US20040098084A1 - Branch grafting device and method - Google Patents
Branch grafting device and method Download PDFInfo
- Publication number
- US20040098084A1 US20040098084A1 US10/653,401 US65340103A US2004098084A1 US 20040098084 A1 US20040098084 A1 US 20040098084A1 US 65340103 A US65340103 A US 65340103A US 2004098084 A1 US2004098084 A1 US 2004098084A1
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- Prior art keywords
- stent graft
- deployment
- limb
- extending
- wire
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2/954—Instruments specially adapted for placement or removal of stents or stent-grafts for placing stents or stent-grafts in a bifurcation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2/06—Blood vessels
- A61F2002/065—Y-shaped blood vessels
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2002/9505—Instruments specially adapted for placement or removal of stents or stent-grafts having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument
- A61F2002/9511—Instruments specially adapted for placement or removal of stents or stent-grafts having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument the retaining means being filaments or wires
Definitions
- This invention relates to a bifurcated or branched stent graft and to a deployment device for deploying a branched stent graft and a method of deploying such a device as well as to a temporary stent graft anchoring system.
- the invention will be generally discussed with reference to deploying a branched stent graft into an internal iliac artery from the common iliac but is not so limited and may be used with deployment into any branched vessel but is particularly applicable where the vessel into which the device is deployed is a blind vessel, that is, access is not available from an end of the vessel remote from the bifurcation from a main vessel.
- distal with respect to a portion of the vasculature of a patient, a deployment device or a prosthesis is the end of the vasculature, deployment device or prosthesis furthest away in the direction of blood flow from the heart and the term ‘proximal’ means the portion of the vasculature, deployment device or end of the prosthesis nearer to the heart.
- proximal means the portion of the vasculature, deployment device or end of the prosthesis nearer to the heart.
- caudal and cranial respectively should be understood.
- the invention is said to reside in an endoluminal stent graft deployment system adapted for deployment of a limb of a branched stent graft into a blind vessel, the deployment system including, a deployment device having a distal end and a proximal end and including the branched stent graft releasably retained thereon at the proximal end thereof, an inner sheath slidably and coaxially mounted on the deployment device, the branched stent graft having a main body and a limb extending therefrom, the limb extending distally from a bifurcation in the main body, the branched stent graft being mounted on the deployment device with the deployment catheter passing through the main body, the inner sheath enclosing the main body up to distally of the bifurcation, and a separate deflecting wire guide extending into the limb from the distal end of the deployment device.
- the endoluminal stent graft deployment device further includes an outer sheath slidably and coaxially mounted on the inner sheath and adapted to enclose the entire stent graft.
- the endoluminal stent graft deployment system further includes an anchor wire arrangement extending between the inner and outer sheaths and extending to and fastened to the main body of the stent graft adjacent to the bifurcation.
- the anchor wire arrangement may include an anchor wire and an anchor release wire and the anchor release wire extending to an anchor wire release arrangement at the distal end of the deployment device and adapted to remain outside the patient during deployment.
- the separate deflecting wire guide may include a guide wire arrangement extending through the limb and extending distally therefrom to assist with directing the limb into the blind vessel.
- the separate deflecting wire guide extending to the limb includes a guide wire and a guide wire sheath, the guide wire being movable within the guide wire sheath from outside the patient during deployment.
- the deployment device may include a guide wire catheter mounted coaxially and movably within a deployment catheter, the guide wire catheter extending to a nose cone and the branched stent graft releasably retained distally of the nose cone.
- the endoluminal stent graft deployment system further includes a diameter reducing arrangement on at least part of the main body of the stent graft and a diameter reducing arrangement on the limb of the stent graft.
- the diameter reducing arrangements may each include ties around the main body or limb to reduce the diameter of the main body or limb from a deployed diameter to a compressed diameter and a trigger wire arrangement to release the ties to allow the main body or limb to expand to the deployed diameter. Generally it is intended that the released ties remain associated with the stent graft.
- the trigger wire arrangement may include a trigger wire release arrangement at the distal end of the deployment device that is adapted to remain outside the patient during deployment.
- the branched stent graft comprises a tubular body and self expanding stents at, at least the proximal and distal ends of the main body and at the distal end of the limb. Further self expand stents may be provided on the main body and limb.
- the stents may be zig-zag Z stents made from Nitinol or stainless steel.
- the limb includes on an outer surface thereof fibres extending therefrom to improve adhesion to the vessel wall.
- the anchor wire arrangement may include an anchor wire and an anchor wire release wire and the anchor wire release wire extending to an anchor wire release arrangement at the distal end of the deployment device and adapted to remain outside the patient during deployment.
- the anchor wire and anchor wire release wire extend through an anchor wire catheter which is positioned between the inner and outer sheaths.
- the invention resides in a method of deploying a limb of a branched stent graft into a blind vessel in a human or animal body, the branched stent graft being mounted on a deployment device, the branched stent graft having a main body and a limb extending therefrom, the limb extending distally from a bifurcation in the main body, the method including the steps of:
- the step of manipulating by withdrawing the deployment device slightly may include the step of retaining the main body of the branched stent graft on the deployment device by means of an anchor wire and the step of releasing the branched stent graft may include the step of releasing the anchor wire.
