Patent Document

RELATED APPLICATIONS 
     This application is a continuation of and claims the benefit of priority under Title 35, United States Code, §120 from U.S. patent application Ser. No. 11/930,111, filed Oct. 31, 2007 now abandoned, which is a continuation of U.S. patent application Ser. No. 11/279,242, filed Apr. 10, 2006, titled Arteriotomy Closure Devices and Techniques, which is a continuation of U.S. Pat. No. 7,025,776 having Ser. No. 10/224,659 and titled Arteriotomy Closure Devices and Techniques and issuing on Apr. 11, 2006, which claims the benefit of U.S. patent application Ser. No. 10/127,714, filed Apr. 23, 2002 and titled Arteriotomy Closure Devices and Techniques, which claims the benefit of priority from U.S. Provisional Patent Application No. 60/286,269, filed Apr. 24, 2001 and titled Percutaneous Vessel Access Closure Device and Method; from U.S. Provisional Patent Application No. 60/300,892, filed Jun. 25, 2001 and titled Percutaneous Vessel Access Closure Device and Method, and from U.S. Provisional Patent Application No. 60/302,255, filed Jun. 28, 2001 and titled Percutaneous Vessel Access Closure Device and Method (Hemostatic Patch or Collar), each of which is incorporated herein in their entirety by reference. 
    
    
     TECHNICAL FIELD 
     The field of the inventions generally relates to cardiovascular and arterial closure devices, and, more particularly, to arterial closure devices and techniques. 
     BACKGROUND 
     In most cardiology and radiology procedures, a catheter is inserted into an artery, such as the femoral artery, through a vascular introducer. When the procedure is complete, the physician removes the catheter from the introducer and then removes the introducer from the arteriotomy into the vessel. The physician then must prevent or limit the amount of blood that leaks through the arteriotomy so that the patient can be discharged. Physicians currently use a number of methods to close the arteriotomy, such as localized compression, sutures, collagen plugs, and adhesives, gels, foams, and similar materials. To use localized compression, the physician presses down against the vessel to allow the arteriotomy to naturally clot. This method, however, can take half an hour or more, and requires the patient to remain immobilized for at least that period of time and be kept in the hospital for observation. There are potentials for clots at puncture site to be dislodged. Moreover, the amount of time necessary for the compression can be significantly increased depending upon how much heparin, glycoprotein IIb/IIA antagonists, or other anti-clotting agents were used during the procedure. Sutures and collagen plugs may have procedure variability, may require time to close the vessel, may have negative cost factors, and may necessitate a separate deployment device. Adhesives, gels, and foams may have negative cost factors, may necessitate a possibly complicated deployment process, and may have procedure variability. 
     SUMMARY 
     In one general aspect, an arterial closure device is deliverable over a tube for placement within and against an arteriotomy. The arterial closure device includes a first member forming an enlargement around the circumference of the arterial closure device and being configured to be received against an outer surface of a vessel; a connecting member having a smaller outer diameter than the first member, extending from the first member, and being configured to be positioned within an arteriotomy of a vessel; and a longitudinal channel configured to receive a tube and passing between the first member and the connecting member. 
     Embodiments of the arterial closure device may include one or more of the following features. For example, the connecting member may include slits. The connecting member may be expandable from a first narrow diameter to a second expanded diameter. 
     The arterial closure device may further include a second member extending from the connecting member, forming an enlargement around the circumference of the arterial closure device and being configured to be received against an inner surface of the vessel when the first member is received against the outer surface of the vessel. The arterial closure device may still further include an adhesive layer on at least one of the first member, the second member, and the connecting member. The first member may extend at an angle from the arterial closure device, the second member may extend at an angle from the arterial closure device, and the first member may be generally oriented in the direction of the second member. 
     The first member may include at least one superelastic/shape memory element configured to move between a first extended position and a second extended position and the second member may include at least one superelastic/shape memory element configured to move between a first extended position and a second extended position. 
     The arterial closure device may further include an adhesive layer on at least one of the first member and the connecting member. The arterial closure device may further include an adhesive within the longitudinal channel. The arterial closure device may further include longitudinal slots along the longitudinal channel. 
     The arterial closure device may further include an extending member extending from the first member in a generally opposite direction away from the connecting member and the longitudinal channel continues from the first member through the extending member. The extending member may include a closable opening of the longitudinal channel. The arterial closure device may further include a slot along at least a part of the length of the arterial closure device. 
     The arterial closure device may further include a deployment tool, the deployment tool including a handle, a contacting section, and an extension that extends between the handle and the contacting section. The contacting section is configured to mate with the arterial closure device to advance the arterial closure device over the tube and deploy the arterial closure device within the vessel. 
     In another general aspect, an arterial closure system includes an arterial closure device and a deployment tool. The arterial closure device includes a first member forming an enlargement around the circumference of the arterial closure device and being configured to be received against an outer surface of a vessel, a connecting member having a smaller outer diameter than the first member, extending from the first member, and being configured to be positioned within an arteriotomy of a vessel, and a longitudinal channel configured to receive a tube and passing between the first member and the connecting member. The deployment tool includes a handle, a contacting section, and an extension that extends between the handle and the contacting section, the contacting section being configured to mate with the arterial closure device to advance the arterial closure device over the tube and deploy the arterial closure device within the vessel. 
     Embodiments of the arterial closure system may include any of the features described above or herein. For example, the arterial closure system may further include a second member extending from the connecting member, forming an enlargement around the circumference of the arterial closure device and being configured to be received against an inner surface of the vessel when the first member is received against the outer surface of the vessel. The first member may include at least one superelastic/shape memory element configured to move between a first extended position and a second extended position; and the second member may include at least one superelastic/shape memory element configured to move between a first extended position and a second extended position. 
     The arterial closure device may include a slot along at least a portion of the length of the arterial closure device and the contacting section of the deployment tool may include a longitudinal slot. 
     In another general aspect, a method of closing an opening in a vessel includes providing an arterial closure device that includes a first member forming an enlargement around the circumference of the arterial closure device and being configured to be received against an outer surface of a vessel, a connecting member having a smaller outer diameter than the first member, extending from the first member, and being configured to be positioned within an arteriotomy of a vessel, and a longitudinal channel configured to receive a tube and passing between the first member and the connecting member. The method further includes providing a deployment tool comprising a handle, a contacting section, and an extension that extends between the handle and the contacting section, the contacting section being configured to mate with the arterial closure device to advance the arterial closure device over the tube and deploy the arterial closure device within the vessel. The method still further includes slidably mounting the arterial closure device to a tube; inserting the tube through an opening into the vessel; using the deployment tool to advance and deploy the arterial closure device by advancing the arterial closure device along the tube until the connecting member is deployed within the vessel and the first member is received against the outer surface of the vessel; and removing the tube from the vessel and from the arterial closure device. 
