, 92C, and 92D  are diagrams showing front, top, perspective and side views of an alternative embodiment of an extra-arterial shoe. 
         FIGS. 93A, 93B, 93C, and 93D  are diagrams showing front, top, perspective and side views of an alternative embodiment of an extra-arterial shoe. 
         FIGS. 94A, 94B, 94C, and 94D  are diagrams showing front, top, perspective and side views of an alternative embodiment of an extra-arterial shoe. 
         FIGS. 95A, 95B, 95C, and 95D  are diagrams showing front, top, perspective and side views of an alternative embodiment of an extra-arterial shoe. 
         FIGS. 96A, 96B, 96C, and 96D  are diagrams showing front, top, perspective and side views of an alternative embodiment of an extra-arterial shoe. 
         FIGS. 97A, 97B, 97C, and 97D  are diagrams showing front, top, perspective and side views of an alternative embodiment of an extra-arterial shoe. 
     
    
    
     DETAILED DESCRIPTION 
     As described herein, illustrative embodiments provide surgical closure systems, devices, and methods useful for (i) bringing about alignment of the tissues surrounding a perforation in a body lumen, thereby closing the aperture in the body lumen, (ii) forming a tamponade at the aperture when bringing about the alignment of the tissues, and (iii) maintaining the tissues surrounding the perforation in alignment until the perforation is sealed. The systems, devices, and methods are used, in some embodiments, to close a surgical perforation in a body cavity, such as the gastrointestinal tract, heart, peritoneal cavity, esophagus, vagina, rectum, trachea, bronchi, and blood vessel, including for example, but not limited to the femoral artery, subclavian artery, ascending and descending aorta, auxiliary and brachial arteries femoral vein, iliac vein, subclavian vein, and vena cava. 
       FIGS. 1A and 1B  are diagrams showing a perspective view and a cross-sectional view of an exemplary closure device  100  deployed at a sealing position  102  in a body lumen  104 . 
     The closure device  100  includes a sealable member  106  (e.g., a flexible wing) positionable against an interior surface  108  of the tissue  110  adjacent the aperture  112  in the tissue (e.g., so as to form a tamponade at the aperture  112 ). Although flat or slightly curved when in a relaxed state, the sealable member  106  flexibly curves to conform to the interior surface  108  of the lumen  104  to which it engages, in the deployed state. 
     The closure device  100  includes a support member  118  (e.g., a foot) comprising a base  120  (e.g., an O-ring foot-core) and a column  122 . The base  120  supports the sealable member  106  during the delivery and deployment of the sealable member  106  in the body lumen  104  by retaining and/or holding the sealable member  106  against the interior surface  108  of the tissue  110  when the closure device  100  is in the sealing position. In some embodiments, the base  120  exerts a force to bias the sealable member  106  against the tissue. 
       FIG. 2A  is a diagram of the sealable member  106  and the base  120  of the support member  118  in a relaxed position, according to an illustrative embodiment.  FIG. 2B  is a diagram of the members in a deployed state at the sealing position, according to an illustrative embodiment. In certain embodiments, the base  120  slightly bends when in the relaxed position. 
     In some embodiments, once implanted in the body lumen, the base  120  presses against the interior shape of the lumen  104  by hydraulic pressure exerted by fluids in the body lumen  104  (e.g., by hemodynamic hydraulic forces exerted by blood in a blood vessel). In doing so, the base  120  improves the seal formed by the sealable member  106  over the aperture  112 , thus, providing a faster and more secure closure of the aperture  112 . The base  120  connects to the column  122 , which is disposed, when the device is in the sealing position, in and through the aperture  110 . In certain embodiments, a guard member  126  (see  FIGS. 1A and 1B ) maintains the column  122  in position at the sealing position once the device  100  is deployed, whereby the guard member  126  prevents the dislodgement of the sealable member  106  from the sealing position, e.g., due to impact near the aperture or movement of the patient. 
     In some embodiments, once implanted in the body lumen, the base  120  bends against the interior shape of the lumen  104  so as to compress the peripheral portions of the sealable member  106  against the interior surface  108  of the tissue  110 . Hydraulic pressure, as discussed above, may contribute to the bending of the base  120  in such embodiments. The base  120 , in these embodiments, also improves the seal formed by the sealable member  106  over the aperture  112 , thus, providing a faster and more secure closure of the aperture  112 . The support member  118  may also include a guard member  126  to prevent the dislodgement of the sealable member  106  from the sealing position, e.g., due to impact near the aperture or movement of the patient. 
     In some embodiments, the support member  118  may include a guard member  126  to prevent the dislodgement of the sealable member  106  from the sealing position, when hydraulic pressure of a blood vessel is relatively low. The guard member may provide a mean to compress the implant into a vessel (e.g., by an operator). 
     Lateral Support Portions of the Base 
       FIGS. 3A and 3B  are diagrams showing a perspective view and a bottom view of a support member of the closure device, according to an illustrative embodiment. The base  120  of the support member  118  includes (i) a central portion  302  that connects to column  122  and (ii) one or more lateral support portions  306  extending from the central portion  302 . The lateral support portions  306  have support surfaces  308  that retain and/or hold the peripheral portions of the sealable member  106  against the interior surface  108  of the tissue  110 . In certain embodiments, the lateral support portion  306  retains and/or holds the peripheral portions and exerts a force that biases the sealable member  106  against the tissue. In certain embodiments, the force is compressive. The lateral support portions  306  in conjunction with the sealable member  106  increase the rigidity of the closure device  100  at regions of contact with the tissue  110 , while allowing the closure device  100  to bend during the deployment and during the delivery. The increased rigidity reduces the risk that of inadvertent dislodgment of the closure device  100  after it has been deployed in the body lumen  104 , e.g., due to an impact near the closure device or movements of the patient or of inadvertent pull-out of the device  100  (e.g., through the aperture) during its deployment into the body lumen  104 . 
     In some embodiments, the central portion  302  forms a rigid core to which the lateral support portions  306  flexibly connect. In some embodiments, the central portion  302  and the lateral support portions  306  form a single unitary body. 
     In some embodiments, the lateral support portions  306  forms a gap  320  with respect to the central portion  302 . 
     Still referring to  FIGS. 3A and 3B , the central portion  302  of the base  120  includes an anterior support portion  310  and a posterior support portion  312 . The contact surfaces  304  of both the anterior and posterior support portions  310 ,  312  contact and/or press against the anterior and posterior portions of the sealable member  106 . The lateral support portions  306  extend from at least one of the anterior support portion  310  and the posterior support portion  312 . As shown, the posterior support portion  312 , in some embodiments, is disposed proximally to the column  122  of the support member  118 , and the anterior support portion  312  is disposed distally to the column  122 . 
     Directionally-Inducted Rigidity of the Devices 
     In another aspect, the flexible support member  118  may be shaped to provide more rigidity to peripheral portions of the sealable member  106  along a direction to which the sealable member is pulled during the deployment of the closure device  100 . The directionally-induced rigidity ameliorates the risk of an accidental pull-out of the sealable member from the lumen  104  during deployment. 
       FIGS. 4A and 4B  are diagrams showing a support member  118  of the closure apparatus  100  with directionally-induced rigidity. This increased rigidity is employed at a specific part of the base  120  that, preferably, corresponds to the direction of the column  122 . In certain embodiments, the base  120  provides more resistance, for example, at region  312 , making the portion of the sealable member  106  corresponding to such region subject to less bending. Thus, greater force may be applied to that region of the sealable member  106  before the sealable member  106  would pull through the aperture  112 . This reduces the risk that the implant can dislodge from its deployed position due to, for example, movements by the patient and/or impact to the nearby area. The greater force also gives the surgeon a better tactile feel of sealable member  106  during the deployment and creates better apposition of the sealable member  106  against the inner lumen of the body lumen  104 . Thus, a faster and more effective seal can be created. 
     As shown in  FIGS. 4A and 4B , the posterior support portion  312  is disposed proximally to the column  122  of the support member  118  and has first maximum cross-sectional area  402 . The anterior support portion  310  is disposed distally to the column  122  of the support member  118  and has a second maximum cross-sectional area  404 . The first maximum cross-sectional area  402 , in certain embodiments, is larger than the second maximum cross-sectional area  404  such that the posterior support portion  312  (and/or adjacent portions of the lateral support member) is more rigid than the anterior support portion  310 . 
     In certain embodiments, the base  120  of the support member  118  has a varying cross-sectional thickness along the direction between the anterior support portion  310  and the posterior support portion  312 . The varying thickness along this direction may provide greater rigidity at the posterior support portion  312  of the base  120  than the anterior support portion  310 . 
