Abstract: A surgical access device includes a proximal housing having proximal and distal end portions, the distal end portion of the housing being configured and adapted to engage a proximal portion of a flexible wound retractor. The proximal housing can be provided with a plenum chamber being defined therein, the plenum chamber being in fluid communication with at least one nozzle. The nozzle is preferably configured to direct pressurized fluid in an axial direction from the plenum chamber into a central bore of the surgical access device to provide a constant gaseous seal around a surgical instrument inserted therethrough, while inhibiting a loss of pressurized fluid from the body cavity therethrough. The plenum chamber can be adapted and configured to receive pressurized fluid and conduct the pressurized fluid to the at least one nozzle.

Abstract: Bodily implants that can be compacted in a distal-to-proximal direction, and which facilitate repositioning of the implant after compaction. The implants include at least one pull string for expanding the implant in a radial direction while compacting the implant in the longitudinal direction. Where multiple pull strings are provided, they can be secured to the implant at spaced locations along the implant length, and pulled successively to compact the implant in a distal-to-proximal direction. A guide member may also be provided to receive the pull strings and facilitate longitudinal compaction.

Abstract: A device for delivering an implant to a vascular disorder of a patient includes a delivery pusher. A stationary blade may be coupled to the delivery pusher. The stationary blade may include a sharp and stationary cutting component for cutting through a suture coupling the implant to the delivery pusher and for thereby releasing the implant when placed in proximity to the vascular disorder. In some cases, the strength of a junction connecting the suture to the implant is equal to or greater than the tensile strength of the suture itself. Additionally, or alternatively, a detachment handle may be fixedly and permanently attached to the delivery pusher such that a user of the device need not couple the detachment handle to the delivery pusher. The detachment handle may include a user manipulable component for initiating a mechanical release of the implant when placed in proximity to the vascular disorder.

Abstract: A stentless support structure capable of being at least partly assembled in situ. The support structure comprises a braided tube that is very flexible and, when elongated, becomes very long and very small in diameter, thereby being capable of placement within a small diameter catheter. The support structure is preferably constructed of one or more thin strands of a super-elastic or shape memory material such as Nitinol. When released from the catheter, the support structure folds itself into a longitudinally compact configuration. The support structure thus gains significant strength as the number of folds increase. This radial strength obviates the need for a support stent. The support structure may include attachment points for a prosthetic valve.

Abstract: A punctum dilating and plug inserting system includes an inserter and a protective cover defining a dilator. The inserter includes a longitudinal body, and a handle. The handle has a rounded stationary member and a trigger rotatably connected to the handle by a living hinge. A mounting wire extends through the body and is connected to the trigger. When the trigger is activated, the wire is retracted and a plug mounted on a distal end of the wire is released. A packaging is provided for receiving, protecting, and handling at least a portion of the entire inserter until ready for use. An end of the packaging includes a dilator dip for dilating the punctum in advance of receiving the punctum plug.

Abstract: An apparatus comprises a sleeve, a seal, and an anchor assembly. The sleeve is flexible and non-permeable and is configured to fit in a duodenum. The seal is positioned at the proximal end of the sleeve and is configured to seal the proximal end of the sleeve against the stomach mucosa, the pylorus, or the duodenum mucosa. The anchor assembly comprises a pair of atraumatic anchor ends and a resilient member positioned between the anchor ends. At least a portion of the resilient member extends along at least a portion of the length of the sleeve. The resilient member is configured to bias the anchor ends generally toward each other, to thereby substantially anchor the sleeve in the duodenum. The sleeve is configured to prevent chyme from contacting the mucosa of the duodenum; and to prevent enzymes excreted in the duodenum from mixing with chyme in the duodenum.

Abstract: An occlusive coil delivery device includes an occlusive coil having a plurality of open pitched windings at a proximal end thereof, and a delivery wire assembly having a proximal tubular portion, a distal coil portion and a lumen, and a delivery wire adapter having a proximal end and a distal end. The delivery wire assembly having a delivery wire forming a first conductive path and extending through the lumen from a proximal end of the delivery wire assembly to a location distal of the distal coil portion, and a second conductive path formed by the proximal tubular portion and distal coil portion. The distal end of the adapter comprising a plurality of fingers configured to interface between adjacent open pitched windings of the proximal end of the occlusive coil, with the proximal end of the delivery wire adapter secured to a distal portion of the delivery wire.