     Embodiments of the method of closing an opening in a vessel may include any of the features described above or herein. For example the arterial closure device may further include a second member extending from the connecting member, forming an enlargement around the circumference of the arterial closure device and being configured to be received against an inner surface of the vessel when the first member is received against the outer surface of the vessel and an adhesive layer is positioned on at least one of the first member, the second member, and the connecting member, and deploying the arterial closure device further comprises positioning the second member against the inner surface of the vessel. 
     The arterial closure device, the arterial closure system, and the arterial closure method provides considerable advantages, as described herein. For example, the ACDs and methods described herein can provide: (1) the ability to deploy an ACD without the removal and re-insertion of a second device; (2) the ability to be used on most commercial vascular introducers, catheters, tubes, etc.; (3) the ability to use tactile feedback to correctly and properly deploy an ACD without direct or indirect visual assistance; (4) the ability to use adhesives to secure the device to the vessel; (5) the ability to use adhesives to close off the device to prevent blood leaking or seepage; and (6) the ability to provide eluting therapeutic agents incorporated within or on the device. Moreover, the device, system and method are advantageously simple to use, inexpensive, and effective as a percutaneous vessel access closure device and method. 
    
    
     
       DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a side view of a arterial closure device positioned around a tubular section of a vascular introducer. 
         FIG. 2  is a side view of the arterial closure device of  FIG. 1  advanced through a percutaneous opening by a deployment instrument. 
         FIG. 3  is a side view of the arterial closure device of  FIG. 1  deployed through a vessel wall. 
         FIG. 4  is a cross-sectional side view of the arterial closure device of  FIG. 1  deployed through a vessel wall. 
         FIG. 5  is a top view of the arterial closure device of  FIG. 1 . 
         FIGS. 6 and 7  are side and cross-sectional side views, respectively, of a second implementation of a arterial closure device deployed within an arteriotomy of a vessel wall. 
         FIG. 8  is a bottom end view of the arterial closure device of  FIG. 6  showing the flared end opened. 
         FIG. 9  is a bottom end view of the arterial closure device of  FIG. 6  showing the flared end closed. 
         FIG. 10  is a top end view of the arterial closure device of  FIG. 6  showing the flared end partially closed. 
         FIG. 11  is a side view of the arterial closure device of  FIG. 6  showing the flared end. 
         FIGS. 12 and 13  are a cross-sectional side view and a top view, respectively, of the arterial closure device of  FIG. 1  having an adhesive on the inner diameter and tissue engagement areas. 
         FIGS. 14 and 15  are a cross-sectional side view and a top view, respectively, of the arterial closure device of  FIG. 6  having an adhesive on the inner diameter and tissue engagement areas. 
         FIGS. 16 and 17  are a cross-sectional side view and a top view, respectively, of the arterial closure device of  FIG. 1  having grooves on the inner diameter to form a thinned or weakened wall. 
         FIG. 18  is a side view of an angled arterial closure device. 
         FIG. 19  is a side view of an angled arterial closure device having a foldable extending member. 
         FIG. 20  is a side view of a deployment tool. 
         FIG. 21  is a side view of the deployment tool of  FIG. 20  used to deploy a arterial closure device. 
         FIG. 22  is an end view of the deployment tool  FIG. 20 . 
         FIG. 23  is a side view of the deployment tool of  FIG. 20  having an extended contacting member. 
         FIG. 24  is a side view of the deployment tool of  FIG. 23  used to deploy a arterial closure device. 
         FIG. 25  is an end view of the deployment tool  FIG. 23 . 
         FIG. 26  is a cross-sectional side view of a arterial closure device having angled closure edges for compressing a vessel wall. 
         FIG. 27  is a top view of the arterial closure device of  FIG. 26 . 
         FIG. 28  is a side view of the arterial closure device of  FIG. 26  being advanced through the skin into a vessel with the closure edges deflected. 
         FIG. 29  is a side view of the arterial closure device of  FIG. 26  deployed and secured onto vessel wall with the closure edges occluding the arteriotomy. 
         FIG. 30  is a side view of a arterial closure device. 
         FIG. 31  is an end view of the arterial closure device of  FIG. 30 . 
         FIG. 32  is a perspective side view of a vascular connector having a closable end. 
         FIG. 33  is an end view of the arterial closure device of  FIG. 32 . 
         FIG. 34  is a side view of a liner having a longitudinal slot for a arterial closure device. 
         FIG. 35  is an end view of the liner of  FIG. 34 . 
         FIG. 36  is a side view of a liner having a radial slot. 
         FIG. 37  is an end view of the liner of  FIG. 36 . 
         FIG. 38  is a side view of a plug-style arterial closure device that includes an adhesive layer on the vessel contact areas. 
         FIG. 39  is a side view of a plug style arterial closure device that has limited vessel protrusion and includes an adhesive on the vessel contacting areas. 
         FIGS. 40 and 41  are side views of the plug style arterial closure device of  FIG. 39  being deployed and deployed within a vessel. 
         FIG. 42  is an end view showing the distal end of the introducer inside a vessel. 
         FIGS. 43 and 44  are end views showing a flared arterial closure device deployed along the introducer. 
         FIG. 45  is an end view showing the flared arterial closure device of  FIG. 43  deployed against the vessel to close the arteriotomy. 
         FIGS. 46 and 47  are electrical schematics for a direct resistive element heating circuit and an ohmic tissue heating circuit. 
         FIG. 48  is a perspective view of a tube used to fabricate a arterial closure device. 
         FIG. 49  is a perspective view of the tube of  FIG. 48  showing material being removed. 
         FIG. 50  is a side view of the tube of  FIG. 48  with the material removed. 
         FIG. 51  is a top view of the curved configuration. 
         FIG. 52  is a side view of the configuration of  FIG. 51 . 
         FIG. 53  is a perspective view of a fabric covering. 
         FIGS. 54-58  are side views showing the fabric covering of  FIG. 53  being mounted within the curved configuration of  FIG. 51  to form a arterial closure device. 
         FIG. 59  is a side view of a configuration having side arms that fold over each other. 
         FIGS. 60 and 61  are front and cross-sectional side views of a deployment tool for deploying the arterial closure device. 
         FIG. 62  is a cross-sectional side view of the deployment tool of  FIG. 60  having the arterial closure device within. 
     
    
    
     DETAILED DESCRIPTION 
     Referring to  FIGS. 1-3 , a vascular closure system  100  generally includes two components: a arterial closure device (“ACD”)  105  and a deployment instrument  110 . The ACD  105  is slidably mounted to a vascular introducer  115  or other tubular device, such as a catheter, advanced over a tube section  120  of the introducer  115  using the deployment instrument  110 , passed through a percutaneous opening  125 , and placed through an arteriotomy  130  in a vessel wall  133  into a blood vessel  135 . The deployment tool  110  and the introducer  115  then are removed from the blood vessel  135  and out of the percutaneous opening  125 . 