     Referring still to  FIG. 4B , in certain embodiments, the lateral support portions  306  extend from the posterior support portion  312  at a location  406  between (i) a posterior end  408  of the posterior support portion  312  and (ii) the central portion  302 , thereby forming a region  410 . The region  410  can be characterized as a tab  410  that extends from a perimeter defined by the lateral support portions  306  around the central portion  302 . The tab  410  provides additional surface area  412  (see  FIG. 4A ) to the posterior region of the sealable member  106 . 
     In addition, the lateral support portions  306  may extend from the anterior support portion  310  at a location  414  between an anterior end  416  of the anterior support portion  310  and the central portion  302 , thereby forming a region  418 . This region  418  can also be characterized as a tab  418 . The tab  418  provides additional surface area  420  to the anterior region of the sealable member  106 . 
     In some embodiments, as shown in  FIG. 4C , the support member has increased the first maximum cross-sectional area AA and the second maximum cross-sectional area BB. The increased cross-sectional area may provide more rigid support, so that the support member  118  has better user tactic feel. The increased cross-sectional area may reduce risk of dislocation of the supporting member from arteriotomy. 
     In some embodiments, as shown in  FIGS. 4D and 4E , the base may not have a gap between the one or more lateral support portions and the central portion. The continuous surface may facilitate faster endothelial cell coverage and encapsulation when implanted in vivo. 
       FIG. 5  is a diagram of an example closure device  100  secured to a delivery apparatus  500  of the device  100 . The apparatus  500  is equipped with an appropriate docking mechanism for a given closure device  100 . In certain embodiments, the docking mechanism comprises a T-shaped engagement arm that engages a corresponding recess on the closure device  100 . In some embodiments, the recess and engagement arms may include a pin or protrusion, e.g., for alignment. 
     As shown, the column  122  of the support member  118  is angularly disposed, when secured to the apparatus  500 , along an axis  502  corresponding to a longitudinal axis of a delivery shaft  504  to which the closure device  100  is releasably attached. The delivery shaft  504  may engage the column  122 , in some embodiments, at two recesses  510  located on the proximal tip of the column  122 . In certain embodiments, the column  122  forms an angle  506  between a plane  508  corresponding to the sealable member  106  in a rest configuration and the longitudinal axis  502  of the delivery shaft  504 . In certain embodiments, the angle  506  is between about 10 degrees and about 70 degrees, including, but not limited to, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, and 70 degrees. 
     Additional examples of the delivery apparatus is found in U.S. Patent Application Publication No. US 2014/0018846, titled “Implants and Methods for Percutaneous Perforation Closure,” the content of which is incorporated herein in its entirety. 
     Examples of the Support Member 
     Various embodiments of the lateral support portions are now described. In some embodiments, the lateral support portions  306  extend from the central portion  302  to form a continuous structure, for example, but not limited to, a ring (e.g., circle, oval, rectangular, ellipse, diamond) around the central portion  302  of the base  120 . In other embodiments, the lateral support portions  306  form one or more cantilevers that extend from the central portion  302 .  FIGS. 6-16  are diagrams showing perspective views of other exemplary embodiments of the support members  118 . 
     As shown in  FIGS. 6-9 , the lateral support portions  306  form a continuous structure around the central portion  302 . Specifically, as shown in  FIG. 6 , the lateral support member  306  forms a straight connection region  602  that extends from the anterior support portion  310  and the posterior support portion  312  of the base  120 . 
     As shown in  FIG. 7 , each of the lateral support members  306  forms a straight support region  702 . Each of the straight support regions  702  is parallel to the anterior support portion  310  and the posterior support portion  312  of the base  120 . 
     As shown in  FIG. 8 , the lateral support member  306  forms a diamond-shaped support region  802 . In certain embodiments, the diamond-shaped support region  802  has a uniform cross-sectional thickness. In other embodiments, the diamond-shaped support region  802  has a varying cross-sectional thickness in which the thickness is greater at the point of connection  804  than at the peripheral portion  806 . 
     As shown in  FIG. 9 , the lateral support member  306  has a wide base at one region, which then tapers to a point of connection with the central portion  302 . As shown, a protruded region  902  extends from the anterior support portion  310 . The protruded region  902  then tapers to the point of connection  908 . This shape can be characterized as a snow shoe or a leaf. Alternatively, in certain embodiments, the protruded region  902  extends from the posterior support portion  312 , and the taper region  904  extends from the anterior support portion  310 . 
     As shown in  FIGS. 10 to 12 , each of the lateral support portions  306  forms a non-continuous structure around the central portion  302 . Specifically, in  FIG. 10 , the lateral support member  306  forms an arcuate structure  1002  around the central portion  302 . Each of arcuate portions  1002  extends from the anterior support portion  310  and the posterior support portion  312  of the base  120  of the support member  118 . 
     In  FIGS. 11 and 12 , each of the lateral support members  306  also forms an arcuate portion  1102  around the central portion  302 . The arcuate portion  1102  has a connection region  1104  that extends from the central portion  302  of the base  120 . In  FIG. 11 , each of the arcuate portions  1102  has a single connection region  1104 . In  FIG. 12 , each of the arcuate portions  1102  has a plurality of connection regions  1202 . 
     Referring still to  FIGS. 11 and 12 , in certain embodiments, the cross-sectional thickness of the base  120  is varied between the central portion  302  and the peripheral regions  1106  of the lateral support portions  306 . 
     In  FIG. 13 , the lateral support portions  306  form a continuous structure around and connected through the central portion  302 . The structure can be characterized as a wagon wheel. In such embodiments, the lateral support portion  306  have between 4 and 20 connection regions  1302 . In certain embodiments, the connection regions  1302  are uniformly spaced apart from each other. In other embodiments, the spacing between the connection regions  1302  is varying. For example, the connection regions  1304  proximally located to the posterior support portion  312  may be spaced more closely to one another than connection regions  1306  distally located to the posterior support portion  312 . 
     In  FIGS. 14 to 15 , the lateral support portions  306  form one or more cantilevers  1402  that extend from the central portion  302  (or the anterior support portion). In some embodiments, the cantilevers  1402  have a uniform cross-sectional thickness (see  FIG. 14 ). In other embodiments, the cantilevers  1402  have a varying cross-sectional thickness (see  FIG. 15 ). 
     In  FIG. 16 , the lateral support portions  306  form a continuous surface with the central portion  302 . The structure can be characterized as a disc. 
     Additional views of the various embodiments, as well as further examples of the closure device  100 , are provided in  FIGS. 23A-72C . 
     Other Components of the Closure Device 
     Referring back to  FIG. 3A , the column  122  of the support member  118 , in some embodiments, has an engagement portion  124  to secure the guard member  126  (e.g., an insertable or engagable pin or cage in  FIG. 18A ) to the support member  118 . In some embodiments, the guard member  126  is maintained at a location relative to the exterior surface  116  of the tissue  110  when the closure device  100  is in the sealing position. In some embodiments, the guard member  126  compresses against the exterior surface  116  of the tissue  110  when the closure device  100  is in the sealing position. In some embodiments, the guard member  126  is moveable, from a stowed state to a deployed state, to engage exterior surface  116  of the tissue adjacent the aperture such that a portion of the tissue is disposed between the guard member  126  and the sealable member  106  when the closure device  100  is in the sealing position. In certain embodiments, and as shown in  FIG. 3A , the engagement portion  124  comprises a cavity  124  in the column  122  to allow an extra-luminal pin (as the guard member  126 ) to be inserted therethrough. 
     Examples of the extra-luminal pin are described U.S. Patent Application Publication No. US 2014/0018847, titled “Percutaneous Perforation Closure Systems, Devices, and Methods.” In other embodiments, the engagement portion  124  is a protrusion or a recess on the exterior surface of the column  122  to which a slotted cage or shoe (as a guard member) can engage. 
     In certain embodiments, the base  120  of the support member  118  has a uniform thickness between about 0.1 mm and about 1.5 mm, including 0.1, 0.15, 0.2, 0.25, 0.3, 0.35, 0.4, 0.45, 0.5, 0.55, 0.6, 0.65, 0.7, 0.75, 0.8, 0.85, 0.9, 0.95, 1.0, 1.05, 1.10, 1.15, 1.20, 1.25, 1.30, 1.35, 1.40, 1.45, and 1.5 mm. In other embodiments, the thickness is varying. 
     The sealable member  106 , in some embodiments, is sized to be larger than the diameter of the aperture (e.g., between 12 F and 30 F). In some embodiments, the sealable member  106  has a thickness preferably between about 0.05 mm and about 0.6 mm. In some embodiments, the sealable member  106  has a thickness between about 0.005 mm and 4 mm, e.g., depending on the size of the aperture and the size of the vessel/lumen. 
     In certain embodiments, the thickness of the sealable member and/or support member, as deployed in the vessel/lumen, is selected based on the size of the aperture to be sealed and/or the size of the blood vessel/hollow vessel. Table 1 lists exemplary ranges of thicknesses of a sealable member to close an aperture based on the aperture/incision size that is formed. Table 2 lists exemplary ranges of thicknesses of the sealable member to close an aperture based on the vessel diameter size. Table 3 lists exemplary ranges of thicknesses of sealable member to close an aperture base on the size of the hollow vessel. 
     
