Abstract:
An intravascular anchoring implant is disclosed. The present invention also relates to the attachment to the intravascular implant of second and possibly third implants, such as a graft attachment device and a vascular graft. Methods of using the implant within the vasculature of the body, particularly adjacent to vascular aneurysms, are also disclosed

Description:
BACKGROUND OF THE INVENTION  
       [0001]     1. Field of the Invention  
         [0002]     The present invention relates generally to an intravascular fixation implant and methods of using the implant within the vasculature of the body, particularly adjacent to vascular aneurysms. The present invention also relates to the attachment to the intravascular implant of second and possibly third implants, such as a graft attachment device and a vascular graft.  
         [0003]     2. Description of the Related Art  
         [0004]     An aneurysm is an abnormal dilatation of a biological vessel. Aneurysms can alter flow through the affected vessel and often decrease the strength of the vessel wall, thereby increasing the vessel&#39;s risk of rupturing at the point of dilation or weakening. Implanting a vascular prosthesis through the vessel with the aneurysm is a common aneurysm therapy. Vascular grafts and stent grafts (e.g., ANEURX® Stent Graft System from Medtronic AVE, Inc., Santa Rosa, Calif.) are examples of vascular prostheses used to treat aneurysms by reconstructing the damaged vessel.  
         [0005]     Stent grafts rely on a secure attachment to the proximal, or upstream, neck of an aneurysm, particularly for aortic abdominal aneurysms (AAA), but several factors can interfere with this attachment. The neck does not contract and expand evenly as blood flows through the vessel. The portion of the neck closest to the spine remains relatively fixed while the remainder of the vessel expands and contracts in response to the changing blood pressure during normal pulsatile flow. This circumferentially dynamic expansion and contraction of the neck presents problems for attachment systems that expand and contract evenly around the entire circumference.  
         [0006]     Devices have been developed that attempt to solve the issue of vascular graft attachment, but those that permit for substantial radial expansion and contraction fail to have expansion and contraction rates that vary with respect to the angle around the vessel. U.S. Pat. No. 6,152,956 to Pierce discloses a radially expandable collar connected by wires to an expandable stent. The stent is used to anchor the collar to the aneurysm neck and has barbs with sharp ends that spring radially outward to embed into the walls of the vascular tissue. The stent is expandable, but is equally resilient at all angles around the entire circumference of the stent. Therefore, the stent is not designed to contract and expand dynamically with respect to the angle around the vessel. Further, the barbs are equidistantly located around the circumference of the vessel, further impairing circumferentially dynamic expansion and contraction.  
         [0007]     U.S. Pat. No. 6,361,556 by Chuter discloses a stent for attaching to grafts, where the stent is connected to an attachment system for anchoring to the vessel. The attaching system has hooks angled toward the graft. The stent is substantially rigid and balloon expandable and therefore maintains a fixed diameter and resists deformation from forces imposed by the vascular environment. The stent is therefore unable to substantially accommodate any expansion and contraction, let alone circumferentially dynamic expansion and contraction. The stent may not seal the graft under changing geometric conditions over time. The stent also has hooks equidistantly located around the circumference of the vessel that, like the barbs of Chuter described infra, further impair circumferentially dynamic expansion and contraction.  
         [0008]     There is thus a need for a device and method that can securely anchor a vascular graft within a vessel and adjust to the circumferentially varying contraction and expansion of the anchoring vessel during normal pulsatile flow. A need also exists for a device and method that can adjust to tortuous vasculature.  
       BRIEF SUMMARY OF THE INVENTION  
       [0009]     A fixation device for implantation in a biological vessel is disclosed. The fixation device has a frame having a longitudinal axis. The frame is configured to expand at variable amounts circumferentially with respect to the longitudinal axis. The frame can have a first section and a second section. The first section can remain fixed with respect to the vessel.  
         [0010]     Also disclosed is a vascular fixation device having a first fixation section, a first arm and a second fixation section. The first arm has a first end and a second end. The first end is attached to the first fixation section. The second end of the first arm is attached to the second fixation section.  
         [0011]     The vascular fixation device can also have a second arm. The second arm can have a first end and a second end. The first end of the second arm can be attached to the first fixation section. The second end of the second arm can be a terminus. The vascular fixation device can also have a third arm extending from the second fixation section.  
         [0012]     A vascular fixation device having a first fixation section, a first arm, and a second arm is also disclosed. The first arm extends from the first fixation section. The first arm has a first end. The first end of the first arm has a terminus. A second arm extends from the first fixation section. The second arm has a first end. The first end of the second arm has a terminus.  
         [0013]     The first arm can extend from the fixation section in a first direction. The second arm can extend from the fixation section in a second direction. The first direction can be substantially opposite to the second direction. The device can also have a graft attachment device. The graft attachment device can have a first end and a second end. The first end of the graft attachment device can be attached to the fixation section. The second end of the graft attachment device can be attached to a first vascular graft.  
         [0014]     Further disclosed is a device for fixing to a vascular wall. The device has a fixation section, a first arm, a second arm, and a graft attachment device. The first arm extends from a first side of the fixation section. The second arm extends from a second side of the fixation section. The graft attachment device has a first end and a second end. The first end of the graft attachment device is attached to the fixation section.  
         [0015]     The second end of the graft attachment device can be attached to a first vascular graft. The first vascular graft can have a bifurcated graft. The second end of the graft attachment device can be attached to a second vascular graft. The first end of the graft attachment device can be attached to the fixation section near the vascular wall. The graft attachment device can be configured to radially expand when the graft attachment device is subject to a force in the direction of the graft.  
         [0016]     An assembly for fixing to a vascular wall is also disclosed. The assembly has an anchor and a graft. The graft has a first end. The graft is attached to the anchor. The assembly is configured so that when a force is applied pushing the graft away from the anchor then the first end of the graft radially expands.  
         [0017]     Additionally disclosed is a method of attaching a vascular prosthesis to a vascular wall. The method includes deploying a fixation device in a vessel and attaching a vascular prosthesis to the fixation device. The fixation device has a fixation section, a first arm extending from the fixation section, and a second arm extending from the fixation section. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0018]      FIG. 1  illustrates an embodiment of the intravascular graft anchoring assembly and the see-through proximal end of a graft.  