     Referring to  FIGS. 4 and 5 , the ACD  105  is generally compliant, tubular, and includes a first member  140 , a second member  145 , a connecting member  150  between the first member and the second member, and an optional extending member  155  that extends from the second member. A longitudinal channel  160  passes between a first opening  165  in the extending member (or second member if the extending member is not present) and a second opening  170  in the first member  140 . 
     The ACD  105  is formed of a tubular structure of sufficient length and thickness (e.g., a single wall thickness of between 0.005″ and 0.05″, and more particularly between 0.01″ and 0.02″) that can be advanced over the introducer  115 , and through the puncture site  125 . The ACD  105  has sufficient rigidity to be advanced through the puncture site  125  yet is compliant enough to be compressed onto itself by the natural elasticity of the vessel wall  133  after the introducer  115  is removed. Moreover, the connecting member  150  can be configured to have a natural elasticity such that when it is no longer mounted over the introducer tube  120 , it will return to its original smaller diameter state. The ACD IOS may include, for example, longitudinal sections of the tube where the wall thickness is thinner (e.g., connecting member  150 ) thereby creating creases or weakened areas that receive the vessel wall  133 . The creases would reduce the amount of compressive force required to collapse the tube onto itself. A design allowing tactile feedback may be used to determine the proper insertion position (depth). The tactile feedback could be accomplished by the ACD  105  having one or more rings of increased wall thickness, an “hour glass” geometry, a thin, narrow, then wide geometry, combination, or other means to provide an abrupt change in the advancing force resistance during deployment. The ACD  105  may be manufactured in many different French sizes, to match the outer diameter of any commercial vascular introducers  115 . 
     The ACD  105  is placed around the outside of any commercially available introducer  115 , or other device that is inserted into the cardiovascular system (e.g., catheter, etc.), and positioned adjacent to the proximal end of the introducer (i.e., near the valve or luer fitting of the introducer). The introducer  115  then is inserted into the vasculature using standard techniques. Prior to removing the introducer  115 , the tubular ACD  115  is advanced to the skin, for example, by the physician manually advancing the ACD along the tube  120 . The deployment instrument  110  then is positioned against or clipped onto the tuber  120 , advanced to be in contact with the proximal end (i.e., second member  145 ) of the ACD  105 , and advanced through the skin such that at least the distal most portion (e.g., first member  140 ) of the ACD is inside the vessel  135 . The ACD  105  is prevented from deforming or collapsing during insertion by the rigidity of the tube  120 . The tube  120  also acts as a guide to position the ACD  105  through the puncture site  125  during its advancement and deployment. When the introducer  115  is removed, the deployment instrument  110  is held in position and still in contact with the ACD  105  preventing the ACD from coming out of the vessel  135  along with the introducer. Once the introducer  115  is completely removed, the ACD  105  is compressed together due to the elastic recovery of the vessel wall  133 , achieving hemostasis and effectively sealing the arteriotomy  150  and puncture site  125 . 
     The ACD  105  can be partially or completely fabricated from a biocompatible material, such as expanded polytetrafluoroethylene (ePTFE), polyester, polyurethane, silicone, Dacron, urethane, and/or a composite or combination of these or other suitable materials. The ACD  105  also can be partially or completely fabricated from a biodegradable/bioabsorbable material, including modified cellulose, collagen, fibrin, fibrinogen, elastin or other connective proteins or natural materials, polymers or copolymers such as polylactide [poly-L-lactide (PLLA), poly-D-lactide (PDLA)], polyglycolide, polydioxanone, polycaprolactone, polygluconate, polylactic acid (PLA), polylactic acid-polyethylene oxide copolymers, poly(hydroxybutyrate), polyanhydride, polyphosphoester, poly(amino acids), poly(alpha-hydroxy acid) or related copolymers of these materials as well as composites and combinations thereof and combinations of other biodegradable/bioabsorbable materials. 
     The ACD  105  also can be partially or completely fabricated from materials that swell, or expand when they are exposed to a fluid, such as blood, or another fluid, for example, that can be added by the physician to cause the material to swell. These materials include hydrophilic gels (hydrogels), regenerated cellulose, polyethylene vinyl acetate (PEVA), as well as composites and combinations thereof and combinations of other biocompatible swellable or expandable materials. 
     The ACD  105  can be made using several methods and processes including extrusion, molding (i.e., injection molding or other known molding techniques), casting, dip coating, spraying, adhesive bonding, ultra-sonic welding, composite fabrication techniques, and combinations of these and/or other similar methods and processes. 
     The ACD  105  also can have a biocompatible contact adhesive or other material within the longitudinal channel  160  so that when the longitudinal channel is compressed within the arteriotomy  130 , the adhesive bonds the inside surfaces of the longitudinal channel together. This assists or expedites the sealing of the arteriotomy. Additionally, bonding materials can be used on the outside of the ACD  105 , for example, on the outer surface of the first member  140 , the second member  145 , the connecting member  150 , and or the optional extending member  155 . In particular, the bonding material is especially useful where the ACD contacts the vessel wall  133  defining the arteriotomy  130 . 
     The biocompatible contact adhesive adhesive/bonding compounds/solutions could be added during the manufacturing process, just prior to deployment, or after the device has been deployed. The bonding materials could be in the form of a liquid, semi solid, or solid. Suitable bonding materials include gels, foams and microporous mesh. Suitable adhesives include acrylates, cyanoacrylates, epoxies, fibrin-based adhesives, other biological based adhesives, UV light and/or heat activated or other specialized adhesives. The adhesive could bond on initial contact, or longer, to allow repositioning if desired. The preferred adhesive may be a crystalline polymer that changes from a non-tacky crystalline state to an adhesive gel state when the temperature is raised from room temperature to body temperature. Such material is available under the trade name Intillemer™ adhesive, available from Landec Corp. as well as composites and combinations thereof and combinations of other materials. Suppliers of biocompatible adhesives include, but are not limited to, Plasto (Dijon, France), Haemacure (Montreal, Canada), Cohesion (Palo Alto, Calif.), Cryolife (Kennesaw, Ga.), TissueLink (Dover, N.H.), and others. To increase the work time of the adhesive or allow repositioning of the vascular coupler after it has been deployed, the adhesive can be blended with a material, such as a starch or other material, that retards or delays bonding to allow repositioning of the coupler after it has been deployed. A degradable coating can be placed over the adhesive coating so that it degrades and exposes the adhesive. Other adhesives are understood to include composites-based adherents and combinations of the above materials and other suitable materials as are known in the art. 
     To improve later detection of the ACD  105 , it can be fabricated from materials that include one or more radiopaque materials, such as barium sulfate, bismuth trioxide, or other any other radiopaque material. The radiopaque material is added to the materials from which the ACD  105  is fabricated or to the bonding materials that are placed in, on, or around the ACD. 
