ADJUSTABLE SHEATH DEVICE

Abstract

The disclosure generally relates to retractable sheaths for protecting a luminal surface of a bodily vessel or canal from the introduction of a medical device within the bodily vessel or canal comprising a valve, a continuous elastomeric outer tube, and an at least partially discontinuous inner tube wherein the at least partially discontinuous inner tube is located within the outer tube luminal channel to form a circumferentially retractable elongated sleeve; also retractable sheaths comprising a rigid collar and a circumferentially retractable elongated sleeve comprising two separate layers including a continuous elastomeric outer layer and an expandable inner layer discontinuous at least in part, are disclosed herein.

Claims

1. A retractable sheath for protecting a luminal surface of a bodily vessel or canal from the introduction of a medical device within the bodily vessel or canal, the retractable sheath comprising: a rigid collar comprising a valve and having an inner surface defining an opening extending through the collar; a continuous elastomeric outer tube having an outer tube proximal opening located at an outer tube proximal end and an outer tube distal opening located at an outer tube distal end defining an outer tube luminal channel therebetween, the outer tube proximal end affixed to the rigid collar; and an at least partially discontinuous inner tube formed from a coiled discontinuous sheet having an external sheet surface and internal sheet surface, the at least partially discontinuous inner tube having an inner tube proximal opening located at an inner tube proximal end and an inner tube distal opening located at an inner tube distal end defining an inner tube luminal channel therebetween, the inner tube proximal end affixed to the rigid collar, wherein the at least partially discontinuous inner tube is located within the outer tube luminal channel to form a circumferentially retractable elongated sleeve, a portion of the at least partially discontinuous inner tube is movable independently of the continuous elastomeric outer tube, and the external sheet surface is slidable against an outer tube luminal surface.

2. A retractable sheath according to claim 1, wherein the external sheet surface of the at least partially discontinuous inner tube is in direct contact with the outer tube luminal surface, and the at least partially discontinuous inner tube is movable independently of the continuous elastomeric outer tube, and the external sheet surface is slidable against an outer tube luminal surface.

3. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube is a coiled discontinuous sheet formed from the lamination of at least two layers, the first layer comprising a material selected from a group consisting of low friction polymers, and the second layer comprising a material selected from a group consisting of structural biocompatible materials and sheet woven biocompatible meshes.

4. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube is a coiled discontinuous sheet formed from the lamination of at least three layers, the first layer comprising a material selected from a group consisting of low friction polymers, the second layer comprising a material selected from a group consisting of structural biocompatible materials and sheet woven biocompatible meshes, and the third layer comprising a low friction polymer.

5. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube is a coiled discontinuous sheet formed from a first layer comprising a fluorinated polymer, the first layer also providing the internal sheet surface, bonded to a second layer comprising nylon.

6. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube is a coiled discontinuous sheet formed from a first layer comprising a fluorinated polymer, the first layer also providing the internal sheet surface, bonded to a second layer comprising nylon, and a third layer comprising any one of a longitudinal reinforcing element, an axial reinforcing element, or a braided reinforcing element.

7. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube is formed from at least a first coiled discontinuous sheet, the first coiled discontinuous sheet providing the internal sheet surface, the partially discontinuous tube further comprising a second discontinuous sheet, the second discontinuous sheet providing the external sheet surface, and wherein the continuous elastomeric outer tube provides an elastomeric tube inner surface and an elastomeric tube outer surface.

8. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube is formed from at least a first coiled discontinuous sheet, the first coiled discontinuous sheet providing the internal sheet surface, the at least partially discontinuous inner tube further comprising a second discontinuous sheet, the second discontinuous sheet providing the external sheet surface, and further comprising at least one intermediary discontinuous sheet positioned between the first coiled discontinuous sheet and the second discontinuous sheet.

9. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube is formed from a coiled discontinuous sheet having an oblique edge wherein the coiled discontinuous sheet is wound about the length of the at least partially discontinuous inner tube along the oblique edge.

10. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube is formed from a coiled discontinuous sheet having an oblique edge wherein the coiled discontinuous sheet is wound about the length of the at least partially discontinuous inner tube along the oblique edge, at a pitch of approximately between 0.3 lengths of the at least partially discontinuous inner tube and at least 2 lengths of the at least partially discontinuous inner tube.

11. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube is formed from a coiled discontinuous sheet having an oblique edge having a sharp edge at the internal sheet surface, and wherein the coiled discontinuous sheet is wound about the length of the at least partially discontinuous inner tube along the oblique edge.

12. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube has a greater thickness at the inner tube proximal end than at the inner tube distal end.

13. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube comprises a tube portion that is between approximately 0.05 mm to 0.5 mm thick.

14. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube comprises a tube portion that is between approximately 0.1 mm to 0.4 mm thick.

15. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube comprises a tube portion that is between approximately 0.25 mm to 0.35 mm thick.

16. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube comprises a radio opaque material selected from the group consisting of metals and radio-opaque polymers, located at the inner tube distal end.

17. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube comprises a radio opaque material selected from the group consisting of metals and radio-opaque polymers, located substantially along the length of the inner tube.

18. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube comprises a first tapering tube portion at the inner tube proximal end, a second tapering tube portion at the inner tube distal end and a non-tapering portion therebetween.

19. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube comprises a first non-tapering tube portion at the inner tube proximal end, a second non-tapering tube portion at the inner tube distal end and a tapering portion therebetween.

20. A retractable sheath according to claim 1, wherein the continuous elastomeric outer tube has a greater thickness at the outer tube proximal end than at the outer tube distal end.

21. A retractable sheath according to claim 1, wherein the continuous elastomeric outer tube is formed from a composite material comprising a longitudinal reinforcing element.

22. A retractable sheath according to claim 1, wherein the continuous elastomeric outer tube comprises a first tube portion having a first thickness and a second tube portion having a second thickness.

23. A retractable sheath according to claim 1, wherein the continuous elastomeric outer tube comprises a first tube portion having a first thickness and a second tube portion having a second thickness, wherein the first tube portion is located at the outer tube proximal end and is between approximately 30 mm to 100 mm in length.

24. A retractable sheath according to claim 1, wherein the continuous elastomeric outer tube has a greater hardness at the outer tube proximal end than at the outer tube distal end.

25. A retractable sheath according to claim 1, wherein the continuous elastomeric outer tube is a between 10A to 90A harder at the outer tube proximal end than at the outer tube distal end.

26. A retractable sheath according to claim 1, comprising a lubricious layer or surface coating applied to any one of an external sheet surface, an internal sheet surface, an elastomeric tube outer surface, or an elastomeric tube inner surface.

27. A retractable sheath according to claim 1, comprising a lubricious layer or surface coating applied to an internal sheet surface.

28. A retractable sheath according to claim 1, comprising a lubricious layer or surface coating selected from the group consisting of fluoropolymers, polyolefins, polyamides, polymer blends, and radio-opaque additives applied to any one of an external sheet surface, an internal sheet surface, an elastomeric tube outer surface, or an elastomeric tube inner surface.