       
         
           
               
             
               
                 TABLE 1 
               
             
            
               
                   
               
               
                 Example thicknesses of a sealable member for closure of a blood vessel 
               
               
                 (e.g., having an internal diameter between about 6 and 12 mm), selected 
               
               
                 based on the incision/puncture size at the blood vessel. 
               
            
           
           
               
               
               
               
               
            
               
                   
                   
                   
                 Sealable Member Thickness 
                   
               
               
                   
                 French 
                 Hole Size 
                 (mm) 
               
            
           
           
               
               
               
               
               
            
               
                   
                 size 
                 (mm) 
                 Min 
                 Max 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
            
               
                   
                 6 
                 2 
                 0.04 
                 0.5 
               
               
                   
                 9 
                 3 
                 0.04 
                 0.75 
               
               
                   
                 12 
                 4 
                 0.04 
                 1 
               
               
                   
                 15 
                 5 
                 0.04 
                 1.5 
               
               
                   
                 18 
                 6 
                 0.04 
                 2 
               
               
                   
                 21 
                 7 
                 0.04 
                 2.5 
               
               
                   
                 24 
                 8 
                 0.04 
                 3 
               
               
                   
                 27 
                 9 
                 0.04 
                 4 
               
               
                   
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE 2 
               
             
            
               
                   
               
               
                 Example thicknesses of a sealable member for closure of a blood 
               
               
                 vessel, selected based on the size of the blood vessel. 
               
            
           
           
               
               
               
            
               
                   
                 Sealable Member Thickness 
                   
               
               
                 Vessel Size (Internal 
                 (mm) 
               
            
           
           
               
               
               
            
               
                 Diameter, mm) 
                 Min 
                 Max 
               
               
                   
               
            
           
           
               
               
               
            
               
                 5 
                 0.04 
                 0.5 
               
               
                 6 
                 0.04 
                 0.75 
               
               
                 7 
                 0.04 
                 1 
               
               
                 9 
                 0.04 
                 1.5 
               
               
                 11 
                 0.04 
                 2 
               
               
                 15 
                 0.04 
                 3 
               
               
                 20 
                 0.04 
                 3.5 
               
               
                 30 
                 0.04 
                 4 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE 3 
               
             
            
               
                   
               
               
                 Example thicknesses of a sealable member for closure of a non-blood 
               
               
                 carrying hollow vessel (e.g., having an internal diameter between 
               
               
                 15 and 100+ mm), selected based on the size of the hollow vessel. 
               