     Referring to  FIGS. 6-11 , a second implementation of a arterial closure device is shown as a arterial closure device (“ACD”)  200 . The ACD  200  includes a first member  205 , a second member  210 , and an optional extending member  215  that extends from the second member. A longitudinal channel  220  passes between a first opening  225  in the extending member (or second member if the extending member is not present) and a second opening  230  in the first member  205 . The ACD  200  is implanted within an arteriotomy  130  in a manner similar to the implantation of the ACD  105 . However, the ACD  200  does not include a member that is substantially in contact with the inner wall of the vessel  135 . Instead, the ACD has a flare, or two or more short slits  235  in the side wall of the first member  205 . The flare or slits  235  are designed to open or flare around the catheter or introducer  120  when advanced to the top of the vessel puncture site ( FIG. 8 ). The materials from which the ACD  200  or the second member  205  are fabricated may be a very elastic material such that when around the introducer it expands and when advanced beyond the end of the introducer, it contracts such that the individual flares pinch or otherwise catch the edges of the arteriotomy or punctured vessel and pull them together while contracting ( FIG. 9 ). This action is intended to close the arteriotomy  130  and create hemostasis. The inside of the flared section  235  of the ACD  200  may have a biocompatible contact adhesive or other bonding material, as described above, that further secures the ACD within the arteriotomy and to the vessel  135 , and, in particular the second member  210  to the top or outer surface of the vessel. 
     As indicated above, the adhesive or bonding materials can be implemented on any of the above ACDs. For example, referring to  FIGS. 12 and 13 , the ACD  105  has an adhesive or bonding material  270  on the inner diameter and tissue engagement areas. Similarly, referring to  FIGS. 14 and 15 , the ACD  200  has the adhesive or bonding material  270  on the inner diameter and tissue engagement areas. In this manner, adhesive  270  will close the respective longitudinal channel  160 ,  200  of the ACD  105 ,  200  to reduce or eliminate seepage blood. Moreover, the adhesive  270  around the tissue contacting areas will bond the ACD to the vessel wall to reduce or eliminate seepage of blood through those regions. 
     Referring to  FIGS. 16 and 17 , the ACD  105  can have the inner diameter of the longitudinal channel  160  modified to include ridges  280  and channels  285  that weaken or thin the wall section of the ACD. In this manner, the inner diameter of the longitudinal channel  160  can be expanded or reduced depending upon the circumferential pressure exerted against the ACD. For example, when passing the introducer through the longitudinal channel the inner diameter will be expanded. When the introducer is subsequently removed, the inner diameter is reduced because of the natural elastic recoil properties of the ACD. In this manner, the seepage of blood through the longitudinal channel is reduced or eliminated. Moreover, the surfaces of the inner diameter of the longitudinal channel can be coated with an adhesive, as described above, to further ensure that the inner diameter is closed. 
     The ACDs described herein also can include one or more therapeutic agents that affect healing at the site where the device is deployed. The agent(s) can be incorporated into the structure forming the device and/or incorporated into a coating. Such therapeutic agents may include, but are not limited to, antithrombotics (such as anticoagulants), antimitogens, antimitotoxins, antisense oligonucleotides, gene therapy solutions, nitric oxide, and growth factors and inhibitors. Direct thrombin inhibitors that may be beneficial include Hirudin, Hirugen, Hirulog, PPACK (D-phenylalanyl-L-propyl-L-arginine chloromethyl ketone), Argatreban, and D-FPRCH.sub.2 Cl (D-phenylalanyl-L-propyl-L-arginyl chloromethyl ketone); indirect thrombin inhibitors include Heparin and Warfarin (coumadin). Alternatively, a clot promoter may be used, such as protamine sulphate or calcium hydroxide. Additional therapeutic materials include, aspirin, dexamethasone, dexamethasone phosphate, streptokinase, tocopherol, TPA, urokinase, paclitaxel (Taxol), actinomycin, rapamyacin, or other. Sirolimus, or other antibiotics may also be used. The therapeutic compounds/solutions may be blended with the device base materials during fabrication, applied just prior to deployment, or after the device has been deployed. Additionally, the therapeutic materials may be located on, through, inside, or combination of the device in holes, grooves, slots or other indentation to allow elution of the therapeutic compound(s). Post device fabrication coating methods include, but are not limited to, dipping, spraying, brushing, submerging the devices into a beaker containing a therapeutic solution while inside a vacuum chamber to permeate the device material, etc. 
     The geometry of the ACDs described herein is shown for illustration purposes as being generally round. However, they can be of any other geometry, such as oval, elliptical, rectangular, square, ridged, or a combination of shapes. The ACD has been illustrated as forming a generally perpendicular angle with the vessel wall once deployed. Nonetheless, the inventors intend the configuration to be at any suitable angle, such as between 30° and 60°, or, for example, 45° or as otherwise desired. A range of angles of the ACD can be available and the physician can choose the appropriate ACD based on the angle at which the introducer is introduced into the vessel. For example, referring to  FIG. 18 , a ACD  290  is formed to have the extending member  155  extending at an angle of approximately 45° from the second member  145 . In addition, the first member  140  and the second member  145  are longitudinally offset. This configuration is designed to cause the extending member  155  to follow the path created by the introducer. Referring also to  FIG. 19 , the ACD has a second member  292 , a foldable extending member  294 , and a groove  296  positioned between the second member  292  and the folding extending member  294 . In this manner, the extending member  294  can be folded or bent over to be less obtrusive and to close off the flow of blood through the ACD. 
     Referring to  FIGS. 20-22 , a deployment tool  300  is designed to engage or otherwise contact the proximal edge, or other edge, of the ACD. The tool  300  is generally handheld and includes a handle  305 , an extension  310 , and a contacting section  315  that clips onto, or otherwise contacts the outside of the introducer and mates with the ACD. The contacting section  315  has sufficient length to advance the ACD through the tissue to the desired position on the vessel. The handle  305  or grasping section can be, for example, round, rectangular, elliptical, or a combination of shapes or other shape that fit comfortably in the hand. The contacting section  315  can have a cross-sectional geometry of a partially open tube having more than 50% diameter coverage, so that it can clip onto, and slide over the outer diameter of the introducer. 
     Referring also to  FIGS. 23-35 , the deployment tool can include an additional extension  320  that is configured to fit around the extending member  155  and mate with the second member  145 . The extension  320  can be attached to the introducer after the introducer is positioned within the artery. 