Abstract: A system for treating uterine tissue comprises an elongated introducer with a working end configured for endometrial ablation. The working end includes an expandable seal for positioning in a patient's cervical canal and an actuator pump mechanism carried by a proximal handle coupled to the introducer for expanding the seal. The handle optionally includes a mechanism for simultaneously expanding the seal and deploying a treatment element on the working end of the introducer.

Abstract: A surgical tool for inserting a spile or plug into the punctal opening of a meatus such as a lacrimo-nasal canaliculus comprises an oblong, hollowed member shaped and dimensioned to be conveniently manipulated with one hand and having at one of its end a punctal opening and meatus-dilating shaft and, at the opposite end, a plug inserter. The dilating shaft has a cross-diameter substantially equal to the cross-diameter of the plug and is terminated by a conical spike. The inserter comprises a tip extending axially from the member and having, at its distal end, a cup whose internal geometry is commensurate with a cap at the proximal end of the plug. A penetration-resisting bearing surface is provided by the cup rim. The plug can be allowed to retract within the cup under the force of insertion. A steel wire running through the inserter has its distal end inserted into the cap of the plug.

Abstract: The present invention provides minimally invasive devices and methods for accessing the sinuses and their surrounding structures for surgery and other treatments. The anterior ethmoid and maxillary sinuses are accessed and treated under minimal anesthesia with little or no postoperative limitation of activity or adverse symptoms. Direct visual verification of the sinuses and their natural ostia is utilized. Other paranasal sinuses may be treated by this method as well. The sinuses, in particular the maxillary and anterior ethmoid, are accessed via a direct anterior to posterior axis and the natural ostia of those sinuses is directly visualized for placement of a guide-free dilator, in the desired location within the natural ostia. That access to the maxillary ostium is accomplished by the anterior transuncinate “keyhole” approach in which a hole is punched in the uncinate process with the described devices according to the described methods.

Abstract: An automatic wireless medical device release system may reduce the overall diameter of the medical device delivery system. The medical device delivery system may include a medical device with a looped portion at a distal end of the medical device. A capture wire may be located on a delivery tool that is distal to the medical device. The looped portion of the medical device may be attached to a bend in the capture wire. The bend in the capture wire may be maintained by a sheath covering the delivery tool. Removal of the sheath may automatically remove the bend in the capture wire, which may release the looped portion of the medical device from the capture wire.

Abstract: A system for delivering an implant device to a vascular site in a patient a delivery pusher apparatus, an implant device detachably connected to the delivery pusher apparatus by a tether having a distal end connected to a proximal end of the implant device, wherein the tether is substantially non-tensioned when connecting the implant device to the delivery pusher, and an electrical heating element configured coaxially around at least a portion of the tether, wherein heat generated by the heating element severs the tether at a point near the proximal end of the implant device.

Abstract: In order to later identify the location of a biopsy or surgery, various means and methods for permanently and non-surgically marking selected tissue in the human body are used. Later visualization of the markers is readily accomplished using state-of-the-art imaging systems.

Abstract: A family of barrel structures is provided in a kit. Each barrel structure is differently sized and configured for advancement into anal canals of different anatomic morphologies. Instructions are provided for using the barrel structures to treat an individual. The instructions instruct assessing an anatomic morphology of an anal canal of an individual to be treated and selecting one of the barrel structures based upon the assessed anatomic morphology. Each barrel structure carries an electrode sized and configured to be coupled to a source of tissue ablation energy to be applied through the electrode to form a lesion. Each barrel structure includes a transparent side wall visualized by a direct line of sight from an end portion of the first barrel structure. The instructions instruct inserting the selected barrel structure into the anal canal and visualizing by the direct line of sight through the transparent side wall of the selected barrel structure the dentate line and the targeted tissue region.

Abstract: A bariatric device and method of causing at least partial satiety in a recipient includes positioning a body in a recipient, the body having a wall defining a lumen, the wall configured to generally conform to the shape and size of the proximal cardiac portion of the stomach. Force is exerted with the wall on the proximal cardiac portion of the stomach in the absence of food thereby activating receptors located in the proximal cardiac portion of the stomach, thereby influencing a neurohormonal feedback mechanism of the recipient to cause at least partial satiety by augmenting fullness caused by food and simulating fullness in the absence of food.