- the step of releasing the branched stent graft may include the step of releasing diameter reducing ties on the limb and main body of the branched stent graft using a trigger wire system.
- the step of deploying the deployment device may include the step of releasably retaining the branched stent graft on the deployment device by means of an inner and outer coaxial sheath, the outer sheath retaining the whole of the branched stent graft and the inner sheath retaining a portion of the main body of the branched stent graft distal of the bifurcation.
- the invention is said to reside in an endoluminal stent graft deployment system adapted for deployment of a limb of a branched stent graft into a blind vessel, the deployment system including, a deployment device having a distal end and a proximal end and including the branched stent graft releasably retained thereto at the proximal end thereof; an inner sheath slidably and coaxially mounted on the deployment device, an outer sheath slidably and coaxially mounted on the inner sheath, the branched stent graft having a main body and a limb extending therefrom, the limb extending distally from a bifurcation in the main body, the branched stent graft being mounted on the deployment device in an annular recess thereon with the deployment catheter passing through the main body, the inner sheath enclosing the main body up to distally of the bifurcation, the outer
- the endoluminal stent graft deployment system further includes a guide wire arrangement extending through the limb and extending distally therefrom to assist with directing the limb into the blind vessel.
- the deployment device may include a guide wire catheter mounted coaxially within a deployment catheter, the guide wire catheter extending to a nose cone and the annular recess being between the nose cone and the deployment catheter.
- the endoluminal stent graft deployment system further includes a diameter reducing arrangement on at least part of the main body of the stent graft.
- the endoluminal stent graft deployment system further includes a diameter reducing arrangement on the limb of the stent graft.
- the diameter reducing arrangement may include ties around the stent graft to reduce the diameter of the stent graft from a deployed diameter to a compressed diameter and a trigger wire arrangement to release the ties to allow the stent graft to expand to the deployed diameter.
- the trigger wire arrangement may include a trigger wire release arrangement at the distal end of the deployment device and adapted to remain outside the patient during deployment.
- the branched stent graft comprises a tubular body and self expanding stents at at least the proximal and distal ends of the main body and at the distal end of the limb.
- the guide wire arrangement extending to the limb may include a guide wire and a guide wire catheter extending to the distal end of the deployment device, the guide wire being movable within the guide wire catheter from outside the patient during deployment.
- the anchor wire arrangement may include an anchor wire and an anchor release wire and the anchor release wire extending to an anchor wire release arrangement at the distal end of the deployment device and adapted to remain outside the patient during deployment.
- the invention is said to reside in an endoluminal stent graft deployment system adapted for endoluminal deployment of a stent graft, the deployment system including a deployment device having a distal end and a proximal end and including the stent graft releasably retained thereon at the proximal end thereof, characterized by an anchor wire arrangement extending from the distal end of the deployment device and engaging the stent graft to thereby anchor the stent graft during manipulation of the deployment device or other deployment devices through the stent graft.
- the anchor wire arrangement includes an anchor wire and an anchor release wire and the anchor release wire extending to an anchor wire release arrangement at the distal end of the deployment device and adapted to remain outside the patient during deployment.
- the deployment device may include an inner sheath and an outer sheath and the anchor wire and an anchor release wire extend between the inner and outer sheaths in an anchor wire catheter.
- FIG. 1 shows a deployment device according to one embodiment of the invention.
- FIG. 2A to 2 I show various stages of deployment using the device shown in FIG. 1.
- U.S. Pat. No. 5,387,235 entitled “Endovascular Transluminal Prosthesis For Repair Of Aneurysms” discloses apparatus and methods of retaining grafts onto deployment devices. These features and other features disclosed in U.S. Pat. No. 5,387,235 could be used with the present invention and the disclosure of U.S. Pat. No. 5,387,235 is herewith incorporated in its entirety into this specification.
- U.S. Pat. No. 5,720,776 entitled “Stent Barb” discloses improved barbs with various forms of mechanical attachment to a stent.
- U.S. Pat. No. 6,206,931 entitled “Graft Prosthesis Materials” discloses graft prosthesis materials and a method for implanting, transplanting replacing and repairing a part of a patient and particularly the manufacture and use of a purified, collagen based matrix structure removed from a submucosa tissue source.
- PCT Patent Publication Number No. WO98/53761 entitled “A Prosthesis and a Method of Deploying a Prosthesis” discloses an introducer for a prosthesis which retains the prosthesis so that each end can be moved independently.
- PCT Patent Publication No. WO99/29262 entitled “Endoluminal Aortic Stents” discloses a fenestrated prosthesis for placement where there are intersecting arteries. This feature and other features disclosed in PCT Patent Publication No. WO99/29262 could be used with the present invention and the disclosure of PCT Patent Publication No. WO99/29262 is herewith incorporated in its entirety into this specification.
- PCT Patent Publication No. WO03/034948 entitled “Prostheses for Curved Lumens” discloses prostheses with arrangements for bending the prosthesis for placement into curved lumens. This feature and other features disclosed in PCT Patent Publication No. WO03/034948 could be used with the present invention and the disclosure of PCT Patent Publication No. WO03/034948 is herewith incorporated in its entirety into this specification.