            
           
           
               
               
               
            
               
                   
                 Sealable Member Thickness 
                   
               
               
                 Vessel Size (Internal 
                 (mm) 
               
            
           
           
               
               
               
            
               
                 Diameter, mm) 
                 Min 
                 Max 
               
               
                   
               
            
           
           
               
               
               
            
               
                 15 
                 0.04 
                 3 
               
               
                 40 
                 0.04 
                 8 
               
               
                 &gt;100 
                 0.04 
                 20+ 
               
               
                   
               
            
           
         
       
     
     The sealable member  106  is preferably circular in shape. It should be understood, however, that other geometries may be provided for the hole and/or the disk portion, including, but not limited to, ovals. The sealable member  106  has a hole (e.g., located at or near the center of the member) sized to accept the column  122 . In some embodiments, the sealable member  106  is free to rotate relative to the base  120  of the support member  118  about an axis concentric to the column  122 . Other examples of the sealable member is described in U.S. Patent Application Publication No. US 2014/0018847, titled “Percutaneous Perforation Closure Systems, Devices, and Methods,” and U.S. Provisional Application No. 62/092,212, titled “Implantable Sealable Member with Mesh Layer,” the content of each of these applications is incorporated by reference herein in its entirety. 
     The sealable member and/or the base comprises, in some embodiments, at least one material selected from the group consisting of Polydioxanone, Poly-L-lactide, Poly-D-lactide, Poly-DL-lactide, Polyglycolide, ε-Caprolactone, Polyethylene glycol, and a copolymer thereof. In some embodiments, the material of the sealable member and/or the base is a copolymer of Polydioxanone, Poly-L-lactide, Poly-D-lactide, Poly-DL-lactide, Polyglycolide, ε-Caprolactone, and Polyethylene glycol. In some embodiments, the copolymer includes (a) monomers of Polydioxanone, Poly-L-lactide, Poly-D-lactide, Poly-DL-lactide, Polyglycolide, ε-Caprolactone, or Polyethylene glycol, and (b) one or more additional monomers. In some embodiments, the (a) and (b) monomers form a polymer that is bioabsorbable. One of ordinary skill in the art will appreciate that other suitable biodegradable material may be employed. 
     In certain embodiments, the thickness of the support member  118  and the sealable member  106  are selected such that the members  106 ,  118  are bendable to be loaded into the cannula  2202  while having sufficient rigidity to form and maintain a tamponade at the aperture when the device  100  is in the sealing position. In some embodiments, the thickness of the support member  118  and the sealable member  106  are selected such that a portion of the members  106 ,  118  is rigid. 
     In some embodiments, the base  120  of the support member  118  is sufficiently flexible to roll into a delivery funnel used for delivering the implant into the body lumen.  FIGS. 21A, 21B , and  21 C are diagrams showing a sequence of the transition, in some embodiments, of the sealable member and the support member from a stowed state to a delivery state when the closure apparatus is loaded in a delivery cannula. 
     In some embodiments, during deployment to close a hole, e.g., in a hollow vessel, the implant  100  is loaded into a delivery cannula  2102  through a loading funnel  2102  which reduces the cross-sectional area of the implant  100  (e.g., support member  118  and sealable member  106 ) to make it possible to deliver the implant through an introducer catheter into a hollow vessel (such as an artery or a vein) within which there had been made an access hole to perform a minimally invasive procedure. During this delivery and deployment of the implant, the support member  118  (e.g., O-ring foot core) supports the wing. 
     As shown in  FIG. 21A , the device  100  is in an open configuration. The sealable member  106  and the base  120  are in a resting state. It should be appreciated that in certain embodiments, the base  120  may be pre-loaded to bias the sealable member  106  when in the resting state. 
       FIG. 21B  shows the sealable member  106  and the base  120  of the support member  118  progressively folded down as they pass proximally through a narrowing zone  2106  of the funnel  2102 . In certain embodiments, the narrowing zone  2106  includes a first offset surface to initiate folding of the sealable member  106  along one of its side. A second offset surface then initiates folding of the other side as the support member  118  continues to pass through the funnel  2102 . The different initiation of the folding of the base  120  and sealable member  106  ensures that they fold in an overlapping manner. In some embodiments, the funnel  2102  includes a third surface  2107 . 
       FIG. 21C  shows the sealable member  106  and the support member  118  in their folded state. The folded implant is prepared for direct insertion into a body lumen, e.g., an artery. The loading funnel  2104  is then detached from the delivery cannula  2202 .  FIG. 22  is a diagram of the sealing member and support member in the delivery configuration in the delivery cannula  2202 . Further examples of the loading funnel and delivery cannula is described in U.S. Patent Application Publication No. US 2014/0345109, filed Mar. 13, 2014, titled “Loading Devices and Methods for Percutaneous Perforation Closure Systems,” the content of which is incorporated by reference herein in its entirety. 
     Referring back to  FIG. 3B , the support member  118  has a channel  314  for guiding the guide wire  202  (see  FIG. 2 ). In some embodiments, the channel  314  runs through the support member  118  between a bottom surface  316  of the base  120  and a top surface  318  of the column  122  (see  FIG. 18A ). Referring to  FIGS. 17A, 17B, 18A and 18B , in certain embodiments, the channel  314  runs from the bottom of the center of the support member  118  to the top of the column  122  for guide wire access.  FIG. 17A  shows the closure device  100  and the guard member  126 , prior to the deployment of the guard member  126 .  FIG. 17B  shows an embodiment of guard member containing a locking feature (xx) to lock the guard member into position. A wedge feature (yy) which closes guide wire access channel  314  reduces blood loss through this avenue. The guard member contains a guide wire lumen ( 22 ) which can accommodate up to a 0.018″ guide wire.  FIG. 18A  is a cross-sectional perspective view of diagram of the guard member  126  in the deployed state.  FIG. 18B  is view of a diagram of the guard member ( FIG. 17B ) in the deployed state in support member ( FIG. 4C ) 
     Threaded Portion on the Support Member 
       FIGS. 19A, 19B, and 19C  are diagrams of a perspective view, a side view, and a front view of a closure device with a threaded portion  1900  to allow assembly of the sealable member  106  to the support member  118  without distortion or deformation of the sealable member  106 . The threaded portion  1900  provides a region for the sealable member  106  to load onto the support member  118 . Without having to distort and/or deform the sealable member  106  during assembly of the sealable member  106  onto the support member  118 , the risk of damage to the sealable member  106  during manufacturing is reduced. The threaded portion may include a protrusion  1902  that encircles the body  1904  of the column  122 . The protrusion  1902  includes a gap  1904 . The protrusion  1902  has a greater diameter, in some embodiments, than that of the column  122 . 
     The threaded portion may be employed with a support member having a rigid foot core. Further examples of rigid foot cores are described in U.S. Patent Application Publication No. US 2013/0274795, titled “Devices and Methods for Delivering Implants for Percutaneous Perforation Closure,” the contents of which is incorporated herein in its entirety. Examples of rigid foot core with threaded portions are provided in  FIGS. 23A-72C . 