Abstract: The invention relates to a device for the implantation of microcoils into body cavities and blood vessels, in particular aneurysms, with said microcoils comprising wires forming a plurality of windings, at least one microcoil serving as occlusion helix for the occlusion of the body cavity or blood vessel, and the device consisting of a catheter, one or several microcoils movably arranged in longitudinal direction within the catheter and at least one securing means passing at least partially through the lumen of the occlusion helix, with said securing means being fixed in its end areas inside the microcoils. Such a fixation of the securing means is achieved in at least one end area by providing a frictional connection with the microcoil in such a manner that this connection is detachable from the microcoil when a certain tensile force acting on the securing means is exceeded.

Abstract: A stentless support structure capable of being at least partly assembled in situ. The support structure comprises a braided tube that is very flexible and, when elongated, becomes very long and very small in diameter, thereby being capable of placement within a small diameter catheter. The support structure is preferably constructed of one or more thin strands of a super-elastic or shape memory material such as Nitinol. When released from the catheter, the support structure folds itself into a longitudinally compact configuration. The support structure thus gains significant strength as the number of folds increase. This radial strength obviates the need for a support stent. The support structure may include attachment points for a prosthetic valve.

Abstract: Devices and methods for treating a diseased tracheobronchial region in a mammal. The device can be a stent which can include a sustained-release material such as a polymer matrix with a treatment agent. The stent can be bioabsorbable and a treatment agent can be incorporated therewith. A treatment method can be delivery of a stent to a tracheobronchial region by a delivery device such as a catheter assembly.

Abstract: A drug eluting angioplasty balloon (1, 101) suitable to adopt a deployed configuration and a collapsed configuration, the balloon having an outer wall (10) disposed around a core (11) defining an axis (X). The balloon (1, 101) comprising in the collapsed configuration a plurality of folds (12, 12?, 112) that are laid in a tangential direction about the core (11) and form a plurality of cavities (13a, 13b, 113) loaded with a drug (14), the cavities (13a, 13b, 113) are comprised between the folds (12, 12?, 112), wherein the folds (12, 12?, 112) originates from distinct longitudinal lines (25, 25?, 125, 125?) along the outer wall (10), are arranged in pairs and are circumferentially wrapped about the core (11) in such a way that a fold of one pair overlaps an adjacent fold of another pair and are wrapped in opposite directions.

Abstract: A stentless support structure capable of being at least partly assembled in situ. The support structure comprises a braided tube that is very flexible and, when elongated, becomes very long and very small in diameter, thereby being capable of placement within a small diameter catheter. The support structure is preferably constructed of one or more thin strands of a super-elastic or shape memory material such as Nitinol. When released from the catheter, the support structure folds itself into a longitudinally compact configuration. The support structure thus gains significant strength as the number of folds increase. This radial strength obviates the need for a support stent. The support structure may include attachment points for a prosthetic valve.

Abstract: Provided herein are a system, method, and apparatus for delivering a therapeutic device, e.g. an embolic coil, from a delivery tube at a target site in a patient's body. A heating element is disposed in the delivery tube that can be actuated remotely, and a layer of low temperature adhesive is applied at the heating element to retain the therapeutic device. The kicker in the form of, for example, a compressed spring is mounted within the delivery tube so as to be in contact with the therapeutic device for applying a constant ejector force that is countered by the adhesive force of the low temperature adhesive. When the heating element is actuated, the spring's ejector force overcomes the softened adhesive's adhesive force to force the therapeutic device out of the delivery tube.

Abstract: A mandrel for manufacturing a stent from a single wire includes a cylindrical member having a plurality of pins at a proximal end region, a plurality of pins at a distal end region, and a plurality of indentations between the proximal pins and the distal pins. These indentations form a helical pattern on the outer surface of the cylindrical member. The single wire is wrapped around every proximal pin and distal pin on the mandrel by following the indentations in the mandrel. The single wire is slid through the indentation under any crossing section of wire and over the next crossing section of wire in an under-over pattern.

Abstract: A stent delivery device includes a first retaining polymer disposed about and retaining a self-expanding stent at a proximal end portion, a second retaining polymer disposed about and retaining the self-expanding stent at a distal end portion, a first resistance member in thermal communication with the first retaining polymer, and a second resistance member in thermal communication with the second retaining polymer. The second retaining polymer and second resistance member are configured to allow release and expansion of the distal end portion of the self-expanding stent without expansion of the proximal end portion of the self-expanding stent.