- Australian Provisional Patent Serial No. 60/392,682 entitled “Trigger Wires” discloses release wire systems for the release of stent grafts retained on introducer devices. This feature and other features disclosed in Australian Provisional Patent Serial No. 60/392,682 could be used with the present invention and the disclosure of Australian Provisional Patent Serial No. 60/392,682 is herewith incorporated in its entirety into this specification.
- Australian Provisional Patent Serial No. 10/609,846 entitled “Thoracic Deployment Device” discloses introducer devices adapted for deployment of stent grafts particularly in the thoracic arch. This feature and other features disclosed in Australian Provisional Patent Serial No. 10/609,846 could be used with the present invention and the disclosure of Australian Provisional Patent Serial No. 10/609,846 is herewith incorporated in its entirety into this specification.
- Australian Provisional Patent Serial No. 60/391,737 entitled “A Stent-Graft Fastening Arrangement” discloses arrangements for fastening stents onto grafts particularly for exposed stents. This feature and other features disclosed in Australian Provisional Patent Serial No. 60/391,737 could be used with the present invention and the disclosure of Australian Provisional Patent Serial No. 60/391,737 is herewith incorporated in its entirety into this specification.
- PCT Patent Publication No. WO03/053287 entitled “Improving Graft Adhesion” discloses arrangements on stent grafts for enhancing the adhesion of such stent grafts into walls of vessels in which they are deployed. This feature and other features disclosed in PCT Patent Publication No. WO03/053287 could be used with the present invention and the disclosure of PCT Patent Publication No. WO03/053287 is herewith incorporated in its entirety into this specification.
- Australian Provisional Patent Application No. 2002950950 entitled “Composite Prostheses” discloses prostheses or stent grafts suitable for endoluminal deployment. These prostheses and other features disclosed in Australian Provisional Patent Application No. 2002950950 could be used with the present invention and the disclosure of Australian Provisional Patent Application No. 2002950950 is herewith incorporated in its entirety into this specification.
- the deployment device comprises a deployment catheter 1 having slidably mounted over it an outer sheath 3 and an inner sheath 4 .
- the outer sheath 3 is manipulated from an outer sheath manipulator generally shown as 6 and the inner sheath is manipulated from an inner sheath manipulator 7 .
- Extending from a nose cone 8 throughout the deployment catheter is a guide wire catheter 9 .
- the guide wire catheter 9 is fixed for movement with respect to the deployment catheter 1 by means of a pin vice 10 . Release of the pin vice allows movement of the nose cone with respect to the deployment catheter 1 .
- a stent graft 16 (FIG. 2A) is retained in the region 11 of the deployment device immediately distally of the nose cone 8 as can be particularly seen in FIG. 2A.
- the stent graft 16 includes a proximal body portion 17 enclosed and retained in a constrained state by the outer sheath 3 and a distal body portion 18 enclosed and retained in a constrained state by the inner sheath 4 .
- Extending between the proximal 16 and distal 18 body portions from a bifurcation 15 is a limb 19 .
- the proximal body portion 17 is retained in a compressed state by diameter reducing ties 20 and the limb 19 is retained in a compressed state by diameter reducing ties 21 . The method of releasing these diameter reducing ties will be discussed later.
- a deflecting wire guide arrangement generally shown as 12 on the deployment device in FIG. 1 has a guide wire catheter 13 with a guide wire 14 within it.
- the separate deflecting guide wire catheter 13 extends from the deployment catheter 1 at a Y-piece generally shown as 40 .
- the deflecting guide wire catheter 13 extends from the part of the deployment device which in use remains outside of the patient through the inner sheath 3 and is bent and extends into the limb 19 .
- the deflecting wire guide assists in causing the limb to deflect laterally from the main body of the stent graft.
- An anchor wire arrangement is mounted at 24 to the main body of the stent graft 16 adjacent the bifurcation 15 .
- the anchor wire arrangement includes an anchor wire catheter 25 , an anchor wire 26 which passes through the anchor wire catheter 25 and an anchor wire release wire 27 which also passes through the anchor wire catheter 25 .
- the anchor wire 26 includes a bead 29 at its proximal end so that a suture 30 can be fastened through the stent graft body adjacent to the bifurcation 15 and then around the anchor wire 26 and retained by a knot 28 which is locked by the anchor wire release wire 27 .
- the anchor wire catheter 25 passes between the outer sheath 3 and the inner sheath 4 and extends out of the rear of the outer sheath manipulator 6 .
- the cap 32 can be removed to enable release of the anchor wire release wire 27 and pull it through the anchor wire catheter 25 and the cap 31 can be released to pull the actual anchor wire 26 back.
- the anchor wire release wire 27 is withdrawn the knot 28 is unlocked and the suture 30 is released and the anchor wire 26 is released from the stent graft body 16 .
- the diameter reducing ties 21 on the limb 19 are activated by the release of the trigger wire mechanism 35 on the deployment catheter 1 .