     In some embodiments, the threaded portion is employed in conjunction with a “button” foot core design. The button foot core, in some embodiments, is round. The profile of the “button” foot core is such that the base diameter is only slightly wider than the hole in the center of the wing. The wing can, thus, be threaded onto the column of the button foot core. An example of the “button” foot core design is provided in  FIGS. 70A-71C . 
     In some embodiments, the “button” foot core design is employed for smaller sized apertures (e.g., between 6 and 18 (F) French), e.g., for usage in smaller-sized blood vessels/lumens. 
       FIGS. 20A, 20B, 20C, and 20D  are diagrams showing a sequence for assembling the sealing member to a support member configured with a threaded portion. In certain embodiments, the axis of the sealable member  106  is oriented along the longitudinal axis  2002  of the column  122 .  FIG. 20A  is a diagram of a sealable member  106  oriented with respect to the sealable member  118  according to an embodiment. 
     The sealable member  106  comprises a hole  2004  that has a profile so as to translate along the axis  2002  without contacting the column  122  of the sealable member  118 . Alternatively, the sealable member  106  is oriented along a plane parallel to the base  120  during assembly of the sealable member  106  and the support member  118  (not shown). 
       FIG. 20B  is a diagram of the sealable member  106  disposed around the column  122 . 
       FIG. 20C  is a diagram of the sealable member  106  being rotatably translated onto a contact surface  2006  of the base  120  of the support member  118 . 
       FIG. 20D  is a diagram of the sealable member  106  resting on the contact surface  2306  of the base  120 . 
     In certain embodiments, during the assembly, the support member  118  is stationary with respect to the sealable member  106 , while the sealable member  106  is moved along the column  122  to the treaded section  1900 . In other embodiments, the sealable member  106  is stationary with respect of the support member  118 , while the support member  118  is moved through the hole  2004  of the sealable member  106 . In yet other embodiments, both the sealable member  106  and the support member  118  move with respect to each other. 
     Slotted Shoe 
     In certain embodiments, the surgical closure systems, devices, and methods described herein comprise a device that can exert pressure on the external surface of a tissue. In certain embodiments, the surgical closure systems, devices, and methods described herein comprise an external, e.g., extra-arterial, securing component (e.g., a cage or “shoe”), e.g., to secure a vascular closure device (VCD) implant to a blood vessel and/or to help maintain the seal, e.g., of the arteriotomy or veinotomy by compressing a wall of the artery or vein between it and the wing of the VCD when the device is deployed. In certain embodiments, the cage or shoe, in combination with pressure present in a vessel, e.g., hydraulic pressure present in an artery or vein (e.g., hemodynamic pressure of blood), or other body lumen, improves tamponade formed by the device over the aperture, e.g., an arteriotomy or veinotomy. In some embodiments, the cage or shoe comprises one or more structural features, e.g., indentations, ridges, shoulders, planes, curved planes, cavities, notches, holes, slots, surfaces, and/or grooves. In certain embodiments, the cage or shoe comprises one or more engagement elements (e.g., indentations, ridges, shoulders, planes, curved planes, cavities, notches, holes, slots, surfaces, and/or grooves), e.g., elements that can engage with another device or element, e.g. a support member. In some embodiments, the cage or shoe can be used in combination with column  122  of the support member  118  (see  FIG. 3A ), e.g., to secure a VCD implant to a blood vessel, e.g., an artery or a vein. In certain embodiments, the column or the support member comprise a locking feature that can engage with a feature of the shoe (e.g., an engagement element, e.g., an indentation, notch, hole, surface, slot, and/or groove). In certain embodiments, when the shoe is deployed and fully engaged, a locking feature engages with an engagement element to lock the cage or shoe in place. In certain embodiments, the column or the support member comprise a centering feature that can engage with a feature of the shoe (e.g., an indentation, notch, hole, surface, slot, and/or groove) when the shoe is deployed and fully engaged, e.g., to prevent the cage or shoe from rotating and/or prevent the cage or shoe from becoming unlocked and/or disengaged from the implant. 
     In certain specific embodiments, the cage or shoe is a shoe  7301  as shown in  FIGS. 73A and 73B . In certain embodiments, the cage or shoe has a caged structure and/or comprises one or more concave structural elements. In certain embodiments, the radius (e.g., inner radius) of a concave structural element corresponds to a radius of a surface of the column or the support member, e.g., of a cylindrical portion of the column or the support member. In certain embodiments, the shoe comprises one or more engagement elements that can engage with a support member (e.g., an indentation, notch, hole, surface, slot, and/or groove). In certain embodiments, the shoe comprises a shoulder, e.g., shoulder  7302 . 
     In certain embodiments, a support member, e.g., support member  118 , comprises tabs, e.g., as shown in  FIG. 74 . In certain embodiments, a tabbed support member, e.g., tabbed support member  7401 , comprises one or more locking tabs  7402 , and/or one or more centering tabs  7403 . In certain embodiments, a tabbed support member comprises 1, 2, 3, 4, 5, or more locking tabs. In certain embodiments, a tabbed support member comprises 1, 2, 3, 4, 5, or more centering tabs. The locking tabs and/or the centering tabs can be positioned anywhere on the tabbed support member. In certain embodiments, the tabbed support member comprises one centering tab and two locking tabs. In certain embodiments, the locking tabs are positioned opposite to each other along the circumference of a cylindrical portion of the tabbed support member. In certain embodiments, the one or more locking tabs and the one or more centering tabs are aligned. In certain embodiments, a centering tab is a locking tab. In certain embodiments, the locking tabs “lock” with a feature of the cage or shoe (e.g., an engagement element, e.g., an indentation, notch, hole, surface, slot, and/or groove) when the cage or shoe is deployed and fully engaged, e.g., the locking tabs snap fit with the shoe. In certain embodiments, the locking tabs “lock” in behind the shoulder of the shoe when the shoe is deployed and fully engaged, e.g., the locking tabs snap-fit with the cage or shoe. In some embodiments, the centering tab or tabs can prevent the shoe biasing to one side of the implant, e.g., by preventing the shoe from rotating around the longitudinal axis of column  122 . In certain embodiments, the one or more centering tabs engage an interior surface or interior portion or interior feature of the cage or shoe. In certain embodiments, the one or more centering tabs engage the shoulder of the shoe. In certain embodiments, the one or more centering tabs can prevent the shoe biasing to one side of the implant, e.g., by reversibly engaging one or more features (e.g., notch, hole, surface, slot, and/or groove) of the cage or shoe. In certain embodiments, the one or more centering tabs engage an interior surface, or interior portion, or one or more interior features (e.g., notch, hole, surface, slot, and/or groove) of the cage or shoe. Without wishing to be bound by theory, if the cage or shoe were to move from its intended final position, e.g., toward one side of the implant, one or more of the locking tabs could potentially disengage from the cage or shoe releasing the implant. 
       FIG. 75  depicts shoe  7301  deployed on an exemplary tabbed support member  7401  according to an exemplary embodiment. In certain embodiments, the shoe can secure a vascular closure device (VCD) implant to a blood vessel and/or help maintain the seal, e.g., of an arteriotomy or a veinotomy, e.g., by compressing the wall of an artery or vein between it and a base  120 . 
       FIG. 76  depicts shoe  7301  engaged with an exemplary tabbed support member  7401  according to an exemplary embodiment. In certain embodiments, one or more locking tabs  7402  engage the shoulder of the shoe (e.g., shoe  7301 ), as shown, e.g., in  FIG. 76A  and  FIG. 76B . In certain embodiments, two locking tabs  7402  engage the shoulder of the shoe as shown, e.g., in  FIG. 76C . In certain embodiments, a centering tab engages an interior surface or interior portion or one or more interior features (e.g., notch, hole, surface, and/or groove) of the shoe. 