29. A retractable sheath according to claim 1, comprising a lubricious layer or surface coating of polytetrafluoroethylene (PTFE) applied to an internal sheet surface.

30. A retractable sheath according to claim 1, comprising a lubricious layer or surface coating of polytetrafluoroethylene (PTFE), barium sulfate, titanium oxide, bismuth compounds or oils applied to an internal sheet surface or an external sheet surface.

31. A retractable sheath according to claim 1, comprising a lubricious layer selected from the group consisting of ultra-violet or thermal cure hydrophilic coatings, polytetrafluoroethylene (PTFE) film coatings, and liquid coatings applied to an elastomeric tube outer surface.

32. A retractable sheath according to claim 1, wherein the at least partially discontinuous inner tube: is movable independently of the continuous elastomeric outer tube, and the external sheet surface is slidable against an outer tube luminal surface; is formed from a coiled discontinuous sheet having an oblique edge, wherein the coiled discontinuous sheet is wound about the length of the at least partially discontinuous inner tube along the oblique edge; has a greater thickness at the inner tube proximal end than at the inner tube distal end; comprises a radio opaque material selected from the group consisting of metals and radio-opaque polymers, located at the inner tube distal end; and the external sheet surface of the at least partially discontinuous inner tube is in direct contact with the outer tube luminal surface and the at least partially discontinuous inner tube.

33. A retractable sheath according to claim 32, wherein the continuous elastomeric outer tube is formed from a composite material comprising a longitudinal reinforcing element.

34. A retractable sheath for protecting a luminal surface of a vessel or canal from the introduction of a medical device within the vessel or canal, the retractable sheath comprising: a rigid collar having an inner surface defining an opening extending through the collar, the rigid collar having attached thereto a circumferentially retractable elongated sleeve having a proximal opening and a distal opening defining a luminal channel therebetween, the elongated sleeve comprising two separate layers including a continuous elastomeric outer layer and an expandable inner layer discontinuous at least in part, the discontinuous part of the expandable inner layer comprising a stiff polymeric sheet characterised as having outward annular resistance when forcibly coiled, the stiff polymeric sheet forming at least part of the expandable inner layer when coiled and positioned longitudinally within a lumen formed by the continuous elastomeric outer layer and positioned substantially in contact with a luminal surface of the continuous elastomeric outer layer, wherein the rigid collar is attached to the circumferentially retractable elongated sleeve or one or more intermediate portions between the circumferentially retractable sleeve and the rigid collar, at the proximal end of the sleeve.

35. A retractable sheath according to claim 34, wherein the stiff polymeric sheet comprises an external sheet surface and an internal sheet surface and the external sheet surface is in direct contact with the luminal surface of the continuous elastomeric outer layer, and the expandable inner layer is movable independently of the continuous elastomeric outer layer, and the external sheet surface is slidable against the luminal surface of the continuous elastomeric outer layer.

36. A retractable sheath according to claim 34, wherein the expandable inner layer is a coiled discontinuous sheet formed from the lamination of at least two layers, the first layer comprising a material selected from a group consisting of low friction polymers, and the second layer comprising a material selected from a group consisting of structural biocompatible materials and sheet woven biocompatible meshes.

37. A retractable sheath according to claim 34, wherein the expandable inner layer is a coiled discontinuous sheet formed from the lamination of at least three layers, the first layer comprising a material selected from a group consisting of low friction polymers, the second layer comprising a material selected from a group consisting of structural biocompatible materials and sheet woven biocompatible meshes, and the third layer comprising a low friction polymer.

38. A retractable sheath according to claim 34, wherein the expandable inner layer is a coiled discontinuous sheet formed from a first layer comprising polytetrafluoroethylene, the first layer also providing the internal sheet surface, bonded to a second layer comprising nylon.

39. A retractable sheath according to claim 34, wherein the expandable inner layer is a coiled discontinuous sheet formed from a first layer comprising polytetrafluoroethylene, the first layer also providing the internal sheet surface, bonded to a second layer comprising nylon, and a third layer comprising any one of a longitudinal reinforcing element, an axial reinforcing element, or a braided reinforcing element.

40. A retractable sheath according to claim 34, wherein the expandable inner layer is formed from at least a first coiled discontinuous sheet, the first coiled discontinuous sheet providing the internal sheet surface, the partially discontinuous tube further comprising a second discontinuous sheet, the second discontinuous sheet providing the external sheet surface, and wherein the continuous elastomeric outer layer provides an elastomeric outer layer inner surface and an elastomeric outer layer outer surface.

41. A retractable sheath according to claim 34, wherein the expandable inner layer is formed from at least a first coiled discontinuous sheet, the first coiled discontinuous sheet providing the internal sheet surface, the expandable inner layer further comprising a second discontinuous sheet, the second discontinuous sheet providing the external sheet surface, and further comprising at least one intermediary discontinuous sheet positioned between the first coiled discontinuous sheet and the second discontinuous sheet.

42. A retractable sheath according to claim 34, wherein the expandable inner layer is formed from a coiled discontinuous sheet having an oblique edge wherein the coiled discontinuous sheet is wound about the length of the expandable inner layer along the oblique edge.

43. A retractable sheath according to claim 34, wherein the expandable inner layer is formed from a coiled discontinuous sheet having an oblique edge wherein the coiled discontinuous sheet is wound about the length of the expandable inner layer along the oblique edge, at a pitch of approximately between 0.3 lengths of the expandable inner layer and at least 2 lengths of the expandable inner layer.

44. A retractable sheath according to claim 34, wherein the expandable inner layer is formed from a coiled discontinuous sheet having an oblique edge having a sharp edge at the internal sheet surface, and wherein the coiled discontinuous sheet is wound about the length of the expandable inner layer along the oblique edge.

45. A retractable sheath according to claim 34, wherein the expandable inner layer has an inner layer proximal opening located at an inner layer proximal end and an inner layer distal opening located at an inner layer distal end defining an inner layer luminal channel therebetween, the inner layer proximal end affixed to the rigid collar and having a greater thickness at the inner layer proximal end than at the inner layer distal end.

46. A retractable sheath according to claim 34, wherein the expandable inner layer comprises an inner layer portion that is between approximately 0.05 mm to 0.5 mm thick.

47. A retractable sheath according to claim 34, wherein the expandable inner layer comprises an inner layer portion that is between approximately 0.1 mm to 0.4 mm thick.

48. A retractable sheath according to claim 34, wherein the expandable inner layer comprises an inner layer portion that is between approximately 0.25 mm to 0.35 mm thick.

49. A retractable sheath according to claim 34, wherein the expandable inner layer comprises a radio opaque material selected from the group consisting of metallic elements and radio-opaque polymers, located at the inner layer distal end.