- the diameter reducing ties 20 on the proximal body portion 17 are released by means of the trigger wire release mechanism 36 .
- Trigger wire 38 extends from the diameter reducing ties 20 to the release 36 and trigger wire 39 extends from the diameter reducing ties 21 to the release 35 .
- FIGS. 2A to 21 show various stages of deployment of a stent graft using the deployment device discussed in relation to FIG. 1.
- FIG. 2A it will be seen that the stent graft 16 is retained within the outer sheath 3 and inner sheath 4 in the manner discussed above. It will be noted that the limb 19 is outside the inner sheath 4 but inside the outer sheath 3 .
- FIG. 2B the outer sheath has been withdrawn to allow the limb 19 to deflect laterally.
- FIGS. 2A and 2B For clarity the portion of the iliac bifurcation into which the device is deployed according to this invention is not illustrated in FIGS. 2A and 2B but is shown in dotted lines in later illustrations.
- the deployment device is deployed in an iliac artery which has a common iliac artery 50 branching into an internal iliac artery 51 and the external iliac artery 52 .
- the deployment device has been deployed through the external iliac artery 52 .
- the common iliac artery 50 is deformed into an aneurysmal sac and to provide a good place for deployment of a leg of an endoluminal device to bridge the aneurysm the device of the present invention is deployed.
- the outer sheath 3 has been withdrawn to a position in which where the limb 19 can escape from being retained by the outer sheath 3 and the guide wire 14 has been advanced so that it can extend into the internal iliac artery 51 .
- radiological techniques can be used to ensure proper alignment before advancement of the guide wire 14 into the internal iliac artery 51 .
- Suitable radiopaque markers may be place as needed on the main body and limb to assist with placement and contrast fluids may be provided through the deployment device to assist with visualization of the arterial structure.
- the entire device can be manipulated from outside the patient by being withdrawn slightly so that the limb 19 extends into the internal iliac artery 51 while being guided by the already placed guide wire 14 .
- the diameter reducing ties 21 on the limb 19 are released by removal of the trigger wire release 35 and the limb 19 expands under the effect of self expanding stents to engage with the walls of the internal iliac 51 as particularly can be seen in FIG. 2E.
- fibres 55 are included on the limb 19 to improve adhesion onto the wall of the internal iliac artery 51 by encouraging ingrowth.
- the diameter reducing ties 20 on the proximal body portion 19 have been released by removal of the trigger wire release mechanism 36 so that the proximal body portion expands under the effect of self expanding stents to its full size.
- the proximal body portion does not necessarily engage with the walls of the common iliac artery 50 because of the aneurysmal sac within the vessel 50 .
- the inner sheath 4 is withdrawn to release the distal body portion 18 which expands under the effect of self expanding stents to engage against the walls of the external iliac artery.
- the deployment of the iliac branched stent graft is essentially completed and the nose cone 8 , guide wire catheter 9 and internal sheath 4 along with the separate guide wire catheter 13 and guide wire 14 can be withdrawn leaving the outer sheath 3 in place for deployment of other devices through the iliac branched stent graft 16 as required.
- the anchor wire arrangement may still be maintained in place to hold the branched stent graft in place while further deployment occurs through the device.
- Deployment of subsequent devices can be carried out over guide wire 57 which remains in place after removal of the iliac branched stent graft deployment device.
- FIG. 2H for instance shows the leg 56 of a further stent graft deployed within the proximal end of the proximal body portion 17 .
- the anchor wire arrangement can be withdrawn by withdrawal of the anchor wire release wire 27 which releases the knot 28 so that the anchor wire 26 and the anchor wire catheter 25 can be then be withdrawn to leave the situation shown in FIG. 2I.
- a stent graft can be deployed into a blind vessel such as an internal iliac and then that stent graft anchored while further stent grafting is occurring.
- an anchoring system using an anchor wire catheter, an anchor wire and an anchor wire release is not restricted to this application but may be used in other situations where a temporary anchoring of a stent graft is desirable.
Abstract
Description
- This application claims priority to Australian Provisional Patent Application No. 2002951147, filed Sep. 2, 2002.
- This invention relates to a bifurcated or branched stent graft and to a deployment device for deploying a branched stent graft and a method of deploying such a device as well as to a temporary stent graft anchoring system.
- The invention will be generally discussed with reference to deploying a branched stent graft into an internal iliac artery from the common iliac but is not so limited and may be used with deployment into any branched vessel but is particularly applicable where the vessel into which the device is deployed is a blind vessel, that is, access is not available from an end of the vessel remote from the bifurcation from a main vessel.
- Throughout this specification the term ‘distal’ with respect to a portion of the vasculature of a patient, a deployment device or a prosthesis is the end of the vasculature, deployment device or prosthesis furthest away in the direction of blood flow from the heart and the term ‘proximal’ means the portion of the vasculature, deployment device or end of the prosthesis nearer to the heart. For other lumens within the human or animal body the terms caudal and cranial respectively should be understood.