     The extra-arterial securing component (e.g., a cage or “shoe”) can be deployed using a variety of methods.  FIG. 77  depicts shoe  7301  connected to an exemplary delivery system in an initial position. In certain embodiments, the shoe is mounted on an external shaft, e.g., external shaft  7703 , of the delivery system. In certain embodiments, the shoe is slideably moveable along the longitudinal axis of the external shaft and/or along the axis  502  corresponding to a longitudinal axis of a delivery shaft, e.g., delivery shaft  504 . In certain embodiments, the shoe is rotatable around the longitudinal axis of the external shaft  7703  and/or along the axis  502 . In certain embodiments, the shoe is not rotatable around the longitudinal axis of the external shaft  7703  and/or around the axis  502 . 
     In certain embodiments, the shoe (e.g., shoe  7301 ) can be moved by a shoe delivery element, e.g., a shoe pusher (e.g., shoe pusher  7702 ) and/or a delivery shaft, along the longitudinal axis of the external shaft  7703  and/or along the axis  502 . In certain embodiments, the shoe pusher is mounted on an external shaft, e.g., external shaft  7703 , of the delivery system. In certain embodiments, the shoe pusher is slideably moveable along the longitudinal axis of the external shaft and/or along the axis  502  corresponding to a longitudinal axis of a delivery shaft, e.g., delivery shaft  504 . In certain embodiments, deploying the shoe comprises the steps of reversibly engaging the shoe pusher with the shoe and advancing the shoe pusher distally (e.g., toward the implant), e.g., advancing the shoe pusher a set distance. In certain embodiments, the shoe pusher is reversibly engaged with the shoe such that the shoe can only be moved distally (e.g., toward the implant and away from the operator). In certain embodiments, the shoe pusher is engaged with the shoe such that the shoe can be moved distally and/or proximally (e.g., away from the implant and toward from the operator). 
     In certain embodiments, deploying the shoe comprises the steps of reversibly engaging the shoe pusher with the shoe and advancing the shoe pusher distally (e.g., toward the implant), e.g., advancing the shoe pusher a set distance, and engaging the shoe with the implant (e.g., with the tabbed support member  7401 ) by locking the shoe onto the locking tabs, e.g., locking tabs  7402 , e.g., as shown in  FIG. 78 . 
       FIG. 79  depicts the shoe  7301  deployed and engaged with the implant via tabbed support member  7401  after deployment and after retraction of the shoe pusher  7702  according to an exemplary embodiment. 
       FIG. 80  depicts the shoe  7301  deployed and engaged with tabbed support member  7401  via locking tabs  7402  after deployment of the implant according to an exemplary embodiment. In certain embodiments, the shoe is only deployed when the implant has been withdrawn to the arteriotomy or veinotomy, and tamponade has been achieved. 
     In some embodiments, the cage or shoe comprises one or more shoe connector elements (e.g., shoe connector profiles) and/or delivery shaft profiles. In some embodiments, one or more shoe connector profiles and/or delivery shaft profiles can engage a delivery element, e.g., a shoe pusher and/or a delivery shaft. In some embodiments, one or more shoe connector profiles and/or delivery shaft profiles can engage the implant, e.g., are equivalent to, are part of, comprise, or are identical to the engagement elements engaging the implant, as described above. 
     In certain specific embodiments, the cage or shoe is a shoe  8101 , e.g., as shown in  FIGS. 81A and 81B . In certain embodiments, the shoe comprises one or more shoulders, e.g., shoulder  8102 . In certain embodiments, the shoe comprises a connector element, e.g., shoe connector profile  8103 , which can engage a shoe delivery element. 
     Without wishing to be bound by theory, the shoe connector and the shoe are designed such that the shoe connector can engage the shoe, e.g., at a shoe connector profile, in order to control the alignment of the shoe relative to the support member, e.g., by preventing the shoe from rotating around the longitudinal axis of column  122 . In certain embodiments, the shoe connector profile can have the shape of a circle, square, rectangular, triangle, rhombus and/or any combination or composition thereof. In certain embodiments, the shoe connector profile can have the shape of a key hole. 
       FIG. 82  depicts exemplary shoe  8101  as part of an exemplary delivery system in an initial position. In certain embodiments, the shoe (e.g., shoe  8101 ) can engage a shoe delivery element, e.g., shoe connector  8202 , via a matching shoe connector profile, e.g., shoe connector profile  8103 . 
     In certain embodiments, the shoe (e.g., shoe  8101 ) is deployed by advancing the shoe connector (e.g., shoe connector  8202 ) distally (e.g., toward the implant), e.g., to a set distance, and engaging the shoe with the implant (e.g., with the tabbed support member  7401 ) by locking the shoe onto the locking tabs, e.g., locking tabs  7402 , e.g., as shown in  FIG. 83 . 
       FIG. 84  shows the shoe  8101  deployed and engaged with tabbed support member  7401  via locking tabs  7402  after deployment of the implant according to an exemplary embodiment. In certain embodiments, locking tabs  7402  engage shoulders  8102  after deployment of the implant. F 
       FIG. 85  shows the shoe  8101  deployed and engaged with tabbed support member  7401  after deployment of the implant according to an exemplary embodiment. In certain embodiments, one or more centering tabs (e.g., centering tab  7403 ) can engage the shoe (e.g., shoe  8101 ) via a matching shoe connector profile, e.g., shoe connector profile  8103 . Alternative shapes and/or designs for the cage or shoe are envisioned, e.g., a shoe as shown in  FIGS. 86A and 86B . 
     In some embodiments, the cage or shoe engages with the implant by engaging a locking neck, e.g., on column  122 .  FIG. 87  depicts an implant  8700  comprising a sealable member  106 , a base  120 , and a column  122  comprising a locking neck  8701 . 
       FIG. 88  depicts a sample embodiment of the cage or shoe, e.g., shoe  8800  comprising an engagement slot  8801 . In some embodiments, after deployment of the implant (e.g., implant  8700 ), the shoe (e.g., shoe  8800 ) is deployed, e.g., as described above, e.g., using a shoe pusher. In some embodiments, the shoe pusher pushes the shoe onto the engagement neck such that the engagement slot is splayed during the distal movement of the shoe. In its final engaged position, the shoe is engaged by snap-fitting the engagement slot with the locking neck, e.g., as depicted in  FIG. 89 . In some embodiments, a cage or shoe can have one or more engagement elements that engage the implant via engagement tabs and/or an engagement neck. 
       FIGS. 90-97  depict exemplary embodiments of the cage or shoe. In some embodiments, the cage or shoe has an aperture (e.g., a hole or a slot), e.g., to allow a pin (e.g., a locator pin), or a guard member (e.g., guard member  126 ) or other element to pass through the cage or shoe. In one exemplary embodiment shown in  FIG. 90 , the shoe  9000  comprises hole  9001  to allow a pin (e.g., a locator pin), or a guard member (e.g., guard member  126 ) or other element to pass through the cage or shoe. Exemplary shoe  9000  comprises a shoe connector element  9002 , e.g., to connect the shoe to a shoe pusher or delivery shaft. Other embodiments of a similar configuration are shown in  FIGS. 91 and 92 . 
     In one exemplary embodiment shown in  FIG. 93 , the shoe  9300  comprises slot  9301 , to allow a pin (e.g., a locator pin), or a guard member (e.g., guard member  126 ) or other element to pass through the cage or shoe. Exemplary shoe  9300  comprises a shoulder  9302 . In some embodiments, a shoe or cage, e.g., shoe  9300 , engages with a delivery element, e.g., a shoe pusher, via a shoulder, e.g., shoulder  9302 . Another exemplary embodiment of a shoe as described herein is shown in  FIG. 94 . 
     In one exemplary embodiment shown in  FIG. 95 , the shoe  9500  comprises an engagement slot  9501 . In certain embodiments, the engagement slot can have the shape of a circle, square, rectangular, triangle, rhombus and/or any combination or composition thereof. In certain embodiments, the shoe connector profile can have the shape of a key hole. In some embodiments, the shape of the engagement slot complements the shape of the engagement neck. In one exemplary embodiment shown in  FIG. 96 , the shoe  9600  comprising a narrow, key hole shaped engagement slot  9601  and a connector element  9602 . Another exemplary embodiment of a shoe as described herein is shown in  FIG. 97 . 