50. A retractable sheath according to claim 34, wherein the expandable inner layer comprises a first tapering portion at the inner layer proximal end, a second tapering portion at the inner layer distal end and a non-tapering portion therebetween.

51. A retractable sheath according to claim 34, wherein the expandable inner layer comprises a first non-tapering portion at the inner layer proximal end, a second non-tapering portion at the inner layer distal end and a tapering portion therebetween.

52. A retractable sheath according to claim 34, wherein the continuous elastomeric outer layer has a greater thickness at the outer layer proximal end than at the outer layer distal end.

53. A retractable sheath according to claim 34, wherein the continuous elastomeric outer layer comprises a first outer layer portion having a first thickness and a second outer layer portion having a second thickness.

54. A retractable sheath according to claim 34, wherein the continuous elastomeric outer layer comprises a first outer layer portion having a first thickness and a second outer layer portion having a second thickness, wherein the first outer layer portion is located at the outer layer proximal end and is between approximately 30 mm to 100 mm in length.

55. A retractable sheath according to claim 34, wherein the continuous elastomeric outer layer has a greater hardness at the outer layer proximal end than at the outer layer distal end.

56. A retractable sheath according to claim 34, wherein the continuous elastomeric outer layer is a between 10A to 90A harder at the outer layer proximal end than at the outer layer distal end.

57. A retractable sheath according to claim 34, comprising a lubricious layer or surface coating applied to any one of an external sheet surface, an internal sheet surface, an elastomeric outer layer outer surface, or an elastomeric outer layer inner surface.

58. A retractable sheath according to claim 34, comprising a lubricious layer or surface coating applied to an internal sheet surface.

59. A retractable sheath according to claim 34, comprising a lubricious layer or surface coating selected from the group consisting of fluoropolymers, polyolefins, polyamides, polymer blends, and radio-opaque additives applied to any one of an external sheet surface, an internal sheet surface, an elastomeric outer layer outer surface, or an elastomeric outer layer inner surface.

60. A retractable sheath according to claim 34, comprising a lubricious layer or surface coating of polytetrafluoroethylene (PTFE) applied to an internal sheet surface.

61. A retractable sheath according to claim 34, comprising a lubricious layer or surface coating of polytetrafluoroethylene (PTFE), barium sulfate, titanium oxide, bismuth compounds or oils applied to an internal sheet surface or an external sheet surface.

62. A retractable sheath according to claim 34, comprising a lubricious layer selected from the group consisting of ultra-violet or thermal cure hydrophilic coatings, polytetrafluoroethylene (PTFE) film coatings, and liquid coatings applied to an elastomeric outer layer outer surface.

63. A retractable sheath according to claim 34, wherein the expandable inner layer: is formed from a coiled discontinuous sheet having an oblique edge, wherein the coiled discontinuous sheet is wound about the length of the expandable inner layer along the oblique edge; has a greater thickness at the inner layer proximal end than at the inner layer distal end; comprises a radio opaque material selected from the group consisting of metals and radio-opaque polymers, located at the inner layer distal end; and comprises an external sheet surface and an internal sheet surface and the external sheet surface is in direct contact with the luminal surface of the continuous elastomeric outer layer, and the expandable inner layer is movable independently of the continuous elastomeric outer layer, and the external sheet surface is slidable against the luminal surface of the continuous elastomeric outer layer.

64. A retractable sheath according to claim 63, wherein the continuous elastomeric outer layer is formed from a composite material comprising a longitudinal reinforcing element.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0160] FIG. 1 provides a Computed Tomography scan showing the channel of passage from the femoral arteries, through of the right and left iliac arteries to the abdominal artery.

[0161] FIG. 2 provides a front perspective view of an adjustable sheath according to embodiments of the invention.

[0162] FIG. 3 illustrates a sheath collar according to embodiments wherein FIG. 3(a) provides a side view, FIG. 3(b) provides a rear perspective view, and FIG. 3(c) provides a front perspective view.

[0163] FIG. 4 provides a side and sectional view of an adjustable sheath according to embodiments wherein FIG. 4(a) provides a side view, FIG. 4(b) shows a cut through view at section A-A, FIG. 4(c) shows a cut through view at section B-B, and FIG. 4(d) shows a cut through view at section C-C.

[0164] FIG. 5 provides a perspective, side and sectional view of an adjustable sheath according to embodiments wherein FIG. 5(a) provides a rear perspective view of an adjustable sheath and introducer, FIG. 5(b) provides a side view of the introducer passing through the adjustable sheath lumen, and FIG. 5(c) provides a section view of the adjustable sheath and introducer at section D-D.

[0165] FIG. 6 provides a front perspective view of an adjustable sheath according to embodiments with the outer elastomeric tube removed, wherein FIG. 6(a) illustrates a straight cut inner layer, FIG. 6(b) illustrates a straight cut inner layer having a further cut-out portion, and FIG. 6(c) illustrated a spiral cut inner layer.

[0166] FIG. 7 provides a front perspective and sectional views of an adjustable sheath according to embodiments in an expanded form with the outer elastomeric tube removed wherein FIG. 7(a) provides a front perspective view of an adjustable sheath in an expanded form with the outer elastomeric tube removed and showing a v-cut inner layer, and FIG. 7(b) provides a side section view of the inner layer in an expanded, partially expanded and a retracted position.

[0167] FIG. 8 provides a section view of an adjustable sheath according to the invention wherein FIG. 8(a) provides a section view of a sheath without a laminated inner, and FIG. 8(b) provides a section view of a sheath with a laminated inner layer.

[0168] FIG. 9 provides a section view of an adjustable sheath according to the invention having a clamp joint and a variable thickness inner layer.

[0169] FIG. 10 provides a section view of an adjustable sheath inner layer according to the invention wherein FIG. 10(a) shows an inward oblique cut inner layer, FIG. 10(b) shows a straight cut inner layer, and FIG. 10(c) shows an outward oblique cut inner layer.

[0170] FIG. 11 provides a side perspective view of an adjustable sheath inner layer according to the invention wherein, FIG. 11(a) shows an inner layer having a clockwise helical cut and an overlap in the counter clockwise direction, FIG. 11(b) shows an inner layer having a counter clockwise helical cut and an overlap in the counter clockwise direction, FIG. 11(c) shows an inner layer having a clockwise helical cut and an overlap in the clockwise direction and FIG. 11(d) shows an inner layer having a counter clockwise helical cut and an overlap in the clockwise direction.

[0171] FIG. 12 provides a side view of an adjustable sheath according to embodiments of the invention showing various locations for tapering of the sheath wherein FIG. 12(a) provides a short tapered section at the proximal end of the sheath, FIG. 12(b) provides a tapered section at a central portion of the sheath, FIG. 12(c) provides a tapered section at the proximal portion of the sheath, and FIG. 12(d) provides a tapered section at the distal portion of the sheath.