         [0019]      FIGS. 2-4  illustrate various embodiments of vascular fixation devices.  
         [0020]      FIGS. 5-7  are top views of various embodiments of vascular fixation devices.  
         [0021]      FIGS. 8-16  illustrate various embodiments of vascular fixation devices.  
         [0022]      FIG. 17  illustrates one embodiment of a leg.  
         [0023]      FIG. 18  illustrates an embodiment of a leg attached to another leg.  
         [0024]      FIG. 19  illustrates an embodiment of a leg.  
         [0025]      FIGS. 20-22  illustrate various embodiments of the intravascular graft anchoring assembly.  
         [0026]      FIG. 23  illustrates an embodiment of a graft attachment device.  
         [0027]      FIG. 24  is a top perspective view of an embodiment of a graft attachment device.  
         [0028]      FIG. 25  is a front view of the graft attachment device of  FIG. 24 .  
         [0029]      FIG. 26  illustrates an embodiment of a first section of the graft attachment device.  
         [0030]      FIG. 27  illustrates an embodiment of a second section of the graft attachment device.  
         [0031]      FIG. 28  illustrates an embodiment of a first section of the graft attachment device.  
         [0032]      FIG. 29  illustrates an embodiment of a second section of the graft attachment device.  
         [0033]      FIG. 30  illustrates an embodiment of a graft attachment device.  
         [0034]      FIGS. 31 and 32  illustrate various embodiments of the intravascular graft anchoring assembly.  
         [0035]      FIG. 33  illustrates an embodiment of the graft.  
         [0036]      FIGS. 34-36  illustrate various embodiments of cross-section A-A of  FIG. 33 .  
         [0037]      FIG. 37  illustrates an embodiment of the rim.  
         [0038]      FIGS. 38-40  illustrate various embodiments of cross-section B-B of  FIG. 37 .  
         [0039]      FIG. 41  illustrates an embodiment of the rim.  
         [0040]      FIGS. 42-44  illustrate various embodiments of cross-section C-C of  FIGS. 41 and 46 .  
         [0041]      FIG. 45  illustrates an embodiment of the interference receptacle.  
         [0042]      FIG. 46  illustrates an embodiment of the rim.  
         [0043]      FIG. 47  illustrates an embodiment of the intravascular graft anchoring assembly attached to a graft.  
         [0044]      FIG. 48  illustrates an embodiment of the intravascular graft anchoring assembly attached to two grafts.  
         [0045]      FIGS. 49-51  are sagittal cross-sections of a method of deploying the intravascular graft anchoring assembly in a patient.  
         [0046]      FIG. 52  is cross-section D-D of  FIG. 51  during diastole.  
         [0047]      FIG. 53  is cross-section D-D of  FIG. 51  after diastole and before systole.  
         [0048]      FIG. 54  is cross-section D-D of  FIG. 51  during systole.  
         [0049]      FIGS. 55-57  illustrate a method of using the intravascular graft anchoring assembly of  FIG. 32 .  
         [0050]      FIG. 58  illustrates a method of using the intravascular graft anchoring assembly of  FIG. 31 .  
         [0051]      FIG. 59  is an anterior view of a method of using two intravascular graft anchoring assemblies of  FIG. 20 .  
         [0052]      FIG. 60  is an anterior view of a method of using two intravascular graft anchoring assemblies of  FIG. 22 .  
         [0053]      FIG. 61  illustrates a graft.  
         [0054]      FIG. 62  illustrates a method of using the graft.  
         [0055]      FIG. 63  illustrates cross-section E-E.  
         [0056]      FIGS. 64-71  illustrate various methods of preparing the graft for deployment.  
         [0057]      FIGS. 72-84  illustrate various methods of deploying the intravascular graft fixation assembly and the graft. 
     
    
     DETAILED DESCRIPTION  
       [0058]      FIG. 1  illustrates an intravascular graft anchoring assembly  2  that can have a vascular fixation device  4  attached to a graft attachment device  6 . The graft attachment device  6  can be attached to a graft  8 . The intravascular graft anchoring assembly  2  can have a longitudinal axis  10 .  
         [0059]     The vascular fixation device  4  can be, for example, an AAA anchor, an intravascular stent or a heart valve ring. The vascular fixation device  4  can have a first arm  12  resiliently attached to a fixation section  14  and a second arm  16  resiliently attached to the fixation section  14 . The first arm  12  can attach to the opposite side of the fixation section from the second arm  16 . The first and second arms  12  and  16  can have a continuously circumferentially expandable spring, for example, a coil spring, angled spring, corrugated sheet, or a combination thereof, or the first arm  12  can be not continuously circumferentially expandable, for example a leaf spring.  
         [0060]     The first arm  12  can extend from the fixation section  14  at a first arm angle  18 . The first arm angle  18  can be from about −85° to about 85°, more narrowly from about −60° to about 60°, for example about 0°. The second arm  16  can extend from the fixation section  14  at a second arm angle  20 . The second arm angle  20  can be from about −85° to about 85°, more narrowly from about −60° to about 60°, for example about 0°.  
         [0061]     The first arm  12  can be attached to the fixation section  14 . The first arm  12  can have a terminus  22  at the end opposite to the attachment to the fixation section  14 . The first arm  12  can have a first member  24   a  and a second member  26   a.    
         [0062]     The second arm  16  can be attached to the fixation section  14 . The second arm  16  can have a terminus  22  at the end opposite to the attachment to the fixation section  14 . The second arm  16  can have a first member  24   b  and a second member  26   b.  The first and second members  24   b  and  26   b  of the second arm  16  can be integral with or distinct from the first and second members  24   a  and  26   a  of the first arm  12 . The second arm  16  can be similar to the first arm  12 . The first arm  12  can be about parallel with the second arm  16 . The first arm  12  can be unparallel with the second arm  16 .  