     The deployment tool  300  can be made partially or completely from several different polymer materials including polycarbonate, nylon, polyethylene, polytetrafluoroethylene (PTFE), fluoroethylene-propylene (FEP) or polyfluoroacrylate (PFA), polyester ether ketone (PEEK), polyamide, polyimide, polyethyleneterephthalate (PET), combination or other material able to withstand sterilization processing. The tool can also be made partially or completely from several different types of metals including stainless steel; spring metal alloys such as Elgiloy™, Inconel™; superelastic/shape memory alloys such as Nitinol (NiTi) as well as composites and combinations thereof and combinations of other materials. 
     The deployment tool  300  can be made using several methods and processes including extrusion, molding (injection and other), casting, adhesive bonding, ultrasonic welding as well as combinations thereof and combinations of other methods and processes. 
     Modifications of the deployment tool  300  are possible. For example, the proximal edge of the ACD (i.e., of the extending member  155  or the second member  145 ) and the distal edge or other portion of the advancement tool  300  may have interlocking geometries to aid and/or control the position of the ACD during advancement along the introducer. The engagement/contact section  315 ,  320  of the tool  300  may have a cross-sectional geometry of a complete circle that is designed to split away from the introducer once the ACD has been advanced and deployed. Splitting can be accomplished by having weakened areas in the wall of the tubing, such as linear perforations, or linear scores. This version would require that the deployment tool be back loaded onto the introducer before the ACD is placed onto the introducer and prior to insertion into the vessel. 
     The inside, concave section of the contact section  315 ,  320  may be coated with a hydrophilic or other lubricious material to reduce the friction during advancement and deployment of the ACD In addition to the deployment tool  300  contacting the proximal edge of the ACD, the contacting section  315 ,  320  of the tool can be lengthened and designed to further attach to and compress the distal edge of the ACD, thereby providing additional support during insertion and deployment into the vessel. 
     Referring to  FIGS. 26-29 , a ACD  350  includes a first angled closure edge  355 , a second angled closure edge  360 , an extending member  365 , and a connection member  370  between the first and second angled closure members. The first angled closure edge  355  and the second angled closure edge are generally directed at each other such that they define a narrow opening  375  through which the vessel wall  133  is received. The ACD  350  is deployed over the introducer tube section  120  using, for example, the deployment tool  300 . As illustrated in  FIG. 28 , the second angled closure edge  360  is deflected away from the first angled closure edge  355 . The deflection can be caused, for example, by the contacting section  320  surrounding the second angled closure edge  360 . In this manner, when the deployment tool  300  is removed, the second angled closure edge  360  deflects back to compress the vessel wall  133  between the angled closure edges  355 ,  360 . The angled closure edges  355  and  360  are formed, for example, from a flexible member, such as a polymer, superelastic/shape memory material, or a combination of the two. For example, the superelastic/shape memory member can be coated with a polymer. 
     Referring to  FIGS. 30 and 31 , a ACD  400  includes a threaded section  405  and an extending section  410 . The threaded section  405  includes threads  415  mounted on and between a first member  420  and a second member  425 . The extending section  410  includes a longitudinal channel  430  that includes a distal shaped channel  435 . A deployment tool having a mating shaped distal end is inserted into the longitudinal channel  430  such that it mates with the distal shaped channel  435 . By rotating the deployment tool, the ACD can be threadably inserted into the arteriotomy. 
     In general, the distal edge of the ACD  400  is designed to engage the opening of the arteriotomy or puncture site and protrude to a specific depth based on how many times the ACD was advanced, twisted or turned. The ACD  400  may have a stop  437  to limit how far the device protrudes into the vessel. The same “screw” type distal edge could be used on a hemostatic plug, made from a solid piece of material, rather than a tube structure. A deployment tool would be needed that has, for example, a grasping distal end for insertion into the vessel. 
     The ACD  400  can be modified to include a longitudinal channel that pass through the entire length of the device and deployed over a introducer. In this case, the deployment tool and the proximal edge of the ACD would have a mating geometry such that the deployment tool is rotated to threadably insert the ACD through the arteriotomy. 
     Referring to  FIGS. 32 and 33 , a ACD  450  includes a tissue contacting member  455  and an extending member  460 . A longitudinal channel  463  passes through the ACD. The extending member  460  includes a longitudinal slot  465  and a circumferential channel  470  in which a contracting member  475  is received. The contracting member  475  tends to close the longitudinal channel  463  unless kept open, for example, by an introducer  115  within the channel. In this manner, when the ACD  450  is deployed within the arteriotomy and the introducer is removed, the longitudinal channel is closed, which prevents or limits blood flow or seepage through the channel. The ACD can be formed from any of the materials described above. For example, the ACD can be formed from a polymer and the extending member can be formed from a flexible material such as a polyurethane/Dacron composite that easily collapses as a consequence of contraction property of the contracting member  475 . 
     Referring to  FIGS. 34 and 35 , a ACD inner liner  480  is formed as a simple slotted tube  485  that includes a slot  490  along its length that functions a means for side access onto the introducer, after the introducer has been inserted into the vessel. The slot  490  can be formed as a longitudinal or radial slit, illustrated below. The ACD inner liner can be opened sufficiently to attach onto the introducer from the side. Any configuration of the ACDs described herein is built around the ACD liner  480  with a slot formed within the ACD. The tube  485  optionally can extend from the ACD and then be clamped at the proximal end once the ACD liner  480  and ACD are deployed. 
     Referring to  FIGS. 36 and 37 , a ACD liner  500  includes a tube  505  that includes a radial slot  510  along an extending member  515  and through a first member  520  and a second member  525 . The ACD inner liner  500  is sufficiently openable to be threaded onto the introducer from its side. Any configuration of the ACDs described herein can be built around the ACD liner  500  with a slot formed within the ACD. The tube  505  optionally can extend from the ACD and then be clamped at the proximal end once the ACD liner  500  and ACD are deployed. 
     Referring to  FIGS. 38-41 , a plug style ACD  550  that is similar to ACD  105  includes a channel  555  into which a deployment tool  552  is inserted to deploy the ACD through an arteriotomy to close the arteriotomy. The ACD includes an adhesive layer  560  for bonding to the tissue. The ACD  550  differs from the ACD  105  in that the channel  555  does not extend the entire length of the ACD. A ACD  570  ( FIG. 39 ) is similar to the ACD  550  except that it has limited vessel protrusion, similar to the ACD  200  above. The ACD  550 ,  570  is placed into the arteriotomy and held briefly for an adhesive bond to form. The deployment device  552  then can be removed. 
     The distal end of the deployment tool  552  also can have a grasping feature to grasp the proximal end of the plug ACD during deployment and to release after the plug ACD has been seated in or is on the vessel, and able to release when the tool is being withdrawn. 