Abstract: A mechanism for removing a fluid-filled object from a patient. The apparatus includes a deflation tube with a puncture member at one end of the tube for piercing a hole in the object wall. The apparatus includes a retrieval mechanism slidable within the deflation tube lumen. The retrieval mechanism includes an expansion element that is expandable when positioned within the object from a first configuration with a dimension less than that of the deflation tube lumen to a second or deployed configuration with a dimension that is greater than an outer dimension of the puncture member. The expansion element contacts an inner surface of the inflatable object as the deflation tube and retrieval mechanism are withdrawn from the body cavity. The expansion element may be a T-bar, a foldable anchor, an inflatable member, or another expandable form.

Abstract: Described herein are systems and methods from delivering prosthetic devices, such as prosthetic heart valves, through the body and into the heart for implantation therein. The prosthetic devices delivered with the delivery systems disclosed herein are, for example, radially expandable from a radially compressed state mounted on the delivery system to a radially expanded state for implantation using an inflatable balloon of the delivery system. Exemplary delivery routes through the body and into the heart include transfemoral routes, transapical routes, and transaortic routes, among others.

Abstract: A hybrid cannula may comprise a rigid portion overmolded with a flexible portion. The rigid portion at its proximal end may comprise a rigid flange for preventing the proximal end of the hybrid cannula from being pushed through the portal. The flexible portion may comprise a dam within the passage of the hybrid cannula, the dam defining interior spaces thereof between the proximal and distal ends of the hybrid cannula. The flexible portion's distal end may comprise a variety of features extending therefrom, including a flange and/or a cannulated tip. The flexible portion's proximal end may further comprise a membrane to prevent liquid from projecting during insertion of a tool into the dam and/or removal of the tool from the dam. The hybrid cannula can be useful in minimally invasive surgical procedures, including arthroscopic and endoscopic surgeries.

Abstract: A vasoocclusive coil is reinforced with a stretch resistant member to improve safety during retraction of the coil. The stretch resistant member is fixedly attached at one end to the vasoocclusive coil, and the other end of the stretch resistant member is detachably mounted to an elongated pusher member to allow for placement and release of the vasoocclusive coil within the patient's vasculature.

Abstract: A complex coil configured such that in a relaxed, minimum energy state configuration loops are formed having various orientations relative to each other. The complex coil provide improved thrombus formation and reduced rotation or tumbling once implanted. The complex coil is formed of a material that may be deformed for purposes of placing the complex coil into a catheter and returns to a complex shape that includes said loops once deployed.

Abstract: Orally administrable polymer-carrying units for expanding in a stomach of a mammal to fill a space in the stomach, the polymer-carrying units including: a carrier; a plurality of polymer molecules expandable in aqueous solutions, releasably coupled to the carrier; and means for selectively decoupling the polymer molecules from the carrier so that the polymer molecules and carrier are released in the stomach, are provided.

Abstract: Devices and methods for treatment of a patient's vasculature with some embodiments configured for delivery with a microcatheter for treatment of the cerebral vasculature of a patient. Embodiments may include a self-expanding resilient permeable shell having a radially constrained elongated state configured for delivery within a catheter lumen, an expanded state with a globular and longitudinally shortened configuration relative to the radially constrained state, and a plurality of elongate filaments which are woven together, which define a cavity of the permeable shell Some embodiments may include at least about 40% composite filaments having a high strength material and a highly radiopaque material. In some embodiments, the total cross sectional area of the highly radiopaque material is between about 11% and about 30% of the total cross sectional area of the plurality of elongate elements.

Abstract: This is a device for occluding a space within the body. In particular, the device comprises a proximal portion having a complex, three-dimensional shape and a distal portion, where the diameter of the shape defined by the distal portion is smaller than the diameter of the shape defined by the proximal portion. The devices may be placed in a desired site within a mammal and are useful in occluding devices.

Abstract: A system for treating heart disease, such as pulmonary hypertension or right heart failure, including an implantable component and external components for monitoring the implantable component is provided. The implantable component may include a compliant member, e.g., balloon, coupled to a reservoir via a conduit. Preferably, the compliant member is adapted to be implanted in a pulmonary artery and the reservoir is adapted to be implanted subcutaneously. The external components may include a clinical controller component, monitoring software configured to run a clinician's computer, a patient monitoring device, and a mobile application configured to run on a patient's mobile device.