         [0063]     The fixation section  14  can have a support structure, for example, a back member  28  attached at one end to a top member  30  and at the opposite end to a bottom member  32 . The top member  30  can distinctly or integrally attach to the first members  24  of the first and/or second arms  12  and/or  16 . The bottom member  32  can distinctly or integrally attach to the second members  26  of the first and/or second arms  12  and/or  16 . The fixation section  14  can have tissue mainstays  34 . The tissue mainstays  34  can be, for example, a barb, spike, tab, deflected member, hole in a plate or tab, tissue in-growth matrix, hook, peg, coil, pigtail or leaf spring, or any combination thereof.  
         [0064]     The fixation section  14  can have a first and/or second connector  36  and/or  38 . The connectors  36  and  38  can be tubes, shafts, weld points, glue, hubs, or any combination thereof. The first and/or second connector  38  can attach directly to the fixation section  14 . The second connector  38  can attach to the first connector  36 .  
         [0065]     The graft attachment device  6  can have a first end  40  that can have one or more legs  44 , for example, support wires. The legs  44  can be attached to the first and/or second connectors  36  and/or  38 . The legs  44  can extend away from the vascular fixation device  4 . The legs  44  can attach to the second end  42  of the graft attachment device  6  at leg attachments  46 .  
         [0066]     The leg attachments  46  can be integral with, or distinct from, the legs  44 . The graft attachment device  6  can have a graft attachment device diameter  48 . The graft attachment device diameter  48  can be from about 10 mm (0.39 in.) to about 50 mm (2.0 in.), more narrowly from about 15 mm (0.59 in.) to about 38 mm (1.5 in.). The graft attachment device  6  can be configured so that the graft attachment device diameter  48  can increase, decrease or remain constant when a distally directed force is applied to the graft attachment device  6 .  
         [0067]     The graft  8  can be fixedly or removably attached to the second end  42  of the graft attachment device  6 . The graft  8  can be unitary or bifurcated. The proximal end of the graft  8  can be reinforced to keep open. The graft  8  can be an AV fistula graft, for an abdominal or thoracic aortic aneurysm, for example, TALENT® Stent Graft System and ANEURX® Stent Graft (from Medtronic, Inc., Minneapolis, Minn.), EXCLUDER® (from W.L. Gore &amp; Associates, Inc., Newark, Del.), ANCURE® Endograft System (from Guidant Corp., Indianapolis, Ind.); VANGUARD® stent-graft series and Passager Stent Graft (from Boston Scientific Corp., Natick, Mass.), Lifepath Endovascular Graft (from Edwards Lifescience Corp., Irvine, Calif.), Mialhe/Stentor and Cragg EndoPro System (from MinTec Inc., formerly of France), ZENITH® AAA Endovascular Graft System (from Cook, Inc., Bloomington, Ill.), Quantum (from Johnson &amp; Johnson, New Brunswick, N.J.), POWERLINK® System (from Endologix, Inc., Irvine, Calif.) and C.R. Bard, Inc., Murray Hill, N.J.); Anson (from Anson), ENOVUS (by TriVascular, Inc., Santa Rosa, Calif.), ANACONDA™ Stent-Graft (Sulzer Vascutech, Germany), Corvita Endovascular Graft (from Corvita Inc., Schneider Corp. and Boston Scientific Corp. Natick, Mass.), ELLA Stent-Graft (ELLA-CS, Hradec Králové, Czech Republic) or combinations thereof. The graft  8  can be made from a flexible textile structure, for example, the materials described in the immediately following patents and patent applications, all of which are hereby incorporated by reference in their entirety: U.S. Pat. No. 6,019,786 by Thompson, U.S. Pat. Nos. 6,159,239, 6,164,339, 6,192,994 all by Greenhalgh and U.S. Patent Application Nos. 2002/0083820, 2002/0058992, 2002/0052649, 2002/0052660, 2002/0042644 all by Greenhalgh and 2002/0066360 to Greenhalgh et al.  
         [0068]     Any or all elements of the intravascular graft anchoring assembly  2  can be made from, for example, a single or multiple stainless steel alloys, nickel titanium alloys (e.g., Nitinol), cobalt-chrome alloys (e.g., ELGILOY® from Elgin Specialty Metals, Elgin, Ill.; CONICHROME® from Carpenter Metals Corp., Wyomissing, Pa.), molybdenum alloys (e.g., molybdenum TZM alloy, for example as disclosed in International Pub. No. WO 03/082363 A2, published 9 Oct. 2003, which is herein incorporated by reference in its entirety), tungsten-rhenium alloys, for example, as disclosed in International Pub. No. WO 03/082363, polymers such as polyester (e.g., DACRON® from E. I. Du Pont de Nemours and Company, Wilmington, Del.), polypropylene, polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE), polyether ether ketone (PEEK), nylon, polyether-block co-polyamide polymers (e.g., PEBAX® from ATOFINA, Paris, France), aliphatic polyether polyurethanes (e.g., TECOFLEX® from Thermedics Polymer Products, Wilmington, Mass.), polyvinyl chloride (PVC), polyurethane, thermoplastic, fluorinated ethylene propylene (FEP), extruded collagen, silicone, echogenic, radioactive, radiopaque materials or combinations thereof. Examples of radiopaque materials are barium sulfate, titanium, stainless steel, nickel-titanium alloys, tantalum and gold.  
         [0069]     Any or all elements of the intravascular graft anchoring assembly  2  can be a matrix for cell ingrowth or used with a fabric, for example a covering (not shown) that acts as a matrix for cell ingrowth. The matrix and/or fabric can be, for example, polyester (e.g., DACRON® from E. I. du Pont de Nemours and Company, Wilmington, Del.), polypropylene, PTFE, ePTFE, nylon, extruded collagen, silicone or combinations thereof.  