     Referring to  FIGS. 42-45 , a ACD can have a distal end geometry, which once positioned at the puncture site, is designed to compress the vessel wall for increased securement and sealing. For example, a ACD  600  may have a flare  605 , or two or more longitudinal slits in the side of the tube, that are designed to open, or flare apart when advanced and in contact with the top of the vessel puncture site (i.e., arteriotomy). The ACD  600  can be made from a very elastic material and/or a superelastic/shape memory material such that when the introducer is removed, the flares or slits will pinch, or otherwise bring the edges of the punctured vessel together, effectively creating hemostasis. The inside of the flared section of the closure device could have biocompatible contact adhesive, other bonding material, and/or small barbs or protrusions that may assist in securing the device to the top of the vessel wall. 
     Referring to  FIGS. 46 and 47 , heat can be used to assist with, or as an adjunct to, the process by recovering the ACD, activating (e.g., causing to flow, etc.) a hemostatic material to the puncture site that assists in sealing (e.g., through vessel contraction including the denaturing and reformation of collagen at the site) or accelerate healing, or a combination of these or other beneficial effects. Direct resistive element heating ( FIG. 46 ) or ohmic tissue heating ( FIG. 47 ) can be utilized. Biocompatible electrode materials (e.g., gold, platinum, and other suitable materials) can be mixed with the base material of the ACD as a powder during manufacturing, or as a wire, strip, or other geometry, added onto any surface of the device, and connected to a suitable (i.e., electrical and biocompatible) conductor. For ohmic tissue heating, one conductor  620  is connected to an RF power source. Another conductor is connected to a ground pad  630  placed on the patient&#39;s body, and also connected to the power source. For direct resistive element heating, both conductors from the power source  625  are connected to an electrode  635 . Once the sealing of the puncture site has occurred, a twisting, cutting, or other manipulative action removes the conductor previously attached to the closure device. Alternatively, a special tip is placed over a standard electro surgical tool (e.g., Bovie) to insert through the skin and make contact with the closure device, tissue or both. 
     Alternative versions of the closure device may utilize an electrode that is formed by ion deposition, sputter coating, spraying, dip coating, adhesive, combination or other method or design. 
     Referring to  FIGS. 48-58 , a superelastic/shape memory ACD  700  is made from a superelastic/shape memory sheet or tube  705 . The sheet or tube  705  is etched, cut, or otherwise machined to remove material  710  ( FIG. 49 ) to leave a starting configuration  715  ( FIG. 50 ). The method of removing the material may be, for example, photo-etching and/or laser or chemical cutting. The starting configuration includes first extending members  720 , second extending members  725 , and a connecting member  730  between the first and second extending members. The first and second extending members  720  and  725  then are bent and curved ( FIGS. 51 and 52 ). The first and second extending members are curved to mate with the inner and outer surface, respectively, of a vessel. For example, longer first and second extending members  720   a  and  725   a  are bent to be generally perpendicular to the connecting member  730  and have a curvature that is similar to that of the length dimension of a vessel wall. The shorter first and second extending members  720   b  and  725   b  are bent to have a radius of curvature that is similar to that of the radius of curvature of the circumference of a vessel wall. The shapes of the first and second extending members  720 ,  725  are set using known techniques of imparting shapes in superelastic/shape memory materials, as described in further detail below. 
     A fabric covering  740  ( FIG. 53 ), such as Dacron, then is mounted to the curved configuration  715 . The covering  740  includes distal side openings  745  and proximal side openings  750 . A longitudinal channel  755  passes between a distal opening  760  and a proximal opening  765 . The covering  740  is pulled distal end through the curved configuration  715  and the extending members  720  are straightened from their retracted state and passed through the distal side openings  745  ( FIG. 54 ). The covering  740  then is pulled back such that the distal side openings  745  are tight against the first extending members  720  ( FIG. 55 ). The first extending members  720  then are allowed to expand back to their retracted state. The second extending members  725  then are straightened from their retracted state and passed through the proximal side openings  750  ( FIG. 56 ). The second extending members  725  then are allowed to expand back to their retracted state, thereby trapping a proximal end  760  of the covering against the connecting member  730  between the first and second extending members  720 ,  725  ( FIGS. 57 and 58 ). The longitudinal channel  755  passes through the covering  740  and the shaped configuration  715 . 
     Referring to  FIG. 59 , the second extending members  725   b  can be configured to curve back over and under the opposite second extending member  725   b . Thus, instead of curving against the outer circumference of the vessel in which the device is implanted, the second extending members  725   b  function to close the longitudinal channel  755  when they are in their retracted position. The covering  740  is mounted to the curved configuration  715  as described above. The second extending members  725   b  are kept in a straightened position because of the introducer or catheter that passes through the longitudinal channel  755 . When the introducer or catheter is removed, the second extending members  725   b  return to their retracted position, thereby closing or partially closing the longitudinal channel  755 . The covering  740  also contributes to the closure of the longitudinal channel  755  and reduction or elimination of blood leakage or seepage through the longitudinal channel. 
     Referring also to  FIGS. 60-62 , the ACD  700  is deployed using a deployment tool  775 . The deployment tube includes a handle  780 , an extension  783 , a guide  786 , and a pusher tuber  789 . The guide  786  extends from the extension  783  and includes a first longitudinal channel  791  and a longitudinal ridge  792  that passes along the inner surface of the first longitudinal channel  791 . The pusher tube  789  is slidably mounted within the first longitudinal channel  791  and includes a second longitudinal channel  793 , a pusher surface  794 , and a groove  796  that is configured to slide over the longitudinal ridge  792 . The guide  786  and the pusher tube  789  include longitudinal slots  797 ,  798  so that the deployment tool  775  can be placed around the catheter or introducer. With the ACD  700  positioned over a catheter or introducer  120 , and positioned within the longitudinal channel  791  in the guide  786 , the physician pushes the ACD  700  along the introducer  120  into the vessel using the pusher tube  789 . Of course, the ACD can be placed within an arteriotomy using other deployment tools or even by hand. 
     The ACDs herein may contain a metallic braid, coil, sheet, strip, wire, rod, or other configuration on the inner diameter, outer diameter, within, and/or a combination of these. The metallic material could be made from superelastic/shape memory alloys such as Nitinol. The metallic braid or coil could be annealed in one configuration during manufacture and processed and packaged in another configuration. When the material is exposed to normal body temperature (i.e., 37° C.), it will be set to either expand apart or contract inward depending on the design and annealed geometry (diameter). This characteristic may assist with the closure of the ACD. 
     It is important to understand basic terminology when describing metals with elastic, superelastic, or shape memory behavior. Elasticity is the ability of the metal, under a bending load, for example, to deflect (i.e., strain) and not take a permanent “set” when the load (i.e., stress) is removed. Common elastic metals can strain to about two percent before they set. Superelastic metals are unique in that they can withstand up to about ten percent strain before taking a set. This is attributed to a “stress-induced” phase change within the metal to allow it to withstand such dramatic levels of strain. Depending on the composition of the metal, this temperature that allows such a phase change can vary. And if the metal is “set” at one temperature, and then the temperature is changed, the metal can return to an “unset” shape. Then, upon returning to the previous “set” temperature, the shape changes back. This is a “shape-memory” effect due to the change in temperature changing the phase within the metal. 