Abstract: The present invention provides a medical device having an catheter body defining proximal and distal portions, and a guidewire lumen at least partially disposed within and movable within the catheter body. The medical device may include an expandable element defining a proximal end and a distal end, wherein the proximal end is coupled to the distal portion of the catheter body and the distal end is coupled to the guidewire lumen. In addition, an actuator element may be coupled to the guidewire lumen for longitudinal movement thereof, and a tensioning element may further be coupled to the guidewire lumen to bias the guidewire lumen and/or the expandable element towards a particular geometric configuration.

Abstract: Braid-balls suitable for aneurysm occlusion and/or parent vessel occlusion/sacrifice (e.g., in treating neurovascular defects) are disclosed. Especially for aneurysm treatment, but also for either one of the aforementioned treatments, the form of the ball is very important. In particular, the density of the device is paramount in applications where braid itself is intended to moderate or stop blood flow—allowing thrombosis within a volume formed by the ball.

Abstract: A multi-layer occluder for treating a target site within the body is provided. The occluder may include first and second layers. For example, the first layer may include braided strands of metallic material, and the second layer may include braided strands of polymeric material. At least one of the first or second layers may be configured to facilitate thrombosis.

Abstract: A medical device for blood flow restoration and/or for use as an implantable member in a human vessel includes a self-expanding member, a guidewire, and a connection mechanism. The self-expanding member includes a plurality of cells and filaments having specific ranges of thicknesses, widths, and heights. The self-expanding member can take on a volume-reduced coiled form with overlapped edges, and can generate optimal radial forces against a vessel wall and/or thrombus when deployed and expanded.

Abstract: An aneurysm closure device or flow diverter includes a frame member formed of crossing frame elements and a diverter portion formed of a plurality of blade elements extending in radially opposing directions from a diverter element. The flow diverter is ideally suited for diverting the flow of fluid from an aneurysm at a vessel bifurcation, whereupon the blade elements and diverter element can be positioned at the neck of the aneurysm so as to substantially close off the flow path into the aneurysm sac. The crossing frame elements hold the device in position at the bifurcation. The structure provides reliable deployment of the device and closure of an aneurysm.

Abstract: A variety of passive intragastric implant devices for obesity treatment are disclosed. Such passive devices do not autonomously change shape, but instead react within the stomach to induce satiety. The devices may take up volume within the stomach, thus reducing the intake capacity. Additionally, the devices may contact areas within the stomach, such as the cardia surrounding the esophageal sphincter, or the greater and lesser curvatures in the middle of the stomach, to stimulate satiety-inducing nerves. Some devices may combine two or more of these satiety-inducing features. Methods of implant are disclosed including compressing the devices within a delivery tube and transorally advancing the devices through the esophagus to be deployed within the stomach. Removal of the devices occurs in the reverse.

Abstract: The present application discloses an apparatus for treating vascular aneurysms and includes a radially expandable substantially cylindrical structure formed from a plurality of support members and defining a plurality of openings, and at least one reactive material strand selectively integrated into the substantially cylindrical structure. The reactive material is configured to assume a non-reacted state and a reacted state. The reactive material in the reacted state is configured to restrict a flow of blood to an aneurysm.

Abstract: A vascular implant formed of a compressible foam material has a compressed configuration from which it is expansible into a configuration substantially conforming to the shape and size of a vascular site to be embolized. Preferably, the implant is formed of a hydrophilic, macroporous foam material, having an initial configuration of a scaled-down model of the vascular site, from which it is compressible into the compressed configuration. The implant is made by scanning the vascular site to create a digitized scan data set; using the scan data set to create a three-dimensional digitized virtual model of the vascular site; using the virtual model to create a scaled-down physical mold of the vascular site; and using the mold to create a vascular implant in the form of a scaled-down model of the vascular site. To embolize a vascular site, the implant is compressed and passed through a microcatheter, the distal end of which has been passed into a vascular site.