         [0070]     The elements of the intravascular graft anchoring assembly  2  and/or the fabric can be filled and/or coated with an agent delivery matrix known to one having ordinary skill in the art and/or a therapeutic and/or diagnostic agent. The agents within these matrices can include radioactive materials; radiopaque materials; cytogenic agents; cytotoxic agents; cytostatic agents; thrombogenic agents, for example polyurethane, cellulose acetate polymer mixed with bismuth trioxide, and ethylene vinyl alcohol; lubricious, hydrophilic materials; phosphor cholene; anti-inflammatory agents, for example non-steroidal anti-inflammatories (NSAIDs) such as cyclooxygenase-1 (COX-1) inhibitors (e.g., acetylsalicylic acid, for example ASPIRIN® from Bayer AG, Leverkusen, Germany; ibuprofen, for example ADVIL® from Wyeth, Collegeville, Pa.; indomethacin; mefenamic acid), COX-2 inhibitors (e.g., VIOXX® from Merck &amp; Co., Inc., Whitehouse Station, N.J.; CELEBREX® from Pharmacia Corp., Peapack, N.J.; COX-1 inhibitors); immunosuppressive agents, for example Sirolimus (RAPAMUNE®, from Wyeth, Collegeville, Pa.), or matrix metalloproteinase (MMP) inhibitors (e.g., tetracycline and tetracycline derivatives) that act early within the pathways of an inflammatory response. Examples of other agents are provided in Walton et al, Inhibition of Prostoglandin E 2  Synthesis in Abdominal Aortic Aneurysms,  Circulation,  Jul. 6, 1999, 48-54; Tambiah et al, Provocation of Experimental Aortic Inflammation Mediators and Chlamydia Pneumoniae,  Brit. J. Surgery  88 (7), 935-940; Franklin et al, Uptake of Tetracycline by Aortic Aneurysm Wall and Its Effect on Inflammation and Proteolysis,  Brit. J. Surgery  86 (6), 771-775; Xu et al, Sp1 Increases Expression of Cyclooxygenase-2 in Hypoxic Vascular Endothelium,  J. Biological Chemistry  275 (32) 24583-24589; and Pyo et al, Targeted Gene Disruption of Matrix Metalloproteinase-9 (Gelatinase B) Suppresses Development of Experimental Abdominal Aortic Aneurysms,  J. Clinical Investigation  105 (11), 1641-1649 which are all incorporated by reference in their entireties.  
         [0071]     As shown in  FIGS. 2 and 3  the first member  24  can be attached to one or more struts  50 . One end of the strut  50  can attach to the first member  24  at a first strut angle  52 , and the opposite end of the strut  50  can attach to the second member  26  at a second strut angle  54 . The first strut angle  52  can be acute, obtuse or right. The second strut angle  54  can be a function of the first strut angle  52 , the appropriate arm angle  18  or  20 , and the shape of the strut  50 . The first member  24  can attach to the second member  26  at the terminus  22  directly or via one or more struts  50 . The intravascular graft anchoring assemblies  2  can have no struts  50 , as shown in  FIG. 1 . The first member  24  can be unattached to the second member  26  at the terminus  22  (not shown).  
         [0072]     The mainstays  34  can be arranged in various configurations. For example, a single mainstay  34 , such as a spike, can extend proximally from the top member  30  and two other mainstays  34 , such as spikes, can extend distally from the top member  30 . In another example, three mainstays  34  can extend distally from the bottom member  32 . In yet another example, two mainstays  34 , such as tabs with holes, can extend laterally from the back member  28 . In a further example, any combination of the three examples, infra, can be combined. The first and/or second connector  38  can have a pin hole  56  to attach to the legs  44  and/or the second connector  38 .  
         [0073]      FIG. 4  illustrates the vascular fixation device  4  that can have the fixation section  14  with a rounded or semi-circular shaped top member  30  and/or bottom member  32 . Side members  58  can attach the top member  30  and the bottom member  32 . The first and second members  24  and  26  of the first and second arms  12  and  16  can be integral. The first and second members  24  and  26  can be distinct from the top member  30  and the bottom member  32 .  
         [0074]      FIGS. 5 through 7  illustrate top views of various vascular fixation devices  4 . As shown in  FIG. 5 , the vascular fixation device  4  can have a round shape, for example a circular or oval shape, with the fixation section  14  similarly curved when viewed from above. As shown in  FIG. 6 , the fixation section  14  can have an approximately straight shape when viewed from above and the first and second arms  12  and  16  can have a round shape. As shown in  FIG. 7 , some or all of the mainstays  34  can be directed outward from the fixation section  14  when viewed from above.  
         [0075]      FIG. 8  illustrates the vascular fixation device  4  that can have the first arm  12  resiliently attach to the fixation section  14  at a first end  60  of the first arm  12  and a second end  62  of the first arm  12 . The first or second end  60  or  62  of the first arm  12  can be unattached to the fixation section  14  and that end  60  or  62  can end in a terminus  22  (not shown). One or more mainstays  34  can extend from the first and/or second arms  12  and/or  16 .  
         [0076]      FIG. 9  illustrates the vascular fixation device  4  that can have the first fixation section  14   a  that can be resiliently attached to the second fixation section  14   b.  The first end  60  of the first arm  12  can attach to the first fixation section  14   a . The second end  62  of the first arm  12  can attach to the second fixation device  14   b.    
         [0077]      FIGS. 10 through 12  illustrate the vascular fixation device  4  that can have the fixation section  14 , the first arm  12  extending from the fixation section  14  and the second arm  16  extending from the fixation section  14 . The first arm angle  18  can be equal to the second arm angle  20 . The first arm  12  can lie in a plane with the second arm  16 , as shown in  FIGS. 10 and 11 . The arms  12  and  16  can have a sinusoidal configuration, as shown in  FIG. 10 . The arms  12  and  16  can have first members  24  attached via termini  22  to second members  26 , as shown in  FIG. 11 . The arms  12  and  16  can be individual leaders concluding in their respective termini  22 , as shown in  FIG. 12 .  FIG. 13  illustrates the vascular fixation device  4  that can have the first arm  12  extending from the fixation section  14  and concluding in the terminus  22 .  