     Elasticity is a key feature of superelastic materials. When a metal is loaded (i.e., stressed) and undergoes, for example, bending, it may deflect (i.e., strain) in a “springy” fashion and tend to return to its original shape when the load is removed, or it may tend to “set” and stay in a bent condition. This ability to return to the original shape is a measure of the elasticity or “resilience” of the metal. This ability for a metal to be resilient is desirable for such things as springs, shock absorbing devices, and even wire for orthodontic braces where the ability to deflect, but not deform (i.e., set) is important to maintain an applied force. 
     If, under a bending load, the metal takes a set, it is said to have plastically (versus elastically) deformed. This is because the imposed stress, produced by the bending load, has exceeded the “yield strength” (stress) of the metal. Technically, this level of stress that produces a set, is referred to as the “elastic limit”, but is about the same as the yield strength. If the applied load increases past the yield strength of the metal, it will produce more plasticity and can eventually break. The higher the yield strength of the metal, the more elastic it is. “Good” elastic metals can accommodate up to about two percent strain prior to taking a set. But this is not the only factor governing “elasticity”. 
     Another factor that determines the ability of a metal to deflect to a given, desired amount, but not take a set, is the “elastic modulus”, or often called the modulus of elasticity. The modulus of the metal is an inherent property. Steels, for example, have a relatively high modulus (30 msi) while the more flexible aluminum has a lower modulus of about 10 msi. The modulus for titanium alloys is generally between 12 and 15 msi. 
     Resilience is the overall measure of elasticity or “spring-back ability” of a metal. The ratio of the yield strength divided by the modulus of the metal is the resilience. Although it is one thing for a metal to be resilient, it must also have sufficient strength for the intended service conditions. 
     As discussed above, when a metal is loaded, each increment of load (stress) produces a given increment of deflection (strain) within the metal. And the metal remains elastic if the applied is below the yield stress. However, there is a unique class of metal alloys that behave in an even more elastic manner. These are the “superelastic” metals, where, for a given applied stress (load) increment, the strain in the metal can reach 5 or 6 percent or more without taking a set. In these types of metals, the overall strain required to produce a set can reach an impressive 10 percent. This phenomenon is related to a phase change within the metal, and which is induced by the applied stress. This “stress-induced” phase change can also allow the metal to be set at one temperature and return to another shape at another temperature. This is a “shape-memory” effect, discussed below. 
     The most common superelastic metal, used in many commercial applications, is an alloy comprised of about equal parts of nickel (Ni) and titanium (Ti), and has a trade name of “Nitinol”. It is also referred to as “NiTi”. By slightly varying the ratios of the nickel and titanium in Nitinol, the stability of the internal phases in the metal can be changed. Basically, there are two phases: (1) an “austenite” phase and (2) a lower-temperature, “martensite” phase. When the metal is in an austenitic phase condition and is stressed, then a stress-induced martensite forms, resulting in the super-elasticity. This is reversible, and the original shape returns upon release of the applied stress. 
     In general, the Ni-to-Ti ratio in the Nitinol is selected so that the stress-induced martensite forms at ambient temperatures for the case of super-elastic brace and support devices, which are used in ambient conditions. The specific composition can be selected to result in the desired temperature for the formation of the martensite phase (Ms) and the lower temperature (Mf) at which this transformation finishes. Both the Ms and Mf temperatures are below the temperature at which the austenite phase is stable (As and Af). The performance of an ACD can be further enhanced with the use of superelastic materials such as Nitinol. The superelasticity allows for greatly improved collapsibility, which will return to its intended original shape when the introducer (or catheter) is removed from the inside of the ACD. The high degree of flexibility is also more compatible with the stiffness of the engaged vessel. 
     By manipulating the composition of Nitinol, a variety of stress-induced superelastic properties can result, and over a desired, predetermined service temperature range. This allows the metal to behave in a “shape-memory” or “shape recovery” fashion. In this regard, the metal is “set” to a predetermined, desired shape at one temperature when in a martensitic condition, and which returns to the original shape when the temperature is returned to the austenitic temperature. 
     The shape memory phenomenon occurs from a reversible crystalline phase change between austenite and the lower-temperature martensite. In addition to this transformation occurring from an induced stress as described previously, it can, of course, also change with temperature variations. This transformation is reversible, but the temperatures at which these phase changes start and finish differs depending on whether it is heated or cooled. This difference is referred to as a hysteresis cycle. This cycle is characterized by the four temperatures mentioned previously, As, Af, Ms, and Mf. Upon heating from a lower-temperature martensite, the transformation to austenite begins at the As, and will be fully austenite at Af. And upon cooling, austenite will begin to transform back to martensite at the Ms temperature, and become fully martensitic at the Mf. Again, the specific composition of the alloy can result in a desired combination of these four transformation temperatures. 
     In the malleable martensitic state, the alloy can be easily deformed (set). Then upon heating back to the austenitic temperature, the alloy will freely recover back to its original shape. Then if cooled back to the martensitic state, the deformed shape reforms. The typical sequence of utilizing this shape memory property is to set the shape of, for example, a stent or anastomosis connector, while in the higher-temperature austenitic state. Then, when cooled, deform the martensite material, and then heat to recover the original shape. 
     Based on the background information provided above, it can be seen that if the Nitinol material requires an exceptionally tight bend, and one that would normally exceed the elastic limit of the material and thus permanently deform it, a bend can be placed in the device and the device annealed to relieve bending stresses within the device. Following this first bend, the device can be bent further to produce an even sharper bend, and then re-annealed to alleviate the stress from this additional bending. This process can be repeated to attain the desired, sharp bend or radii that would otherwise permanently deform the device if the bend were attempted in a single bending event. The process for recovery from the position of the most recent bend is then performed as described above. 
     Although the example of Nitinol, discussed above, is, by far the most popular of the superelastic metals, there are other alloys that can also exhibit superelastic or shape-memory behavior. These include the following:
         Copper—40 at % Zinc   Copper—14 wt % Aluminum—4 wt % Nickel   Iron—32 wt % Manganese—6 wt % Silicon   Gold—5 to 50 at % Cadmium   Nickel—36 to 38 at % Aluminum   Iron—25 at % Platinum   Titanium—40 at % Nickel—10at % Copper   Manganese—5 to 35 at % Copper   Titanium—49 to 51 at % Nickel (Nitinol)       

     Nitinol, because of the large amount of titanium in the composition, has been the only FDA approved superelastic/shape memory alloy for medical implant devices. The corrosion resistance of Nitinol is superior to that of commonly used 3161 stainless steel, and, if surface oxidized or passivated carefully, can reach corrosion resistance comparable to the most popular titanium implant alloy, Ti6Al4V. Similarly, the metal piece can be electropolished to improve its biocompatibility and blood compatibility. Biocompatibility studies have routinely showed Nitinol as a metal with suitable biocompatibility for medical device applications. 