[0172] FIG. 13 provides a side view of an adjustable sheath according to embodiments of the invention showing an outer layer of varying thicknesses wherein FIG. 13(a) shows a stepped thickening of the outer layer, and FIG. 13(b) shows a gradual thickening of the outer layer.

[0173] FIG. 14 provides a side view of an adjustable sheath according to embodiments of the invention having a haemostatic valve assembly.

[0174] FIG. 15 provides a graphical representation of sheath bendability for adjustable sheaths according to embodiments having a straight cut, spiral cut and v-cut inner layer.

[0175] FIG. 16 provides a graphical representation of the Force (N) required to push the defined payload through the length of the sheath (mm) according to embodiments of the invention.

[0176] Several embodiments of the invention are described in the following examples.

DETAILED DESCRIPTION

[0177] The Computed Tomography scan illustrated at FIG. 1 shows the channel of passage that a removable or implantable medical device, such as a mechanical aortic valve, must take when being delivered through a trans-arterial route from the femoral arteries, through the right and left iliac arteries to the abdominal artery. The termini of the right and left femoral arteries are shown at 110(a) and 110(b), respectively. The right and left iliac arteries are shown at 120(a) and 120(b), respectively, and the abdominal artery is shown at 130. The path of passage of a medical device inserted at the femoral artery to the abdominal artery is shown along the dotted line, in the left image for entry via the right femoral artery 120(a) and in the left image for entry via the left femoral artery 120(b) in the right image.

[0178] The shape of the channel of passage shown in FIG. 1 illustrates some of the vascular curvatures that must be traversed by medical devices during insertion to arrive at the location required for placement. As the images are only two dimensional, they do not illustrate the path that must be navigated in the third dimension around complex bone structures including the pelvis. In use, the device is typically attached to an elongated introducer to pass and manoeuvre the device through the vascular system, often, significant force is placed upon the introducer to force the device through the vascular lumen. During this process the greatest risk of vascular damage occurs where the vessel is at its narrowest. Introducer sheaths, of the type described herein, protect the luminal surface from damage arising from the insertion of medical devices and/or introducers. Depending on the nature of the device or location of insertion or delivery, an introducer sheath may be a short structure for placement and protection around the opening of the vessel and a short way into the vessel, or it may be elongated to extend a longer way from the opening of the vessel to protect a longer section of the luminal wall.

[0179] FIG. 2 illustrates an adjustable sheath 200 suitable for use as an introducer sheath as described above. Adjustable sheath 200 is broadly constructed of two main components; a rigid cylindrical collar 210 and an elongated, tapered sleeve 220. Collar 210 is a hollow structure constructed to allow materials to be fed into the inner lumen of sleeve 220 through the wider opening of the sleeve. Cylindrical collar 210 is formed of a rigid material to allow a user to handle the collar and pass an object or material therethrough. It terminates in a narrowed opening of a similar diameter to the wider opening of sleeve 220 to enable sleeve 220 to be placed and secured therein, thereby connecting the two components.

[0180] Sleeve 220 tapers away from collar 210 for ease of insertion within an incision made to access the patient's vascular system. Sleeve 220 is a smooth, flexible structure tapering from proximal end 230 and narrowing towards distal end 240 to ease the insertion and navigation of the sheath within a vessel. Sleeve 220 is expandable and retractable to enable a wider introducer, valve or other medical device to be introduced into the patient through the lumen of the sleeve, which is capable of expanding around the device, and gently press against the luminal wall of the vessel as it travels through the vessel; and then to also retract to a size similar to its original size once the device is removed, so that it can be gently removed from the patient.

[0181] FIG. 3 illustrates the structure of sheath collar 210. FIG. 3(a) illustrates three main sections formed within collar 210 including a valve portion 310 having a haemostatic valve therein (not shown), a connector portion 320 for providing inlets or other connectors for access to the vessel, and a retainer nut 330 for securing the sleeve 220 (not shown) therein. FIG. 3(b) shows the location of haemostatic valve 340 positioned within valve portion 310. Haemostatic valve 340 may be pierced or penetrated to allow the entry of devices through the sheath collar and into the lumen of the sleeve, and will return to a closed position to preventing the backflow of fluids from the vessel. FIG. 3(c) shows the location of inlet 350 for the connection of medical fluid lines to the sheath collar for the introduction of fluids into the patient.

[0182] Collar 210 is formed from a rigid polymer such as polyethylene, polyester or polypropylene, however, it may equally be formed from any rigid, biocompatible material determined by those skilled in the art as being suitable for the intended purpose.

[0183] FIG. 4(a) provides a side view of expandable sheath 200, illustrating the exterior of the collar 210 and the exterior surface of the sleeve 220. Sleeve 220 is formed of two thin, flexible layers; outer elastomeric tube 410 and expanding inner layer 420. Outer elastomeric tube 410 is formed as an elongated, tapered tube maintaining within it a coiled sheet forming expanding inner layer 420.

[0184] Outer elastomeric tube 410 is formed from an elastomeric material that can be stretched when pressure is exerted from within the lumen of the sleeve but also substantially returns the sleeve to its original diameter once internal pressure is relaxed. The outer elastomeric tube, in a relaxed state, has wall thickness of less than 0.5 mm, and preferably less than 0.2 mm. Elastomeric tube 410 is formed from silicone to maximise the elasticity and minimise wall thickness and thereby minimise the risk of damage to the vascular system. However, other materials may be selected by those skilled in the art for this use once determined as having suitable properties. These may include materials such as latex rubber or non-latex substitutes including nitrile rubber, polyvinylchloride, neoprene, polypropylene and polyisoprene and the like.

[0185] FIG. 4(a) illustrates sectional points at points A-A, B-B and C-C. FIG. 4(b) illustrates a cut through section at point A-A, showing the sleeve in a relaxed state at its widest diameter, at proximal end 230, whereby the outer elastomeric tube 410 is also at its widest diameter. At section A-A, expanding inner layer 420 is uniformly a single layer thick around the entire internal circumference of sleeve 220.

[0186] FIG. 4(c) illustrates a cut through section at point B-B, showing the internal structure of sleeve 220 where outer elastomeric tube 410 is tapered and has a reduced diameter than at section A-A. Expanding inner layer 420 is shown to be overlapping to the extent that the inner layer is folded over twice. Whereas FIG. 4(c) illustrates a cut through section at point C-C, showing the internal structure of sleeve 220 where outer elastomeric tube 410 is at its narrowest, at distal end 240 of sleeve 220. At this point, expanding inner layer 420 is shown to be overlapping to the extent that the inner layer is folded over three times.

[0187] The inner tube may be made of a polymer material such as polyethylene, polypropylene, nylon, polyester, PTFE or other film-like material.

[0188] Expanding inner layer 420 is formed as a sheet of polymeric material such as polyethylene, polypropylene, nylon, polyester, PTFE or other film-like material sheet trimmed to the approximate length of outer elastomeric tube 410 to a width required to be wound three times within distal end 240 of sleeve 220. A suitable material is selected by persons skilled in the art on the basis of its stiffness when wound helically at a pitch equal to the helical pitch at the distal end plus about 1. It would be well known to those skilled in the art, several materials may be suitable for forming expanding inner layer 420.