         [0078]      FIG. 14  illustrates the vascular fixation device  4  that can have circumferentially variable amounts of angular expansion when exposed to, or withdrawn from, a radial force with respect to the longitudinal axis  10 . Wires or zones  64  can have a resistance to angular expansion. More densely arranged zones  64 , for example at a first area  66   a,  can cause higher resistance to angular expansion. Less densely arranged zones  64 , for example at a second area  66   b,  can cause higher resistance to angular expansion. The zones  64  can be representative of material density, material strength, material type including composite materials, geometric configuration, or combinations thereof. The area with the highest resistance to angular expansion, for example first area  66   a,  can be the fixation section  14 . The vascular fixation device  4  can have one zone  64 , two zones  64  or more. The transition between the zones  64  can be gradual or immediate.  
         [0079]      FIG. 15  illustrates a wireform or cellular vascular fixation device  4  that can have, for example, three areas  66   a,    66   b,  and  66   c.  The first area  66   a  can be the fixation section  14 . In the first area  66   a,  the cells or wireform can be the most densely configured of the three areas  66   a,    66   b  and  66   c.  The second area  66   b  can have cells or the wireform of an intermediate density configuration. In the third area  66   c,  the cells or the wireform can be the least densely configured of the three areas  66   a ,  66   b  and  66   c.  (The top and bottom borders of the vascular fixation device are shown for illustrative purposes.)  
         [0080]      FIG. 16  illustrates a vascular fixation device  4  that can the first fixation section  14   a  that can be attached to the second fixation section  14   b.  The first arm  12  and the second arm  16  can extend from the first fixation section  14 . A third arm  68  and a fourth arm  70  can extend from the second fixation section  14   b.    
         [0081]     A connecting brace  72  can fixedly or removably attach the first fixation section  14   a  to the second fixation section  14   b.  The connecting brace  72  can have side braces  74 , a back brace  76  and cross braces  78 . The cross braces  78  can attach one side brace  74  to another side brace  74  and/or one or both side braces  74  to the back brace  76 . The back brace  76  can attach to the first and/or second connectors  36  and/or  38  on each fixation section  14   a  and  14   b.    
         [0082]     The terminus  22  of the second arm  16  can attach directly to the second fixation section  14  in lieu of the third arm  68  (not shown, also the terminus  22  previously on the third arm  68  could then no longer be a terminus  22 ). When the second arm  16  is directly attached to the second fixation section  14 , the connecting brace  72  can be used or can be absent.  
         [0083]      FIG. 17  illustrates the leg  44  that can have an interference member  80  at a distal end  82 .  FIG. 18  illustrates two legs  44  of  FIG. 17  that can be attached to each other by resilient members  84 .  FIG. 19  illustrates the leg  44  that can have a crimp member  86  at the distal end  82 . The crimp member  86  can have a first crimp side  88  and a second crimp side  90 . The crimp sides  88  and  90  can be configured to resiliently angle outward from the leg  44 , as shown by arrows.  
         [0084]      FIGS. 20 and 21  illustrate the intravascular graft anchoring assembly  2  that can have a first end  92  of the intravascular graft anchoring assembly  2 . The first end  92  of the intravascular graft anchoring assembly  2  can be configured to fix to the vessel and can attach to the graft  8 . The first end  92  can be substantially semicircular in shape. The first end  92  can be fixedly or resiliently attached to one or more legs  44 . A back plate  94  can be attached to the first end  92  of the intravascular graft anchoring assembly  2  and/or the legs  44 .  
         [0085]     The legs  44  can be fixedly or resiliently attached to the graft attachment member  102  or  108  at the second end  96  of the intravascular graft anchoring assembly  2 . The legs  44  can be resilient. The graft attachment member  102  or  108  can be attached to a suspension  98  that can effectively act as a mechanical spring and damper. The graft attachment member  102  or  108  can be attached directly to an expandable vascular fixation device  4 . The vascular fixation device  4  can be a stent known to one having ordinary skill in the art, the vascular fixation devices  4  described infra and shown, for example, in  FIGS. 1 through 16 , or combinations thereof.  
         [0086]      FIG. 22  illustrates the intravascular graft anchoring assembly  2  that can have the vascular fixation device  4  attached to the first end  92 . The vascular fixation device  4  can be attached to the first end  92  by an extender  100 .  
         [0087]      FIG. 23  illustrates the graft attachment device  6 . The graft attachment device  6  can have the leg  44 . The leg  44  can attach to a first graft attachment member  102  at the leg attachment  46 .  
         [0088]      FIGS. 24 and 25  illustrate the graft attachment device  6  that can have a first section  104  and a second section  106 . The leg attachments  46  can attach integrally or distinctly with the first graft attachment members  102 , cross members  107 , and second graft attachment members  108 . The cross members  107  can integrally or distinctly attach the first graft attachment members  102  and the second graft attachment members  108 . The graft  8  can fixedly or removably attach to the first graft attachment member  102 , and/or the second graft attachment member  108 , and/or the cross member  107  and/or the legs  44 , for example, by crimping, snapping, sewing, stitching, gluing, welding, interference fitting (e.g., snapping), friction fitting and combinations thereof.  
         [0089]      FIGS. 26 and 27  illustrate the first section  104  and the second section  106 , respectively, of the graft attachment device  6  of  FIGS. 24 and 25 .  FIGS. 28 and 29  illustrate the first section  104  and the second section  106  of the graft attachment device  6  that can have diverging legs  44  and is illustrated in  FIG. 30 .  
         [0090]     The first graft attachment member  102  and the second graft attachment member  108  can have a scalloped shape (shown well in  FIG. 23 ). The scalloped shape can facilitate a non-obstructing use of the graft attachment device  6  distal to vascular side branches off of the implantee vessel. Diverging legs  44  can have diverging branches  110 . The diverging branches  110  can attach to the second end  42  of the graft attachment device  6  at the leg attachment  46 . As shown in  FIG. 25 , when the graft attachment device  6  is exposed to a distally directed force, as shown by arrows  112 , the graft attachment members  102  and/or  108  can radially expand or contract, as shown by arrows  114 .  