- In one form therefore the invention is said to reside in an endoluminal stent graft deployment system adapted for deployment of a limb of a branched stent graft into a blind vessel, the deployment system including, a deployment device having a distal end and a proximal end and including the branched stent graft releasably retained thereon at the proximal end thereof, an inner sheath slidably and coaxially mounted on the deployment device, the branched stent graft having a main body and a limb extending therefrom, the limb extending distally from a bifurcation in the main body, the branched stent graft being mounted on the deployment device with the deployment catheter passing through the main body, the inner sheath enclosing the main body up to distally of the bifurcation, and a separate deflecting wire guide extending into the limb from the distal end of the deployment device.
- Preferably the endoluminal stent graft deployment device further includes an outer sheath slidably and coaxially mounted on the inner sheath and adapted to enclose the entire stent graft.
- Preferably the endoluminal stent graft deployment system further includes an anchor wire arrangement extending between the inner and outer sheaths and extending to and fastened to the main body of the stent graft adjacent to the bifurcation.
- The anchor wire arrangement may include an anchor wire and an anchor release wire and the anchor release wire extending to an anchor wire release arrangement at the distal end of the deployment device and adapted to remain outside the patient during deployment.
- The separate deflecting wire guide may include a guide wire arrangement extending through the limb and extending distally therefrom to assist with directing the limb into the blind vessel.
- Preferably the separate deflecting wire guide extending to the limb includes a guide wire and a guide wire sheath, the guide wire being movable within the guide wire sheath from outside the patient during deployment.
- The deployment device may include a guide wire catheter mounted coaxially and movably within a deployment catheter, the guide wire catheter extending to a nose cone and the branched stent graft releasably retained distally of the nose cone.
- Preferably the endoluminal stent graft deployment system further includes a diameter reducing arrangement on at least part of the main body of the stent graft and a diameter reducing arrangement on the limb of the stent graft.
- The diameter reducing arrangements may each include ties around the main body or limb to reduce the diameter of the main body or limb from a deployed diameter to a compressed diameter and a trigger wire arrangement to release the ties to allow the main body or limb to expand to the deployed diameter. Generally it is intended that the released ties remain associated with the stent graft.
- The trigger wire arrangement may include a trigger wire release arrangement at the distal end of the deployment device that is adapted to remain outside the patient during deployment.
- In one form the branched stent graft comprises a tubular body and self expanding stents at, at least the proximal and distal ends of the main body and at the distal end of the limb. Further self expand stents may be provided on the main body and limb. The stents may be zig-zag Z stents made from Nitinol or stainless steel.
- Preferably the limb includes on an outer surface thereof fibres extending therefrom to improve adhesion to the vessel wall.
- The anchor wire arrangement may include an anchor wire and an anchor wire release wire and the anchor wire release wire extending to an anchor wire release arrangement at the distal end of the deployment device and adapted to remain outside the patient during deployment. The anchor wire and anchor wire release wire extend through an anchor wire catheter which is positioned between the inner and outer sheaths.
- In an alternative form the invention resides in a method of deploying a limb of a branched stent graft into a blind vessel in a human or animal body, the branched stent graft being mounted on a deployment device, the branched stent graft having a main body and a limb extending therefrom, the limb extending distally from a bifurcation in the main body, the method including the steps of:
- deploying the deployment device into a vessel from which the blind vessel extends;
- releasing a limb of the main body of the branched stent graft from the deployment device such that the limb extends laterally and distally adjacent the blind vessel;
- extending a guide wire from the limb into the blind vessel;
- manipulating the deployment device by withdrawing the deployment device slightly to cause the limb to enter the blind vessel assisted by the guide wire, and
- releasing the branched stent graft from the deployment device.
- The step of manipulating by withdrawing the deployment device slightly may include the step of retaining the main body of the branched stent graft on the deployment device by means of an anchor wire and the step of releasing the branched stent graft may include the step of releasing the anchor wire.
- The step of releasing the branched stent graft may include the step of releasing diameter reducing ties on the limb and main body of the branched stent graft using a trigger wire system.
- The step of deploying the deployment device may include the step of releasably retaining the branched stent graft on the deployment device by means of an inner and outer coaxial sheath, the outer sheath retaining the whole of the branched stent graft and the inner sheath retaining a portion of the main body of the branched stent graft distal of the bifurcation.
- In an alternative form the invention is said to reside in an endoluminal stent graft deployment system adapted for deployment of a limb of a branched stent graft into a blind vessel, the deployment system including, a deployment device having a distal end and a proximal end and including the branched stent graft releasably retained thereto at the proximal end thereof; an inner sheath slidably and coaxially mounted on the deployment device, an outer sheath slidably and coaxially mounted on the inner sheath, the branched stent graft having a main body and a limb extending therefrom, the limb extending distally from a bifurcation in the main body, the branched stent graft being mounted on the deployment device in an annular recess thereon with the deployment catheter passing through the main body, the inner sheath enclosing the main body up to distally of the bifurcation, the outer sheath enclosing the entire stent graft and extending proximally of the annular recess, and an anchor wire arrangement extending between the inner and outer sheaths and extending to and fastened to the main body adjacent to the bifurcation.