     In summary, there are various ways of describing elasticity, but the main criterion is the ability of the metal to return to its initial, pre-loaded shape. Some metals can only deflect a couple percent and remain elastic while others, such as superelastic Nitinol, can deflect up to about ten percent. Nitinol is also biocompatible and corrosion resistant. This unique combination of properties allows a device made of Nitinol, such as an arterial closure device, to be fully collapsed within a deployment tool and be subsequently released, at a particular site within the vessel, to form its intended service shape. 
     Materials other than superelastic/shape memory alloys may be used as reinforcements provided they can be elastically deformed within the temperature, stress, and strain parameters required to maximize the elastic restoring force thereby enabling the tubular closure device to recover to a specific diameter and/or geometry once deployed inside, over, or on top of the vessel or other location. Such materials include other shape memory alloys, spring stainless steel 17-7, other spring metal alloys such as Elgiloy™, Inconel™, superelastic polymers, etc. 
     When thermally forming superelastic/shape memory reinforcements, the superelastic/shape memory material(s), previously cut into the desired pattern and/or length, are stressed into the desired resting configuration over a mandrel or other forming fixture having the desired resting shape of the tubular plug, depending on the vessel size or other location where the ACD or plug is intended to be used, and the material is heated to between 300 and 650° Celsius for a period of time, typically between 30 seconds and 30 minutes. Once the volume of superelastic material reaches the desired temperature, the superelastic material is quenched by inserting into chilled water or other fluid, or otherwise allowed to return to ambient temperature. As such, the superelastic reinforcements are fabricated into their resting configuration. The superelastic/shape memory reinforcements may be full or partial length or width of the ACD or tubular plug. 
     Any metal or metal alloy, such as a superelastic/shape memory alloy that comes in contact with blood and/or tissue can be electropolished. Electropolishing may reduce platelet adhesion causing thrombosis, and encourage endothelization of the exposed metallic areas. Electropolishing also beneficially removes or reduces flash and other artifacts from the fabrication of the device. 
     Superelastic/shape memory materials, such as tubular, rectangular, wire, braid, flat, round, combination or other structures also can be used in the design of the closure device, to assist with grasping, contacting, bringing tissue together, sealing, or other desired function. When used as a hollow conduit or reinforcement to a conduit, the superelastic/shape memory materials could be used to resist compressive closure and act as a flexible reinforcing strain relief to prevent kinking and to prevent the conduit from closing. 
     Numerous modifications and/or additions to the above-described embodiments and implementations are readily apparent to one skilled in the art. It is intended that the scope of the present embodiments and implementations extend to all such modifications and/or additions and that the scope of the present embodiments and implementations is limited solely by the claims. 
     For example, the engagement/contact section of the deployment tool can have a cross sectional geometry of a complete circle that may be designed to split away from the introducer once the closure device has been advanced/deployed. Splitting could be accomplished by having thinned or weakened areas in the wall of the deployment device tubing, such as linear perforations, or linear scores, combination, or other perforation configuration. This version would require that the deployment tool be back loaded onto the introducer before the closure device is placed onto the introducer and prior to insertion into the vessel. 
     The deployment tool can be a clip-on tool, can compress the device to reduce the cross sectional profile prior to insertion and/or may include a constraining sheath to reduce a section, or sections of the device during insertion to the target site. This version would be particularly useful for bringing two tissue walls together while yet providing a conduit between the tissues. 
     The proximal end of the ACDs described herein may be closed using hemostats, or other tools, by pinching the end together until the inner diameter bonds, or compresses together. Adhesive may be used to assist in the closure of the device. 
     The proximal edge of the closure device and the distal (or other) edge of the advancement/deployment tool can have interlocking geometries to aid control during advancement (particularly when inserting by twisting or turning while advancing into the vessel). 
     The proximal edge or end of the closure device may have a collar made of a superelastic/shape memory material, an elastic combination of materials or suitable elastic materials that would compress the end of the device together once the introducer is removed from the inner diameter of the closure device. As previously mentioned, the closing and sealing of the device may be enhanced with an adhesive, swellable material, or other coating or layer. 
     The closure means can be other than a tubular structure, such as a plug. A special introducer, having multi-lumens, one for the catheter or other device, and at least one for the hemostatic plug material. The hemostatic material, and matching geometry plunger would be inserted into the proximal end of the special introducer. As the plunger is advanced, the hemostatic material is advanced into position and the introducer is withdrawn from the vessel. 
     The basic device, system and method can be sized and configured for medical devices other than vascular introducers, such as guide wires, catheters, laparoscope, endoscope, trocar, cannula, electrode wire, or other. 
     Using the tubular closure device, especially when made from swellable material, as a reversible sterilization method for women by occluding the fallopian tubes, and men by occluding the vas ducts or tubes. 
     A modified version of the device and system can be used for the closure of septal defects in the heart, as well as anywhere else in the body. For this, as well as other additional applications, the clip on section of the deployment tool would be modified to fit onto the catheter, and be long enough (such as, e.g., full catheter length) to be remotely advanced from the proximal end of the catheter. The deployment tool also may be modified and used to compress the device during insertion into the body to thereby reduce the cross-sectional profile during insertion. The deployment method may be enabled by longitudinal movement, manipulation, or retraction of the deployment tool away from the closure device, which removes the compression of the device and allows the device to expand and fill in the opening, such as a septal defect. 
     The ACDs described herein can be used for cardiovascular applications where hemostasis (temporary or permanent) is desired. Additionally, the ACDs can be used with simple modifications for any tubular, duct, organ, hollow body cavity, or other structures or tissues, where temporary or permanent sealing or plugging is needed, or alternatively, where a conduit or conduit reinforcement is desired. For conduit or conduit reinforcement applications, the material and design used thereby would be sufficiently resistant to compressive closure while still remaining flexible, e.g., longitudinally and/or radially flexible. 
     The ACDs described herein also can be used for gastric bypass procedures, general tissue bunching or bringing tissues together, and on or in other vessels, organs, tissues, bones, and/or other body tissues than those specifically described. 
     While several particular forms of the arterial closure device and deployment tool have been illustrated and described, it will be apparent that various modifications and combinations of the inventions detailed in the text and drawings can be made without departing from the spirit and scope of the inventions. For example, references to materials of construction, methods of construction, specific dimensions, shapes, utilities or applications are also not intended to be limiting in any manner and other materials and dimensions could be substituted and remain within the spirit and scope of the inventions. Accordingly, it is not intended that the inventions be limited, except as by the appended claims. Accordingly, other embodiments are within the scope of the following claims and figures.

Technology Category: 1