         [0091]      FIG. 31  illustrates an intravascular graft anchoring assembly  2  that can have a first graft attachment member  102  that can be fixedly attached to the first leg attachment  46   a.  A leg extension  116  can be fixedly attached to, and extend from, one of the legs  44 . The first leg attachment  46   a  can be slidably attached to the leg extension  116 . The first graft attachment member  102  can be rotatably attached to the second leg attachment  46   b  with respect to a first rotation axis  118 . A converging branch  120  can attach one leg  44  to the other leg  44 .  FIG. 32  illustrates the intravascular graft anchoring assembly  2  that can have the first graft attachment member  102  that can be rotatably attached to the legs at the leg attachments  46  with respect to a second rotation axis  122 .  
         [0092]      FIG. 33  illustrates the graft  8  that can have a graft body  124 . The graft body  124  can be the graft trunk, or other entryway of flow through the graft  8 ). A first graft leg  126  and a second graft leg  128  can extend from the graft body  124 . The graft body  124  can be fixedly attached to a first graft member  130  and a second graft member  132 . The graft body  124  can have a reinforcement, described infra, that culminates at a reinforcement boundary  134  and/or a rim  136 . The graft members  130  and  132  can be distinct members, a radially enlarged portion of the graft body  124 , or combinations thereof. The graft  8  can have unreinforced graft  137  where the graft body  124  is not reinforced. The unreinforced graft  137  can be made from a polymer and/or metal weave made from a material described infra or combinations thereof.  
         [0093]      FIGS. 34 through 36  illustrates cross-section A-A of various grafts  8  that can have a reinforcement  138 , for example a polymer and/or metal weave made from a material described herein or combinations thereof.  FIG. 34  illustrates the graft  8  that can have the first graft member  130  and the second graft member  132  longitudinally separated. The first and second graft members  130  and  132  can be between the reinforcement  138  and the unreinforced graft  137 . The reinforcement  138  can be disposed internally to the graft body  124  when not encapsulating the graft members  130  and  132 . The portion of the unreinforced graft proximal to the reinforcement boundary can continue proximally until the rim  136 .  
         [0094]      FIG. 35  illustrates the graft  8  that can have the unreinforced graft  137  proximal to the reinforcement boundary  134  wrapped around the outside, or into the inside, of the graft body  124 . The wrapped-around portion of the unreinforced graft  137  can be attached, for example by ultrasonic or heat welding, to the graft body  124  at wraparound fixation points  139 .  FIG. 36  illustrates the graft  8  that can have no reinforcement boundary  134 . The reinforcement  138  can extend proximally to, or almost to, the rim  136 .  
         [0095]      FIG. 37  illustrates the rim  136  that can have a lip  140 .  FIG. 38  illustrates the lip  140  that can extend radially inward toward the longitudinal axis  10 .  FIG. 39  illustrates the lip  140  that can extend radially outward away from the longitudinal axis  10 .  FIG. 40  illustrates the lip  140  that can extend proximally and/or radially inward and radially outward with respect to the longitudinal axis  10 .  
         [0096]      FIG. 41  illustrates the rim  136  that can have one or more interference receptacles  142 .  FIG. 42  illustrates that the interference receptacle  142  can have, for example, a unilateral snap-lock port. The interference receptacle  142  can extend radially inward toward the longitudinal axis  10 .  FIG. 43  illustrates the interference receptacle  142  that can extend radially outward away from the longitudinal axis  10 .  FIG. 44  illustrates the interference receptacle  142  that can extend proximally and/or radially inward and radially outward with respect to the longitudinal axis  10 .  FIG. 45  illustrates a cross-section of the interference receptacle  142  that can have, for example, a bilateral snap-lock port  144 .  
         [0097]      FIG. 46  illustrates the rim  136  that can have the interference receptacle  142  that can circumferentially cover the rim  136 . The cross-sections illustrated in  FIGS. 42 through 45  can be for the graft  8  of  FIG. 46 .  
         [0098]      FIG. 47  illustrates the intravascular graft anchoring assembly  2  attached to the graft  8 . The first and second graft attachment members  102  and  108  can interference fit with the first and second graft members  130  and  132  (not shown). The graft  8  can have bifurcating graft legs  126  and  128 . The reinforcement  138  can provide sufficient radial support to keep the rim  136  open without additional radial force from the graft attachment device  6 .  
         [0099]      FIG. 48  illustrates the intravascular graft anchoring assembly  2  attached to the first graft  8   a  and the second graft  8   b.  The legs  44  can be attached directly to the grafts  8   a  and  8   b.  The legs  44  can attach to second ends  42  of two graft attachment devices  6  (not shown). The second ends  42  of the two graft attachment devices  6  can separately attach to their respective graft  8   a  or  8   b.    
         [0000]     Methods of Manufacture  
         [0100]     The elements of the intravascular graft anchoring assembly  2  can be directly attached by, for example, melting, screwing, gluing, welding or use of an interference fit or pressure fit such as crimping, or combining methods thereof. The elements can be integrated, for example, molding, die cutting, laser cutting, electrical discharge machining (EDM) or stamping from a single piece or material. Any other methods can be used as known to those having ordinary skill in the art.  
         [0101]     Integrated parts can be made from pre-formed resilient materials, for example resilient alloys (e.g., Nitinol, ELGILOY®) that are preformed and biased into the post-deployment shape and then compressed into the deployment shape as known to those having ordinary skill in the art.  
         [0102]     Any elements of the intravascular graft anchoring assembly  2 , or the intravascular graft anchoring assembly  2  as a whole after assembly, can be coated by dip-coating or spray-coating methods known to one having ordinary skill in the art. One example of a method used to coat a medical device for vascular use is provided in U.S. Pat. No. 6,358,556 by Ding et al. and hereby incorporated by reference in its entirety. Time release coating methods known to one having ordinary skill in the art can also be used to delay the release of an agent in the coating. The coatings can be thrombogenic or anti-thrombogenic. For example, coatings on the inside of the intravascular graft anchoring assembly  2 , the side facing the longitudinal axis  10  can be anti-thrombogenic, and coatings on the outside of the intravascular graft anchoring assembly  2 , the side facing away from the longitudinal axis  10 , can be thrombogenic.  