[0189] While the expanding inner layer may be constructed from a sheet that is wound or coiled, more successful construction commences with an extruded tube which is subsequently sliced along its longitudinal axis and the sheet portion then wound or coiled. Suitable materials have a balance of resilience and flexibility to allow expansion and contraction without permanent deformation, and they resist buckling and collapse. Likely material choices are polypropylene or polyethylene or polyurethane or fluoropolymer.

[0190] For most uses, the nominal inner diameter of the extruded tube will be larger than the nominal size of the device intended to be delivered through the sheath. In the present embodiment, the nominal inner diameter of the extruded tube is selected to be in the range of 5-20% larger than the nominal size of the payload intended to be delivered through the sheath. This reduces the risk that the two longitudinal edges of the sheet will come into contact during use of the sheath.

[0191] Expanding inner layer 420 and outer elastomeric tube 410 are fixed relative to one another at proximal end 230. They may be attached through welding, bonding or clamping, or by attachment of each to collar 210. Along the length of sleeve 220, expanding inner layer 420 and outer elastomeric tube 420 are free to move relative to one another. A lubricant such as oil, grease, hydrogel or other low friction surface treatment may be applied between expanding inner layer 420 and outer elastomeric tube 420 to facilitate movement between them. At distal end 240 of sleeve 220, expanding inner layer 420 and outer elastomeric tube 410 may be attached to one another at a section of the circumference of outer elastomeric tube 410. They may be attached through welding, bonding or stitching.

[0192] Expanding inner layer 420 and outer elastomeric tube 410 may also be stitched or stapled together with an x-ray opaque material such as stainless steel, titanium, nickel-titanium alloy or other metal or metal alloy, for sensing.

[0193] FIGS. 5(a) to 5(c) illustrate an exemplified use of adjustable sheath 200 upon passage of introducer device 510 through the inner lumen of adjustable sheath 200. During insertion into the vascular system introducer device 510 can be pushed passed haemostatic valve 340 and through the inner lumen of sheath collar 210 and inserted through expanding inner layer 420 (not shown) of sleeve 220. As shown in FIG. 5(b) introducer device 510 protrudes past distal end 240 of sleeve 220 through the expanding inner layer 420. Tapered tip 520 of introducer device 510 can temporarily be retained within distal end 240 of the outer elastomeric tube 410. FIG. 5(c) illustrates expanding inner layer 420 gradually expanding to reduce the degree to which it overlaps upon itself.

[0194] Additionally, to promote ease of feeding devices through expanding inner layer 420, the inner surface of its luminal wall may be coated in a lubricious coating such as silicone or glycerine oil, fluoropolymer based oils, grease, PTFE, hydrophilic polymer or other low friction surface.

[0195] Such lubricious coatings may also be applied within the wrapped area of the expanding inner layer.

[0196] In a similar fashion, outer elastomeric tube 410 can be coated externally in a low friction layer to promote ease of insertion into the vascular system. Surface treatments can include those potentially applied to the expanding inner layer, as well as hydrogel-based coatings that can include medicinal agents to treat or avoid infections or allergies.

[0197] Introducer device 510 is formed with a tapering at its tip to match the inner profile of expanding inner layer 420. However, it may be formed of a uniform diameter to match the inner diameter of expanding inner layer 420, or of a stepped diameter to match both the inner diameter of expanding inner layer 420 at its proximal and distal ends. After insertion of the adjustable sheath into the vessel, introducer device 510 is removed to allow other devices to be routed through the inner lumen of adjustable sheath 200.

[0198] Introducer device 510 may include a small hole at its tip to permit the passage of a wire previously inserted into the vessel.

[0199] Introducer device 510 may be constructed in multiple pieces, with its outer temporarily clamped between two or more pieces such that the user may adjust the position of the introducer pieces to release outer elastomeric tube 410. In an alternative embodiment, the outer elastomeric tube 410 may fold over within the expanding inner layer 420 at the distal end 240 and be retained by the introducer device 510 during vascular insertion and become released during removal of the introducer device 510, as described above.

[0200] FIGS. 6(a) to 6(c) illustrate adjustable sheath 200 with outer elastomeric tube 410 removed. As shown in FIG. 6(a) expanding inner layer 420 is formed as a sheet cut such that, when coiled in a tapered overlapping arrangement, it has a single longitudinal join line 610. As shown in FIG. 6(a), expanding inner layer 420 is formed as a sheet cut such that it has a single longitudinal join line 610. FIG. 6(c) illustrates an optional feature where the expanding inner layer 420 is formed as a sheet cut such that it has a single join line winding helically about the longitudinal axis of the sleeve.

[0201] Expanding inner layer 420 may be cut and shaped into many different shapes. As an alternative, it may be cut so that, in its relaxed state, it is coiled to form a cylinder with no taper wherein the taper induced by a tapered outer tube.

[0202] FIGS. 6(b) and 6(c) illustrate an optional feature wherein the expanding inner layer 420 is further characterised by cut-out section 620, at distal end 240 of expanding section 630, separating tapered section 630 from non-tapered section 640. Cut-out section 620 forms an opening 650 in expanding inner layer 420, whereby the opening extends partially around the circumference of sleeve 220 to enable tapered section 630 to continue to non-tapered section 640 without causing the kinking and localised collapse of sleeve 220. Cut-out section 620 may also promote the ease of manufacture by reducing the risk of misfeeding of the inserted device between the expanding inner layer and the outer elastomeric tube. It may also improve the buckling and kinking strength of the adjustable sheath. The shape of the opening can be selected to be a variety of shapes, for example circular, triangular, ovoid, or T-shaped. The selected shape may be optimised by trial, error and testing of the desired physical properties of the adjustable sheath.

[0203] FIG. 6(c) illustrates an alternative embodiment wherein tapered section 630 is discontinuous. The discontinuous section is rectangular along the entire length of the tapered section 630, but the degree of overlap along the length of the tapered section increases from the proximal end to the distal end, creating helical edge 650 along the length of the tube.

[0204] FIG. 7(a) illustrates an alternative embodiment wherein in the expanded state the edges are not parallel, or V-cut, where the circumference of the inner layer at the distal end is smaller than the circumference of the inner layer at the proximal end. This arrangement can promote a smaller overall distal diameter through a reduced material thickness due to the overlap in the layer, as illustrated in FIG. 7(a). When overexpanded, tapered section 630 will separate at join line 610. To prevent expanding inner layer 420 from locking in an expanded position within the vessel as a consequence of one blunt edge of expanding inner layer 420 becoming wedged upon the other blunt edges of expanding inner layer 420, the edges of the overlapping portions may be cut to be rounded or cut at a non-orthogonal angle. FIG. 7(b) illustrates the movement of one edge of expanding inner layer 420 against the other when being retracted following overextension, when cut at a non-orthogonal angle. When the edges abut one against the other, outer edge 710 slides over inner edge 710 until the expanding inner layer 420 is wound back to its approximate starting position.