     In some embodiments, the extra-arterial securing component (e.g., a cage or “shoe”) comprises at least one material selected from the group consisting of Polydioxanone, Poly-L-lactide, Poly-D-lactide, Poly-DL-lactide, Polyglycolide, ε-Caprolactone, and Polyethylene glycol. In some embodiments, the material of the support member and/or sealable member is a co-polymer of, for example, but not limited to, Polydioxanone, Poly-L-lactide, Poly-D-lactide, Poly-DL-lactide, Polyglycolide, ε-Caprolactone, and Polyethylene glycol. In some embodiments, the co-polymer includes (a) monomers of Polydioxanone, Poly-L-lactide, Poly-D-lactide, Poly-DL-lactide, Polyglycolide, ε-Caprolactone, or Polyethylene glycol, and (b) one or more additional monomers. In some embodiments, the (a) and (b) monomers form a polymer that is bioabsorbable. 
     Although the present invention relating to extra-arterial securing component (e.g., a cage or “shoe”) has been described with reference to particular examples and exemplary embodiments, it should be understood that the foregoing description is in no manner limiting. 
     Moreover, the features described herein may be used in any combination. 
     Example: Implant for Closing a Hollow Vessel 
     In some embodiments, the disclosed technology is an implant capable of closing holes in hollow vessels. The implant consists of three distinct parts: a flexible sealing member (e.g., wing), a pin, and a rigid support member (e.g., foot core). This implant may be attached to and packaged with a delivery system. A design is now described below, though other variants, as described herein, may be employed as viable designs to accomplish the same outcomes. 
     In an example embodiment, the foot core is designed to support the wing during assembly, delivery, and final deployment in the hollow vessel to provide a fast and secure closure of the access site hole. It comprises a flat base with an O-ring shape, two tabs in parallel axis to the foot core column, which protrude out from the perimeter of the O-ring, a threaded section, and recessed sections and through holes. 
     In some embodiments, the foot core is an integral part of the implant. It includes a hole from the bottom of the center of the O-ring section to the top of the column for guide wire access. It further includes a hole in the foot core column to hold the pin. It includes two recesses on the proximal tip of the column for engaging with the delivery system. 
     In some embodiments, the shapes of the two spokes in the O-ring are different. This serves the purpose of the larger rear spoke providing extra support (see, for example,  FIGS. 4A and 4B ) that helps to push the wing against the vessel luminal surface, thereby providing an improved seal. This rear spoke also provides additional security to the user, so that the implant is less likely to be accidently withdrawn fully out of the artery due to folding and/or deformation of the rear spoke. This in turn, provides enhanced tactile feedback to the user during deployment. 
     In some embodiments, the surface of a vessel lumen can be uneven and is not always uniformly smooth. The ability of the wings to form an effective seal against a vessels wall can be adversely affected if it has a very uneven topography. The rear spoke member, in some embodiments, pushes the wing against the vessel wall forcing the artery to conform to the wing. This creates a seal between the wing and the vessel surface in a variety of vessel surface topographies. 
     In some embodiments, the base of the O-Ring is flat, at rest, while the artery has a curvature. When the O-Ring implant is deployed into the artery, the flat foot core base adapts to the curvature of the artery and, in some embodiments, pushes the wing against the artery wall to form a contact between the flexible wing and artery inner luminal wall. This may directly enhance the effectiveness of the seal at the tamponade stage of the deployment as it does not rely on the user having to hold the device in a precise location. 
     In some embodiments, although the O-Ring foot core is constructed of a plastic material, its profile is thin enough to facilitate the “compression/folding” of the transverse sections and not damage itself or the flexible wing during pass through of the implant in the funnel into the loading cannula. The geometry of the foot core base allows the supporting members to fold down under the foot core as it is withdrawn through the loading funnel. The extra support member also keeps the wing in contact with the funnel internal surface during loading giving more consistent loading. 
     The O-ring foot core design and its variants provides, in some embodiments, support for the flexible wing portion of the implant throughout the life cycle of the implant from initial manufacturing when the implant is assembled through transportation and storage and ultimately during all stages of implant deployment into the hole in the hollow vessel for which it is intended to seal. The O-ring foot core provides, in some embodiments, structural support for the flexible wing when the device is fully assembled in its storage tray. During deployment to close a hole in a hollow vessel, the implant is loaded into a cannula through a loading funnel which reduces the cross-sectional area of the implant (O-ring and flexible wing) to make it possible to deliver the implant through an introducer catheter into a hollow vessel (such as an artery or a vein) within which there had been made an access hole to perform a minimally invasive procedure. During this delivery and deployment of the implant, in certain embodiments, the O-ring foot core supports the wing. 
     Uses can include closing access site holes in hollow vessels; closing access site holes in blood vessels; closing holes in arteries; closing small and large holes up to 30 F in hollow vessels; closing access site holes in the abdominal post endoscopic procedures; and closing access site holes in the femoral artery, subclavian artery, ascending aorta, axillary and brachial arteries. 
     Although certain figures and embodiments relate to use of systems and devices for closure of a perforation associated with vascular surgery, one of ordinary skill in the art will appreciate that components of a provided device are not size dependent (i.e., are scalable) and are therefore useful for closure of any perforation in a lumen of a mammal. 
     Although certain figures and embodiments relate to use of systems and devices for closure of a perforation associated with vascular surgery, one of ordinary skill in the art will appreciate that components of a provided device are not size dependent (i.e., are scalable) and are therefore useful for closure of any perforation in a lumen of a mammal. 
     Some embodiments of the present invention are directed to a closure system, device, and method of percutaneous closure of an arteriotomy following endovascular/intra S arterial procedures. 
     Although the present invention has been described with reference to particular examples and exemplary embodiments, it should be understood that the foregoing description is in no manner limiting. Moreover, the features described herein may be used in any combination. 
     In certain embodiments, the invention is used for closing access site holes in blood vessels or arteries, for example, but not limited to, the femoral artery, subclavian artery, ascending aorta, axillary and brachial arteries. 
     In certain embodiments, the invention is used for closing access site holes in the abdominal post endoscopic procedures. 
     In certain embodiments, the invention is used for closing access site holes in hollow vessels. The size of the site holes may be up to 30 French (F) in certain embodiments. 
     Experimental Data 
     The provided technologies were tested in vitro and in vivo. For the in vitro test, the sealable member was tested on a test bench using either a flexible tube or a bovine artery to simulate the body lumen. The bovine artery has an inner diameter between 7.8 mm and 9 mm and a wall thickness between 1.4 and 1.9 mm. The flexible tube has an inner diameter of 7.1 mm and a wall thickness of 0.55 mm. In each of the flexible tube and the bovine artery, an aperture was created with a diameter of 6 and 8 mm respectively. A deployment sheath (e.g., the delivery cannula), used in the procedure, has an inner/outer diameter of 20 F/24 F. 
     The test was performed with water flowing through each of the respective bovine artery and flexible tube, under physiological conditions with a pulse of approximately 60 hertz, a systolic pressure of about 120 mm-Hg, and a diastolic pressure of about 80 mm-Hg. Ten data samples were collected for each test. The amount of water leaked within 5 minutes from the time of deployment is measured and provided in Table 4 and Table 5 below. 
     