         [0103]     The intravascular graft anchoring assembly  2  can be covered with a fabric, for example polyester (e.g., DACRON® from E. I. du Pont de Nemours and Company, Wilmington, Del.), polypropylene, PTFE, ePTFE, nylon, extruded collagen, silicone or combinations thereof. Methods of covering an implantable device with fabric are known to those having ordinary skill in the art.  
         [0000]     Method of Using  
         [0104]     The intravascular graft anchoring assembly  2  can be radially collapsed and loaded into one or more delivery sheaths or catheters  146 , as known to one having ordinary skill in the art. The graft  8  can be attached to the intravascular graft anchoring assembly  2  before being collapsed and loaded into the delivery catheter  146 , or via a separate delivery catheter after the intravascular graft anchoring assembly  2  is deployed.  
         [0105]      FIGS. 49 through 51  illustrate a method of deploying the intravascular graft anchoring assembly  2  into a vascular site  148 , for example proximal to an abdominal or thoracic aortic aneurysm  150 , with one or more delivery catheters  146 . After a guidewire  152  is deployed to the vascular site  148 , the delivery catheter  146  can be moved along the guidewire  152  until the intravascular graft anchoring assembly  2  is in position to be expanded.  
         [0106]     The vascular site  148  can have a portion of wall that is substantially fixed with respect to the remainder of the wall of the vascular site  148 . For example, the posterior portion of the vascular site  148  shown in  FIGS. 49 through 51  is substantially fixed in place by connective tissue  154  that fixes the vascular site  148  to the spine  156 . The delivery catheter  146  can be oriented so the fixation section  14  can be deployed adjacent to the substantially fixed portion of the vascular site  148 , for example the portion closest to the connective tissue  154 .  
         [0107]     The intravascular graft anchoring assembly  2  can be positioned prior to deployment so that the vascular fixation device  4  can be deployed superior to lateral vessel branches, for example the orifice for the renal artery  158 . The intravascular graft anchoring assembly  2  can be positioned prior to deployment so that the second end of the graft attachment device  6  can be deployed inferior to lateral vessel branches, for example the orifice for the renal artery  158 .  
         [0108]     As  FIG. 50  illustrates, the guidewire can be withdrawn as shown by arrow  159 . The catheter  146  can be withdrawn, as shown by arrow  160 . When the catheter  146  is withdrawn, as shown by arrow  160 , the intravascular graft anchoring assembly  2  can be deployed at the vascular site  148  with the fixation section  14  superior to the renal artery  158  and the second end  42  (not shown) of the graft attachment device  6  (or the rim  136  of the graft  8  when the second end  42  of the graft attachment device  6  is not present), inferior to the renal artery  158 . The fixation section  14  can be deployed adjacent to the spine  156 .  FIG. 51  illustrates the fully deployed intravascular graft anchoring assembly  2  attached to the fully deployed graft  8  with the delivery catheter  146  and guidewire  152  removed from the vascular site  148  and the aneurysm  150 .  
         [0109]      FIG. 52  illustrates cross-section D-D at diastole. With the vascular site  148  fully contracted, the first and second arms  12  and  16  (not distinctly shown) can be in a fully contracted configuration to fit the vascular site  148 .  
         [0110]      FIG. 53  illustrates cross-section D-D after diastole and before systole. As the vascular site  148  naturally expands circumferentially, as shown by arrows, away from the connective tissue  154 , the fixation section  14  can stay fixed to the vascular site  148  adjacent to the connective tissue  154  and the first and second arms  12  and  16  can expand to fit the expanding vascular site  148 .  
         [0111]      FIG. 54  illustrates cross-section D-D at systole. With the vascular site  148  fully dilated and expansion of the vascular site  148  having stopped, the first and second arms  12  and  16  can be in an expanded configuration to fit the vascular site  148 . The fixation section  14  can remain fixed to the vascular site  148  adjacent to the connective tissue  154 .  
         [0112]      FIGS. 55 and 56  illustrate a method of deploying the graft  8  using an intravascular graft anchoring assembly  2  that can have the second rotational axis  122 , similar to that of the intravascular graft anchoring assembly  2  of  FIG. 32 .  FIG. 55  illustrates the graft  8  in a collapsed configuration. The first graft leg  126  can be fed into or adjacent to the vascular fixation device  4  to reduce the deployment cross-section. The second graft leg  128  can be placed distal to the intravascular graft anchoring assembly  2 .  FIG. 56  illustrates the intravascular graft anchoring assembly  2  of  FIG. 32  in a collapsed configuration without the graft  8 .  FIG. 57  illustrates that upon deployment, the first graft attachment member  102 , and therefore the graft  8 , can be rotated, as shown by arrows, with respect to the second rotational axis  122  into an expanded, deployed configuration.  
         [0113]      FIG. 58  illustrates the intravascular graft anchoring assembly  2  of  FIG. 31  in a collapsed configuration. The first graft attachment member  102  can be rotated, as shown by arrows  162 , with respect to the first rotational axis  118 . The leg attachment  46  can slide, as shown by arrow  164 , along the leg extension  116 . Upon deployment, the first graft attachment member  102  can be rotated with respect to the first rotational axis  118  into an expanded, deployed configuration, as shown in  FIG. 31 .  
         [0114]     FIGS.  59  illustrates deploying the intravascular graft anchoring assembly  2  of  FIG. 20  in a vessel, for example across the aneurysm  150 . The first end  92  of one or more intravascular graft anchoring assemblies  2  can be deployed to a neck  166  of the aneurysm  150 . The legs  44  can be of a selected length such that the second end  96  of the intravascular graft anchoring assembly  2  can be deployed on an opposite side of the aneurysm  150  from the first end  92  of the intravascular graft anchoring assembly  2 . For example, the second end  96  of the intravascular graft anchoring assembly  2  can be deployed in the iliac arteries  190  and  192  for an abdominal aneurysm  150 . The resiliently deformed legs  44  can apply a force, shown by arrows, fixing the first ends  92  of the intravascular graft anchoring assemblies  2  against the neck  166 .  