[0205] In an alternative embodiment, the expanding inner layer 420 is created through a helically wound continuous strip or wire, characterised by a strip or wire thickness of dimension ‘W’, wound with a helical pitch of between ‘W’ and ‘2W’. The helical winding can be constructed of wire such as titanium, titanium alloy or stainless steel, or of a polymeric material such as polyester, polyethylene, polypropylene or other biocompatible material.

[0206] The helical winding is tapered from distal end to a proximal end.

[0207] In a further alternative embodiment, the expanding inner layer 420 is formed by a continuous thin strip with a series of orthogonal wound coils propagating from one edge such that the coils wind back over the continuous strip. The wound coils are typically of length between 1 mm and 10 mm, with a spacing between them of 0.1 mm to 10 mm. In certain embodiments the diameter of each coil may be consistent along the length of the continuous strip, or varying diameter along the length whereby at least the coil at the distal end is a smaller diameter to the coil at the proximal end.

[0208] To promote visibility of the adjustable sheath to x-ray imaging equipment during medical procedures, a radio opaque marker may be incorporated into the sleeve, in particular at the distal end 240. The marker may be a metallic wire such as nitinol bonded or stitched to the tube, or polymer-based such as a tungsten-filled nylon, polyethylene or polyurethane bonded to the tube, or similar components known to those skilled in the art.

[0209] The radio opaque marker can be incorporated at one of any number of places in the expanding inner layer 420 or the outer elastomeric tube 410.

[0210] The embodiments described herein may be adapted for application in the treatment of a range of different patient types and pathologies. Where the optimisation of the expanding inner layer's physical characteristics is required, for example to impart greater rigidity, resilience or bendability to the sheath to meet the patient's needs, the inner layer may be formed of a composite material to achieve the desire physical characteristics.

[0211] FIG. 8(a) shows an embodiment in which the adjustable sheath inner layer is constructed to have three sub layers, 810, 820 and 830. The inner layers are constructed such that the 810 and 830 are formed of PTFE and they sandwich 820 which is formed of nylon. FIG. 8(b) shows an adjustable sheath inner layer having a laminated inner layer formed from a medical grade polyamide outer sub layer 840 and a PTFE inner sub layer 850. The PTFE inner sub layer 850 reduces sliding friction between the layers to improve useability of the device.

[0212] While FIG. 8 describes the modification of the adjustable sheath inner layer to enhance or alter the physical properties of the adjustable sheath, a further layer may be added to the adjustable sheath to alter its physical properties to meet the demands of certain uses. The adjustable sheath of embodiments described herein may include a structural outer layer (not shown). To meet physical requirements such as longitudinal rigidity, to prevent kinking and buckling as noted above, introducer sheaths may include a longitudinal reinforcing element in either the inner layer or the outer layer. In some embodiments, the structural outer layer is a braided liquid crystal polymer mesh, which provides the adjustable sheath greater rigidity adapted for certain uses. The liquid crystal polymer mesh is located between the outermost and innermost sub layers, and is generally able to move independently of the elastomeric outer layer and expanding inner layer.

[0213] Applications requiring the use of a thin sheath are accommodated by moulding an elastomeric outer tube formed of a composite material construction having a braided nylon mesh moulded within an elastomeric skin. This form of the elastomeric outer tube provides greater structural rigidity without the bulk or thickness of the three layer adjustable sheath described above.

[0214] To permit the removal of air trapped between outer elastomeric tube 410 and expanding inner layer 420 prior to insertion of the adjustable sheath within the vascular system, certain embodiments may incorporate an opening in proximal end 230 of the outer elastomeric tube 410, which is closed with a valve (not shown).

[0215] Attachment of adjustable sheath 200 to sheath collar 210 is achieved in the FIG. 9 embodiment by way of clamp joint 910. Adjustable sheath 200 tapers from the opening of retainer nut 330 to fit the internal diameter of intermediate piece 930. Tapering of the outer elastomeric tube 410 is reinforced by a thickening of attachment region 940 of outer elastomeric tube 410. Outer elastomeric tube 410 is glued to intermediate piece 930 and placed together with the expanding inner layer 420 between the sheath collar 210 and clamp joint teeth 920. Inlet 350 provides for the fitment of a tube to permit the passage of fluids via the sheath collar 210. Where a third layer is adopted, clamp joint 910 is capable of maintaining the outer structural layer, the elastomeric tube and the expanding inner layer sandwiched together between the sheath collar 21 and clamp joint teeth 920.

[0216] In use, prior to a medical procedure, fluid such as saline or a sterilising agent may be introduced to the space between the inner and outer tubes through a valve.

[0217] In certain embodiments, for instance to adapt the expanding inner layer to lap onto itself when constructed of a composite material or to avoid otherwise lapping in an undesirable way, the angle of the expanding inner layer cut may be modified. FIG. 10(a) shows an inward oblique cut 150 on expanding inner layer 420 which is cut at an angle that allows the sheath to recoil if two cut edges meet. FIG. 10(b) shows a straight cut 160 on expanding inner layer 420 which is of a simple construction but does not offer the benefits of an angled cut. FIG. 10(c) shows an outward oblique cut 170 on expanding inner layer 420 which is angled to minimise sharp catch points that may otherwise catch the outer elastomeric layer or any objects passing within the inner lumen.

[0218] In addition to the angle of the cut, the helical cut of the expanding inner layer can also vary in the direction of the rotation of the helix, as well as the mode of lapping onto itself. FIG. 11(a) shows an expanding inner layer 420 having clockwise helical cut 260 (when viewed towards the distal end of the sheath) and an overlap in the counter clockwise direction 270. FIG. 11(b) shows an inner layer having a counter clockwise helical cut 280 (when viewed towards the distal end of the sheath) and an overlap in the counter clockwise direction 270. FIG. 11(c) shows an inner layer having a clockwise helical cut 260 (when viewed towards the distal end of the sheath) and an overlap in the clockwise direction 290. FIG. 11(d) shows an inner layer having a counter clockwise helical cut 270 (when viewed towards the distal end of the sheath) and an overlap in the clockwise direction 290. Persons skilled in the relevant art are well versed in the typical tests to ascertain the optimal combination for direction and an angle on the cut of the layer's edge to eliminate trap points in the sheath. For instance, selections will depends on the properties and characteristics of the device being guided through the sheath and may be tested with such a device to optimise the sheath.

[0219] For simplicity, the above embodiments have described the tapering of the adjustable sheath and being uniformly tapered from the proximal end of the sheath to the distal end of the sheath. However, it may be advantageous to certain uses to vary the position and distance of tapering of the adjustable sheath.