- Preferably the endoluminal stent graft deployment system further includes a guide wire arrangement extending through the limb and extending distally therefrom to assist with directing the limb into the blind vessel.
- The deployment device may include a guide wire catheter mounted coaxially within a deployment catheter, the guide wire catheter extending to a nose cone and the annular recess being between the nose cone and the deployment catheter.
- Preferably the endoluminal stent graft deployment system further includes a diameter reducing arrangement on at least part of the main body of the stent graft.
- Preferably the endoluminal stent graft deployment system further includes a diameter reducing arrangement on the limb of the stent graft.
- The diameter reducing arrangement may include ties around the stent graft to reduce the diameter of the stent graft from a deployed diameter to a compressed diameter and a trigger wire arrangement to release the ties to allow the stent graft to expand to the deployed diameter.
- The trigger wire arrangement may include a trigger wire release arrangement at the distal end of the deployment device and adapted to remain outside the patient during deployment.
- Preferably the branched stent graft comprises a tubular body and self expanding stents at at least the proximal and distal ends of the main body and at the distal end of the limb.
- The guide wire arrangement extending to the limb may include a guide wire and a guide wire catheter extending to the distal end of the deployment device, the guide wire being movable within the guide wire catheter from outside the patient during deployment.
- The anchor wire arrangement may include an anchor wire and an anchor release wire and the anchor release wire extending to an anchor wire release arrangement at the distal end of the deployment device and adapted to remain outside the patient during deployment.
- In an alternative form the invention is said to reside in an endoluminal stent graft deployment system adapted for endoluminal deployment of a stent graft, the deployment system including a deployment device having a distal end and a proximal end and including the stent graft releasably retained thereon at the proximal end thereof, characterized by an anchor wire arrangement extending from the distal end of the deployment device and engaging the stent graft to thereby anchor the stent graft during manipulation of the deployment device or other deployment devices through the stent graft.
- Preferably the anchor wire arrangement includes an anchor wire and an anchor release wire and the anchor release wire extending to an anchor wire release arrangement at the distal end of the deployment device and adapted to remain outside the patient during deployment.
- The deployment device may include an inner sheath and an outer sheath and the anchor wire and an anchor release wire extend between the inner and outer sheaths in an anchor wire catheter.
- This generally describes the invention but to assist with understanding the invention will now be exemplified with the assistance of the accompanying drawings.
- In the drawings:
- FIG. 1 shows a deployment device according to one embodiment of the invention; and
- FIG. 2A to2I show various stages of deployment using the device shown in FIG. 1.
- U.S. Pat. No. 5,387,235 entitled “Endovascular Transluminal Prosthesis For Repair Of Aneurysms” discloses apparatus and methods of retaining grafts onto deployment devices. These features and other features disclosed in U.S. Pat. No. 5,387,235 could be used with the present invention and the disclosure of U.S. Pat. No. 5,387,235 is herewith incorporated in its entirety into this specification.
- U.S. Pat. No. 5,720,776 entitled “Stent Barb” discloses improved barbs with various forms of mechanical attachment to a stent. These features and other features disclosed in U.S. Pat. No. 5,720,776 could be used with the present invention and the disclosure of U.S. Pat. No. 5,720,776 is herewith incorporated in its entirety into this specification.
- U.S. Pat. No. 6,206,931 entitled “Graft Prosthesis Materials” discloses graft prosthesis materials and a method for implanting, transplanting replacing and repairing a part of a patient and particularly the manufacture and use of a purified, collagen based matrix structure removed from a submucosa tissue source. These features and other features disclosed in U.S. Pat. No. 6,206,931 could be used with the present invention and the disclosure of U.S. Pat. No. 6,206,931 is herewith incorporated in its entirety into this specification.
- PCT Patent Publication Number No. WO98/53761 entitled “A Prosthesis and a Method of Deploying a Prosthesis” discloses an introducer for a prosthesis which retains the prosthesis so that each end can be moved independently. These features and other features disclosed in PCT Patent Publication No. WO98/53761 could be used with the present invention and the disclosure of PCT Patent Publication No. WO98/53761 is herewith incorporated in its entirety into this specification.
- PCT Patent Publication No. WO99/29262 entitled “Endoluminal Aortic Stents” discloses a fenestrated prosthesis for placement where there are intersecting arteries. This feature and other features disclosed in PCT Patent Publication No. WO99/29262 could be used with the present invention and the disclosure of PCT Patent Publication No. WO99/29262 is herewith incorporated in its entirety into this specification.
- PCT Patent Publication No. WO03/034948 entitled “Prostheses for Curved Lumens” discloses prostheses with arrangements for bending the prosthesis for placement into curved lumens. This feature and other features disclosed in PCT Patent Publication No. WO03/034948 could be used with the present invention and the disclosure of PCT Patent Publication No. WO03/034948 is herewith incorporated in its entirety into this specification.
- Australian Provisional Patent Serial No. 60/392,682 entitled “Trigger Wires” discloses release wire systems for the release of stent grafts retained on introducer devices. This feature and other features disclosed in Australian Provisional Patent Serial No. 60/392,682 could be used with the present invention and the disclosure of Australian Provisional Patent Serial No. 60/392,682 is herewith incorporated in its entirety into this specification.