       
         
           
               
             
               
                 TABLE 4 
               
             
            
               
                   
               
               
                 Bovine artery: in vitro test comparison of devices, including 
               
               
                 (i) a baseline closure device having a rigid base core 
               
               
                 and a flexible sealable member (see “Current Device 
               
               
                 R#1”) and (ii) a closure device configured with 
               
               
                 a flexible support base and a flexible sealable member 
               
               
                 (e.g., comprising a mesh layer and substrate) (see “New Device R#2”). 
               
            
           
           
               
               
               
               
            
               
                   
                 Total leak in 
                 Current Device 
                 New Device 
               
               
                   
                 5 ml (ml) 
                 R#1 
                 R#2 
               
               
                   
                   
               
            
           
           
               
               
               
               
            
               
                   
                 Mean 
                 5.2 
                 0.9 
               
               
                   
                 SD 
                 4.2 
                 0.7 
               
               
                   
                 Min 
                 0.8 
                 0.0 
               
               
                   
                 Max 
                 12 
                 2.0 
               
               
                   
                   
               
            
           
         
       
     
     
       
         
           
               
             
               
                 TABLE 5 
               
             
            
               
                   
               
               
                 Flexible tube: in vitro test comparison of devices, including 
               
               
                 (i) the same baseline closure device having a rigid base core 
               
               
                 and a flexible sealable member (see “Current Device R#1”) and 
               
               
                 (ii) the same closure device configured with a flexible support 
               
               
                 base and a flexible sealable member (e.g., comprising a mesh 
               
               
                 layer and substrate) (see “New Device R#2”). 
               
            
           
           
               
               
               
               
            
               
                   
                 Total leak in 
                 Current Device 
                 New Device 
               
               
                   
                 5 ml (ml) 
                 R#1 
                 R#2 
               
               
                   
                   
               
            
           
           
               
               
               
               
            
               
                   
                 Mean 
                 13.6 
                 1.8 
               
               
                   
                 SD 
                 12.0 
                 1.2 
               
               
                   
                 Min 
                 0 
                 0.6 
               
               
                   
                 Max 
                 16 
                 4.1 
               
               
                   
                   
               
            
           
         
       
     
     The test illustrates a 5× improvement of the closure device, configured with a flexible support member and a flexible sealable member (e.g., comprising the mesh layer and substrate), in reducing the amount of fluid leakage over the design employing a sealable with no mesh layer (and having a rigid core). In addition to the seal formed from the R#2 closure device having improved leakage performance, as shown in the plots of the histograms and the standard deviation values of the tables, a more consistent closure is also provided. 
     For the in vivo test, the sealable member was tested in animal subjects. A similar 6 mm puncture was made in a pig aorta. The deployment sheath, used in the procedure, also has an inner/outer diameter of 20 F/24 F. Six data samples were collected for each test using the R#1 design and the R#2 design. The total deployment time, tamponade time, time to hemostasis, and total procedure time are provided in Table 6 below. 
     
       
         
           
               
             
               
                 TABLE 6 
               
             
            
               
                   
               
               
                 Pig Aorta: in vivo study comparison of devices, including (i) the 
               
               
                 same baseline closure device having a rigid base core and a flexible 
               
               
                 sealable member (see “R#1”) and (ii) the same closure 
               
               
                 device configured with a flexible support base and a flexible sealable 
               
               
                 member (e.g., comprising the mesh layer and substrate) (see “R#2”). 
               
            
           
           
               
               
               
               
               
               
            
               
                   
                   
                   
                 Time to 
                 Total 
                   
               
               
                   
                 Deployment 
                 Tamponade 
                 Hemostasis 
                 Procedure 
               
               
                   
                 Time (mm:ss) 
                 Time (TT) 
                 (TTH) 
                 Time 
                 ACT 
               
               
                 n = 6 
                 (Inc TT) 
                 (mm:ss) 
                 (mm:ss) 
                 (mm:ss) 
                 (sec) 
               
               
                   
               
            
           
           
               
            
               
                 R#1 in vivo study 
               
            
           
           
               
               
               
               
               
               
            
               
                 Average 
                 07:01 
                 04:08 
                 05:49 
                 12:50 
                 190 
               
               
                 Max 
                 07:45 
                 04:30 
                 30:15 
                 37:38 
                 217 
               
               
                 Min 
                 06:24 
                 04:00 
                 00:00 
                 07:00 
                 165 
               
            
           
           
               
            
               
                 R#2 in vivo study 
               
            
           
           
               
               
               
               
               
               
            
               
                 Average 
                 02:50 
                 00:57 
                 00:38 
                 03:29 
                 294 
               
               
                 Max 
                 03:07 
                 01:37 
                 01:30 
                 04:30 
                 404 
               
               
                 Min 
                 02:15 
                 00:20 
                 00:00 
                 02:15 
                 194 
               
               
                   
               
            
           
         
       
     
     As shown in Table 6, the R#2 design improves the total deployment time by 2.5× over the R#1 design. The total deployment time, used in the observations, includes the time for the device to be positioned and deployed in the pig aorta and for the leakage to stop. 
     In addition, the R#2 design improves the time to hemostasis by 9× over the R#1 design. The time to hemostasis (TTH), used in the observations, refers to the time from which a seal is created and the time for leakage to stop. Less variability in the time to hemostasis is also observed. 
     In addition, the R#2 design reduces the overall closure procedure time by 3.7× over the R#1 design. The activated clotting time (ACT time) was longer by over 100 seconds. The activated clotting time refers to the time for whole blood to clot upon exposure to an activator. 
     Although the present invention has been described with reference to particular examples and exemplary embodiments, it should be understood that the foregoing description is in no manner limiting. Moreover, the features described herein may be used in any combination.