Abstract: A surgical instrument for use with a surgical portal apparatus includes an elongate shaft having proximal and distal ends and defining a longitudinal axis and a dilating member disposed at the distal end of the elongate shaft. The dilating member has a first longitudinal arc segment and a second longitudinal arc segment in diametrical opposed relation to the first longitudinal arc segment. The first and second longitudinal arc segments define respective first and second radii of curvature transverse to the longitudinal axis. The first and second radii of curvature decrease from proximal to distal to define a generally tapered configuration of the dilating member. The first radius of curvature is greater than the second radius of curvature at predefined longitudinal positions of the dilating member such that the first longitudinal arc segment extends distally beyond the second longitudinal segment to define a penetrating tip.

Abstract: Disclosed is an apparatus and a method for surgical dilation and retraction of tissues during a medical procedure, for example a spinal surgery. The apparatus includes a dilator assembly that includes a plurality of slidingly engaging dilators, wherein at least one dilator includes an outer wall shape different from its inner wall shape. At least one of the dilators may include an eccentrically positioned circular channel, a generally oblong outer wall shape, and a longitudinal gap in a wall. The dilator system may be used in a method that provides off center differential dilation of tissues in one or more preferred directions. A retractor system that may be used with the dilator system is also disclosed.

Abstract: This system is a computer-based system for simulating an effect of a specific surgical treatment based on three-dimensional data of a shape of a target vascular site of a subject, comprising: a surgical treatment receiving unit, by a computer, for displaying the three-dimensional data of a shape of a target vascular site on a computer display screen, and receiving a specification of a lesion on display and a selection of a surgical treatment for the lesion, a modification method storage unit, by a computer, for pre-storing selectable surgical treatments and methods for modifying the three-dimensional data for respective surgical treatments in memory, and a modified three-dimensional data output unit, by a computer, for reading out a modification method from the modification method storage unit according to the selection of a surgical treatment, modifying the three-dimensional data related to the specification of the lesion by the selected method, and outputting the modified three-dimensional data.

Abstract: An occlusion device has a covering attached to a support frame that includes a disc-shaped member and a crossbar that extends across a central opening defined by the disc-shaped member. The occlusion device has a first, or deployed, configuration in which the crossbar defines a curve that extends from the disc-shaped member, and a second, or resting, configuration in which the disc-shaped member and the crossbar lie substantially in a single plane. Each of the disc-shaped member and the crossbar include a core wire that extends through a lumen of a coil multiple times.

Abstract: A method for treating a genetically associated chronic obstructive pulmonary disease. At least one implant is advanced into an airway of a lung having a genetically associated chronic obstructive pulmonary disease. The at least one implant is delivered into the lung to increase tension of the lung and thereby improve breathing function of the lung.

Abstract: Apparatus is provided for treating hypertension of a subject. The apparatus includes an implantable element which has a non-circular shape and which is configured to reduce the hypertension by facilitating an assumption of a non-circular shape by a blood vessel in a vicinity of a baroreceptor of the subject, during diastole of the subject. Other embodiments are also described.

Abstract: Removable cardiac implants, applicators for inserting, repositioning and/or removing them, and methods of using them are described. In particular, removable or repositionable ventricular partitioning devices are described. Systems including removable implants and applicators for inserting and/or removing them are also described.

Abstract: A mechanism for removing a fluid-filled object such as an intragastric balloon from a patient. The apparatus includes a delivery tube having a lumen and a retrieval tool able to slide within the lumen that can both puncture and grasp the intragastric balloon. The retrieval tool may have sharpened graspers with either a sharp tip and/or knife-like edges. Alternatively, the delivery tube itself may have sharpened cutting blades that deploy outward to puncture the intragastric balloon. One embodiment utilizes a suction cup tip on the delivery sheath and a sharpened puncture rod that extends past the distal tip of the lumen, for rapid deflation of a balloon. Various embodiments hasten the deflation process and simplify the manipulation required by the surgeon.

Abstract: A system for treating a diverticulum in a body lumen includes a tubular member including a lumen and an elongate member in an elongated state within the lumen of the tubular member. The elongate member is configured to form a coiled state when removed from the tubular member.

Abstract: An access assembly is provided including a tubular member having a proximal end and a distal end, the proximal end in mechanical cooperation with a foldable cap member having a first set of lumens extending the length of the tubular member. The access assembly also includes a first ring secured at the proximal end of the tubular member and a second ring secured at the distal end of the tubular member. The foldable cap member is configured to fold in at least one direction to expose a second set of lumens extending the length of the tubular member.