- Australian Provisional Patent Serial No. 10/609,846 entitled “Thoracic Deployment Device” discloses introducer devices adapted for deployment of stent grafts particularly in the thoracic arch. This feature and other features disclosed in Australian Provisional Patent Serial No. 10/609,846 could be used with the present invention and the disclosure of Australian Provisional Patent Serial No. 10/609,846 is herewith incorporated in its entirety into this specification.
- Australian Provisional Patent Serial No. 60/391,737 entitled “A Stent-Graft Fastening Arrangement” discloses arrangements for fastening stents onto grafts particularly for exposed stents. This feature and other features disclosed in Australian Provisional Patent Serial No. 60/391,737 could be used with the present invention and the disclosure of Australian Provisional Patent Serial No. 60/391,737 is herewith incorporated in its entirety into this specification.
- PCT Patent Publication No. WO03/053287 entitled “Improving Graft Adhesion” discloses arrangements on stent grafts for enhancing the adhesion of such stent grafts into walls of vessels in which they are deployed. This feature and other features disclosed in PCT Patent Publication No. WO03/053287 could be used with the present invention and the disclosure of PCT Patent Publication No. WO03/053287 is herewith incorporated in its entirety into this specification.
- Australian Provisional Patent Application No. 2002950950 entitled “Composite Prostheses” discloses prostheses or stent grafts suitable for endoluminal deployment. These prostheses and other features disclosed in Australian Provisional Patent Application No. 2002950950 could be used with the present invention and the disclosure of Australian Provisional Patent Application No. 2002950950 is herewith incorporated in its entirety into this specification.
- Now looking more closely at the drawings and more particularly the embodiment shown in FIG. 1 and parts of this embodiment shown in FIGS. 2A and 2B it will be seen that the deployment device comprises a
deployment catheter 1 having slidably mounted over it anouter sheath 3 and aninner sheath 4. Theouter sheath 3 is manipulated from an outer sheath manipulator generally shown as 6 and the inner sheath is manipulated from aninner sheath manipulator 7. Extending from anose cone 8 throughout the deployment catheter is aguide wire catheter 9. Theguide wire catheter 9 is fixed for movement with respect to thedeployment catheter 1 by means of apin vice 10. Release of the pin vice allows movement of the nose cone with respect to thedeployment catheter 1. - A stent graft16 (FIG. 2A) is retained in the
region 11 of the deployment device immediately distally of thenose cone 8 as can be particularly seen in FIG. 2A. Thestent graft 16 includes aproximal body portion 17 enclosed and retained in a constrained state by theouter sheath 3 and adistal body portion 18 enclosed and retained in a constrained state by theinner sheath 4. Extending between the proximal 16 and distal 18 body portions from abifurcation 15 is alimb 19. Theproximal body portion 17 is retained in a compressed state bydiameter reducing ties 20 and thelimb 19 is retained in a compressed state bydiameter reducing ties 21. The method of releasing these diameter reducing ties will be discussed later. - A deflecting wire guide arrangement generally shown as12 on the deployment device in FIG. 1 has a
guide wire catheter 13 with aguide wire 14 within it. - The separate deflecting
guide wire catheter 13 extends from thedeployment catheter 1 at a Y-piece generally shown as 40. - The deflecting
guide wire catheter 13 extends from the part of the deployment device which in use remains outside of the patient through theinner sheath 3 and is bent and extends into thelimb 19. When thelimb 1 9 is released as discussed below the deflecting wire guide assists in causing the limb to deflect laterally from the main body of the stent graft. - An anchor wire arrangement is mounted at24 to the main body of the
stent graft 16 adjacent thebifurcation 15. The anchor wire arrangement includes ananchor wire catheter 25, ananchor wire 26 which passes through theanchor wire catheter 25 and an anchorwire release wire 27 which also passes through theanchor wire catheter 25. Theanchor wire 26 includes abead 29 at its proximal end so that asuture 30 can be fastened through the stent graft body adjacent to thebifurcation 15 and then around theanchor wire 26 and retained by aknot 28 which is locked by the anchorwire release wire 27. Theanchor wire catheter 25 passes between theouter sheath 3 and theinner sheath 4 and extends out of the rear of theouter sheath manipulator 6. Thecap 32 can be removed to enable release of the anchorwire release wire 27 and pull it through theanchor wire catheter 25 and thecap 31 can be released to pull theactual anchor wire 26 back. When the anchorwire release wire 27 is withdrawn theknot 28 is unlocked and thesuture 30 is released and theanchor wire 26 is released from thestent graft body 16. - The
diameter reducing ties 21 on thelimb 19 are activated by the release of thetrigger wire mechanism 35 on thedeployment catheter 1. Thediameter reducing ties 20 on theproximal body portion 17 are released by means of the triggerwire release mechanism 36.Trigger wire 38 extends from thediameter reducing ties 20 to therelease 36 andtrigger wire 39 extends from thediameter reducing ties 21 to therelease 35. - This then generally describes the deployment apparatus but to assist with understanding reference will now be made to FIGS. 2A to21 which show various stages of deployment of a stent graft using the deployment device discussed in relation to FIG. 1.