[0220] FIG. 12(a) shows adjustable sheath 200 in which a distal tapered portion 350 is located at the tip of the sheath, for uses in which a longer sheath is required. FIG. 12(b) shows adjustable sheath 200 in which central tapered portion 360 is located at a central portion of the sheath and extends almost the entire length of the sheath. This form of tapering is most applicable to uses in which the introduction of a particular device through the sheath lumen is more difficult than usual. Whereas, adjustable sheath 200, as shown in FIG. 12(c), is formed to provide a proximal tapered portion 370 located at the proximal end of adjustable sheath 200. Such sheaths are preferably for uses that reduce the force for introduction of the introducer tip into the vasculature (not shown). Adjustable sheath 200 depicted at FIG. 12(d) includes a stepped tapered portion 380 including two gradual steps at the proximal end of adjustable sheath 200. Stepped tapered portions provide the capacity to modulate several advantages for specific uses, for instance, the stepped tapered portion 380 is adapted to seal the arterial opening around the sheath during a patient procedure.

[0221] Stepped wall thickness of outer elastomeric tube 410 aids the entry and passage of the sheath within a cavity by providing mixed properties along the length of the sheath. The stepped thickness of sheath wall 450 shown at FIG. 13(a) shows a stepped thickening of the outer elastomeric tube 420 at the proximal end of adjustable sheath 200. This construction allows the user to modify the structural performance of the sheath and tailor the strength and flexibility of the device. In particular, the thickening at the proximal end of the outer elastomeric tube 410 provides rigidity to the portion of the sheath outside the body and flexibility to the portion of the sheath inside the body. FIG. 13(b) shows a gradual change in outer elastomeric tube wall 450 at the proximal end resulting in a more gradual change in structural properties.

[0222] FIG. 14 shows an adjustable sheath assembly according to embodiments described herein, having an adjustable sheath 200, collar 210, connector portion 320, inlet 350 and haemostatic valve 340.

Preliminary Testing of Embodiments

Expansion and Retraction

[0223] Design: Measure the sheath diameter before insertion of the introducer within the sheath, and after retraction of the introducer. Report the percentage retraction of the sheath to its original diameter. Report the force required to retract the introducer.

[0224] Acceptance Criteria: Target maximum retraction percentage.

[0225] Sample Size Tested: One sample of a benchmark sheath, prototype sheath with straight cut taper, prototype sheath with spiral cut taper, prototype sheath with v-cut taper.

[0226] Methods: The proximal outer diameter and the distal end outer diameter of the test sheaths were measured before insertion of the introducer. The introducer was then inserted through the sheath, until it protruded through the distal end. Then the introducer was pulled back through the sheath and fully removed. The force to retract the introducer was recorded to assess any difficulty in retraction. The sheath distal end outer diameter was then remeasured to assess the amount of retraction or spring-back. The retractability percentage was then calculated as a percentage of the initial distal size reduction.

[0227] Results:

TABLE-US-00001 (mm) Benchmark Straight Cut Spiral Cut V cut Initial Proximal Diameter 7.1 7.1 7.1 7.1 Initial Distal Diameter 7.1 5.2 4.8 4.6 Initial Distal size reduction 0 1.9 2.3 2.5 Force to retract N/A 17N 16N 15N Final Diameter 7.1 6.1 5.9 5.6 Retractability % 0% 53% 52% 60%

[0228] All samples experienced the smooth insertion of the introducer, with none requiring excessive force to insert the introducer. All adjustable sheaths demonstrated the characteristic of retracting to the limit of the sheath's capacity once the introducer had protruded past the end of the sheath.

[0229] After retraction of the introducer the V-cut prototype did not fully retract due to the cut edges colliding and failing to lap correctly. The outer layer of the V-cut prototype pulled back from the end of the inner layer by approximately 4 mm, possibly due to increased friction against the introducer.

[0230] Conclusion: All prototype sheaths demonstrated the ability to retract after insertion and removal of the introducer. The V-cut prototype gave the smallest distal end measurements but did not retract as intended. The straight cut and spiral cut prototypes showed nearly equivalent performance, however other performance characteristics should be considered when selecting a preferred design. The force required to retract the valve delivery system is not excessive for any of the designs, and would not pose a problem for a user, or a risk of damage.

Bendability

[0231] Design: Measure the force required to deflect the sheath without the introducer at angles of up to 30°.

[0232] Acceptance Criteria: Force the sheath to bend at an angle up to 30°. This should not exceed the benchmarked force.

[0233] Sample Size Tested: One sample of benchmark sheath, prototype sheath with straight cut taper, prototype sheath with spiral cut taper, prototype sheath with v-cut taper.

[0234] Method: A jig was constructed to hold the sheath, with a cantilever length of 200 mm. A hand-held force gauge was used to deflect the sheath and display the applied force in grams. The applied force was converted to N for consistency.

[0235] Results: The table below shows the force in N to deflect each sample.

TABLE-US-00002 Angle (degrees) Benchmark Straight Cut Spiral Cut V cut 0 0 0 0 0 10 0.44 0.29 0.34 0.20 20 0.59 0.39 0.59 0.39 30 0.78 0.44 0.59 0.49

[0236] Conclusion: All prototype sheaths demonstrated improved bendability compared to the benchmark sample. The three different prototype sheaths displayed different bending and stiffness characteristics as demonstrate in FIG. 15.

Sheath Kinkability

[0237] Design: Measure the force required to kink the sheath, and the angle at which kinking occurs.

[0238] Acceptance Criteria: Angle required to kink the sheath should exceed the benchmark.

[0239] Sample Size Tested: One sample of the benchmark sheath, a prototype sheath with a straight cut taper, a prototype sheath with a spiral cut taper, a prototype sheath with a v-cut taper.

[0240] Method: A jig was constructed to hold the sheath, at a cantilever length of 200 mm. A hand-held force gauge was used to deflect the sheath and display the force applied in grams. Applied force was been converted to N for consistency. The angle to kink was read with reference to the template, which represents the angle between the sheath axis and a line from the point of bending to the sheath distal end.

[0241] Results:

TABLE-US-00003 Benchmark Straight Cut Spiral Cut V cut Force to kink (N) 0.6867 0.981 >1.4 >1 Angle to kink (deg) 30 90 >90 >90

[0242] The spiral cut and v cut samples were able to bend beyond an angle of 90 degrees without kinking. The test for these samples was stopped at this point as the samples exceeded the testing capacity.

[0243] Conclusion: All prototype devices demonstrated improved resistance to kinking compared with the benchmark. The V-cut sample and spiral cut samples both deflected further than the straight cut sample without kinking.

Comparative Performance Testing

[0244] Design: Measure the force required to push a defined payload of 6.7 mm diameter through the sheath.

[0245] Acceptance Criteria: Force to push a payload through the sheath should be less than 40N

[0246] Samples Tested: Sheaths having a lapping inner layer and fully longitudinal elastomeric outer layer were tested against a first commercial product (Benchmark 1) having a continuous folded inner layer and partially longitudinal elastomeric outer layer and a second commercial product (Benchmark 2) having a continuous folded inner layer and a fully longitudinal elastomeric outer layer.