- In FIG. 2A it will be seen that the
stent graft 16 is retained within theouter sheath 3 andinner sheath 4 in the manner discussed above. It will be noted that thelimb 19 is outside theinner sheath 4 but inside theouter sheath 3. - In FIG. 2B the outer sheath has been withdrawn to allow the
limb 19 to deflect laterally. - For clarity the portion of the iliac bifurcation into which the device is deployed according to this invention is not illustrated in FIGS. 2A and 2B but is shown in dotted lines in later illustrations.
- As can be seen in FIG. 2C, the deployment device is deployed in an iliac artery which has a common
iliac artery 50 branching into an internaliliac artery 51 and the externaliliac artery 52. The deployment device has been deployed through the externaliliac artery 52. The commoniliac artery 50 is deformed into an aneurysmal sac and to provide a good place for deployment of a leg of an endoluminal device to bridge the aneurysm the device of the present invention is deployed. - As can be seen in FIG. 2C, the
outer sheath 3 has been withdrawn to a position in which where thelimb 19 can escape from being retained by theouter sheath 3 and theguide wire 14 has been advanced so that it can extend into the internaliliac artery 51. It will be understood by those skilled in the field that radiological techniques can be used to ensure proper alignment before advancement of theguide wire 14 into the internaliliac artery 51. Suitable radiopaque markers may be place as needed on the main body and limb to assist with placement and contrast fluids may be provided through the deployment device to assist with visualization of the arterial structure. - As can be seen in FIG. 2D, once the
guide wire 14 has been deployed into the internaliliac artery 51, the entire device can be manipulated from outside the patient by being withdrawn slightly so that thelimb 19 extends into the internaliliac artery 51 while being guided by the already placedguide wire 14. - Once a sufficient amount of the limb has been deployed into the internal
iliac artery 51, which can be observed by suitable radiological techniques, thediameter reducing ties 21 on thelimb 19 are released by removal of thetrigger wire release 35 and thelimb 19 expands under the effect of self expanding stents to engage with the walls of the internal iliac 51 as particularly can be seen in FIG. 2E. It will be noted thatfibres 55 are included on thelimb 19 to improve adhesion onto the wall of the internaliliac artery 51 by encouraging ingrowth. - As can be seen in FIG. 2F, the
diameter reducing ties 20 on theproximal body portion 19 have been released by removal of the triggerwire release mechanism 36 so that the proximal body portion expands under the effect of self expanding stents to its full size. At this stage, however, the proximal body portion does not necessarily engage with the walls of the commoniliac artery 50 because of the aneurysmal sac within thevessel 50. - In the next stage, as shown in FIG. 2G, the
inner sheath 4 is withdrawn to release thedistal body portion 18 which expands under the effect of self expanding stents to engage against the walls of the external iliac artery. At this stage the deployment of the iliac branched stent graft is essentially completed and thenose cone 8,guide wire catheter 9 andinternal sheath 4 along with the separateguide wire catheter 13 andguide wire 14 can be withdrawn leaving theouter sheath 3 in place for deployment of other devices through the iliac branchedstent graft 16 as required. At this stage, however, the anchor wire arrangement may still be maintained in place to hold the branched stent graft in place while further deployment occurs through the device. - Deployment of subsequent devices can be carried out over
guide wire 57 which remains in place after removal of the iliac branched stent graft deployment device. - FIG. 2H for instance shows the
leg 56 of a further stent graft deployed within the proximal end of theproximal body portion 17. - After deployment of further stent grafts as required, the anchor wire arrangement can be withdrawn by withdrawal of the anchor
wire release wire 27 which releases theknot 28 so that theanchor wire 26 and theanchor wire catheter 25 can be then be withdrawn to leave the situation shown in FIG. 2I. - It will be seen generally by this invention that a stent graft can be deployed into a blind vessel such as an internal iliac and then that stent graft anchored while further stent grafting is occurring.
- The use of an anchoring system using an anchor wire catheter, an anchor wire and an anchor wire release is not restricted to this application but may be used in other situations where a temporary anchoring of a stent graft is desirable.
- Throughout this specification various indications have been given as to the scope of the invention but the invention is not limited to only one of these but may reside in two or more of these combined together. The examples are given for illustration only and not for limitation.
Claims (27)
Priority Applications (1)
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Also Published As
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DE60315475T2 (en) | 2008-04-24 |
AU2002951147A0 (en) | 2002-09-19 |
US8506616B2 (en) | 2013-08-13 |
ATE369097T1 (en) | 2007-08-15 |
US20080114438A1 (en) | 2008-05-15 |
DE60315475D1 (en) | 2007-09-20 |
EP1539040B1 (en) | 2007-08-08 |
WO2004019823A1 (en) | 2004-03-11 |
JP2005537099A (en) | 2005-12-08 |
CA2495912A1 (en) | 2004-03-11 |
JP4628101B2 (en) | 2011-02-09 |
CA2495912C (en) | 2011-05-17 |
EP1539040A1 (en) | 2005-06-15 |
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