[0247] Method: Retain the sheath by clamping the sheath collar to a rigid fixture. Attach the defined payload to a force measuring instrument capable of recording force and distance travelled. Traverse the payload through the sheath at a constant velocity, recording force vs distance travelled.

[0248] Results: FIG. 16 shows the Force (N) required to push the defined payload through. the length of the sheath (mm).

[0249] Conclusion: The sheath consisting of the lapping inner layer met the acceptance criteria for pushing a defined payload through the sheath. The sheath consisting of the lapping inner layer had approximately 40% lower push force than the best folded layer construction. The sheath consisting of the lapping inner layer also showed more consistent push force along the length of the sheath.

Manufacture of Embodiments

[0250] The adjustable sheath is constructed by manufacturing the expanding inner layer and the outer elastomeric tube, assembling and bonding both components to a commercially available collar having a haemostatic valve.

[0251] The expanding inner layer is manufactured from medical grade polyamide according to standard extrusion or injection moulding techniques. For a straight cut inner layer, the raw material is extruded into a long tapered cylindrical shape and a slit cut along the length of the shape.

[0252] For a helical inner layer, once the inner layer is moulded to a desired size and shape, the layer is heat shrunk around a mould of the desired diameter to form a cylindrical portion to bond to the collar. The remaining sheet portion of the layer is cut at an oblique angle to a shape required to coil within the outer elastomeric tube.

[0253] The outer elastomeric tube is formed from silicone to a desired tapered shape using resin moulding techniques know to skilled persons to be suited for moulding and curing thin silicone sheets and tubular structures. The proximal section of the outer elastomeric tube is formed to the same or a slighter larger diameter of the cylindrical portion of the expanding inner layer.

[0254] The sheet portion of the expanding inner layer is manually coiled to a smaller diameter than the outer elastomeric tube and placed within the tube once aligned at the proximal end. A small amount of adhesive is applied at the proximal (or wider) edge of the tapered sleeve such that the adhesive is in contact with the outer elastomeric tube and the expanding inner layer. The proximal edge is then placed around the opening of a commercially available haemostatic valve to bind both the expanding inner layer and the outer elastomeric tube to the collar of the haemostatic valve. Once the adhesive has been allowed to set the sheath is ready for use.

[0255] Throughout this specification the word “comprise”, or variations such as “comprises” or “comprising”, will be understood to imply the inclusion of a stated element, integer or step, or group of elements, integers or steps, but not the exclusion of any other element, integer or step, or group of elements, integers or steps.

[0256] It will be understood that the terms ‘fastener’ or ‘fastening’, ‘coupling’ or ‘sealing’ when used alone or together with other terms such as ‘means’ or others, may be used interchangeably where interpretation of the term would be deemed by persons skilled in the art to be functionally interchangeable with another. Further, the use of one of the aforementioned terms does not preclude an interpretation when another term is included.

[0257] The various apparatuses and components of the apparatuses, as described herein, may be provided in various sizes and/or dimensions, as desired. Suitable sizes and/or dimensions will vary depending on the specifications of connecting components or the field of use, which may be selected by persons skilled in the art.

[0258] It will be appreciated that features, elements and/or characteristics described with respect to one embodiment of the disclosure may be used with other embodiments of the invention, as desired.

[0259] Although the preferred embodiments of the present disclosure have been disclosed for illustrative purposes, those skilled in the art will appreciate that various modifications, additions and substitutions are possible, without departing from the scope and spirit of the disclosure and accompanying claims.

[0260] It will be understood that when an element or layer is referred to as being “on” or “within” another element or layer, the element or layer can be directly on or within another element or layer or intervening elements or layers. In contrast, when an element is referred to as being “directly on” or “directly within” another element or layer, there are no intervening elements or layers present.

[0261] As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items.

[0262] It will be understood that, although the terms first, second, third, etcetera, may be used herein to describe various elements, components, regions, layers and/or sections, these elements, components, regions, layers and/or sections should not be limited by these terms. These terms are only used to distinguish one element, component, region, layer or section from another region, layer or section. Thus, a first element, component, region, layer or section could be termed a second element, component, region, layer or section without departing from the teachings of the present disclosure.

[0263] Spatially relative terms, such as “lower”, “upper”, “top”, “bottom”, “left”, “right” and the like, may be used herein for ease of description to describe the relationship of one element or feature to another element(s) or feature(s) as illustrated in the figures. It will be understood that spatially relative terms are intended to encompass different orientations of structures in use or operation, in addition to the orientation depicted in the drawing figures. For example, if a device in the drawing figures is turned over, elements described as “lower” relative to other elements or features would then be oriented “upper” relative the other

[0264] elements or features. Thus, the exemplary term “lower” can encompass both an orientation of above and below. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein should be interpreted accordingly.

[0265] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the disclosure. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “including”, “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof.

[0266] Embodiments of the description are described herein with reference to diagrams and/or cross-section illustrations, for example, that are schematic illustrations of preferred embodiments (and intermediate structures) of the description. As such, variations from the shapes of the illustrations as a result, for example, of manufacturing techniques and/or tolerances, are to be expected. Thus, embodiments of the description should not be construed as limited to the particular shapes of components illustrated herein but are to include deviations in shapes that result, for example, from manufacturing.

[0267] Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this description belongs. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the relevant art and will not be interpreted in an idealised or overly formal sense unless expressly so defined herein.

[0268] Any reference in this specification to “one embodiment,” “an embodiment,” “example embodiment,” etc., means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of the description. The appearances of such phrases in various places in the specification are not necessarily all referring to the same embodiment. Further, when a particular feature, structure, or characteristic is described in connection with any embodiment, it is within the purview of one skilled in the art to effect and/or use such feature, structure, or characteristic in connection with other ones of the embodiments.

[0269] Embodiments are also intended to include or otherwise cover methods of using and methods of manufacturing any or all of the elements disclosed above.

[0270] While the invention has been described above in terms of specific embodiments, it is to be understood that the invention is not limited to these disclosed embodiments. Upon reading the teachings of this disclosure many modifications and other embodiments of the invention will come to the mind of those skilled in the art to which this invention pertains, and which are intended to be and are covered by both this disclosure and the appended claims.

[0271] All publications mentioned in this specification are herein incorporated by reference. Any discussion of documents, acts, materials, devices, articles or the like which has been included in the present specification is solely for the purpose of providing a context for the present invention. It is not to be taken as an admission that any or all of these matters form part of the prior art base or were common general knowledge in the field relevant to the present invention as it existed in Australia or elsewhere before the priority date of each claim of this application.

[0272] It is indeed intended that the scope of the invention should be determined by proper interpretation and construction of the appended claims and their legal equivalents, as understood by those skilled in the art relying upon the disclosure in this specification and the attached drawings.