         [0115]      FIG. 60  illustrates the graft  8  deployed on the intravascular graft anchoring assemblies  2  of  FIG. 22 . One end of the graft  8  can be attached to the first ends  92  the intravascular graft anchoring assemblies  2 . The other ends of the graft  8  can be attached to the graft attachment members  102  and  108  at the second ends  96  of the intravascular graft anchoring assemblies  2 .  
         [0116]     One intravascular graft anchoring assembly  2  can be deployed followed by the deployment of the graft body  124  on the first end  92  of the deployed intravascular graft anchoring assembly  2 . The graft body  124  can be attached to the first end  92  of the deployed intravascular graft anchoring assembly  2 . A second intravascular graft anchoring assembly  2  can then be deployed so that the first end  92  of the newly deployed intravascular graft anchoring assembly  2  can attach to the graft body  124  adjacent to the first end  92  of the already-deployed intravascular graft anchoring assembly  2 . Graft legs  44  can then be deployed over the intravascular graft anchoring assemblies  2 . The graft legs  44  can be attached to the graft body  124  and to the graft attachment members  102  and  108  on the second ends  96  of the intravascular graft anchoring assemblies  2 .  
         [0117]      FIG. 61  illustrates the graft  8  that can have a bifurcation angle  168 . The bifurcation angle can be the angle from the first graft leg  126  to the second graft leg  128 . The bifurcation angle  168  can vary during use. The bifurcation angle  168  can be from about 0° to about 360°, for example about 30°. The graft body  124  can have a septum  170 . The septum can separate the first graft leg  126  and the second graft leg  128 .  
         [0118]      FIG. 62  illustrates a method of compressing the graft  8  to prepare the graft  8  for deployment, for example minimally invasive deployment. Radially compressive forces, as shown by arrows, can radially compress the graft  8  and the intravascular graft anchoring assembly  2  (not shown) as illustrated by compression folds  172 .  
         [0119]      FIG. 63  illustrates cross-section E-E of  FIG. 61 .  FIG. 64  illustrates attaching the rim  136  of the graft  8  to a temporary fixator  174  on a temporary fixator shaft  176 . The graft  8  can be attached to the intravascular graft anchoring assembly  2  (not shown, but can be attached to the graft  8  in  FIGS. 64-77 ). The temporary fixator shaft  176  can be placed in the first graft leg  126  and the graft body  124 . The temporary fixator shaft  176  can have a lumen  178 , for example a lumen for passing the guidewire  152  therethrough. The temporary fixator  174  can be an adhesive, an interference fit (e.g., a snap), a friction fit (e.g., a bell) or combinations thereof.  
         [0120]      FIG. 65  illustrates invaginating the rim  136  into the graft body  124 . The rim  136  can be left in a non-invaginated configuration during deployment. The temporary fixator shaft  176  can be pulled, as shown by arrows. As the rim  136  invaginates into the graft body  124 , one or more inversion folds  179  can form around the rim  136 .  
         [0121]      FIGS. 66 and 67  illustrate folding, as shown by arrow  180 , the second graft leg  128  into a pre-deployment configuration. The second graft leg  128  can be folded at a fold point  182 . The fold point  182  can be located away from the septum  170 , as shown in  FIG. 66 . The fold point  182  can be located near or on the septum  170 , as shown in  FIG. 67 . The rim  136  can be further invaginated into the graft body  124  and/or first graft leg  126 , as shown by arrow  184 . In a pre-deployment configuration, the bifurcation angle  168  can be from about 90° to about 270°, more narrowly from about 120° to about 250°, yet more narrowly from about 165° to about 195°, for example about 180°.  
         [0122]      FIG. 68  illustrates the graft  8  compressed, as shown in  FIG. 62 , and inserted into the delivery catheter  146 . The inside and/or outside of the delivery catheter  146  can be coated with lubricious and/or therapeutic materials and/or agents.  
         [0123]      FIG. 69  illustrates the graft  8  compressed and inserted into the first delivery catheter  146   a  and the second delivery catheter  146   b.  The first delivery catheter  146   a  can be temporarily attached to the second delivery catheter  146   b.  The first delivery catheter  146   a  can cover the entire graft  8 . The first delivery catheter  146   a  can only cover enough of the graft  8  so as to attach the first delivery catheter  146   a  to the second delivery catheter  146   b.  The second delivery catheter  146   b  can extend from beyond the first graft leg  126 . The second delivery catheter  146   b  can cover the graft  8  up to the inversion fold  179 .  
         [0124]      FIG. 70  illustrates the graft  8  compressed and inserted into the delivery catheter  146 . (For clarity, the delivery catheter  146  is illustrated spaced away from the graft  8  in  FIGS. 70 and 71 .) The fold point  182  can be located anywhere along the septum or the second graft leg  128 . The proximal end of the folded second graft leg  128  can be removably attached to a first end of a tether  186 . A second end of the tether  186  can be removably attached to the inside, outside or any combination thereof, of the delivery catheter  146 . When assembled as shown in  FIG. 70 , the tether  186  can have slack length.  
         [0125]      FIG. 71  illustrates the graft  8  compressed and inserted into the delivery catheter  146 . The proximal end of the already-folded second graft leg  128  can be folded again, so the open end of the folded second graft leg  128  is directed in a distal direction. The proximal end of the twice-folded second graft leg  128  can be removably attached to the inside, outside or any combination thereof, of the delivery catheter  146 .  
         [0126]     The intravascular graft anchoring assembly  2  can be attached to the proximal end of the graft body  124  prior to, or during, deployment. The intravascular graft anchoring assembly  2  can be compressed with the graft body  124 . The intravascular graft anchoring assembly  2  can be placed in the delivery catheter  146  with the graft body  124 . The preparation for deployment can be part of the deployment, itself.  
         [0127]      FIGS. 72-84  illustrate methods of deploying the graft  8  and/or the intravascular graft anchoring assembly  2  in a patient, for example to treat an aortic aneurysm, such as a thoracic or abdominal aortic aneurysm.  FIG. 72  illustrates the aortic aneurysm  150 , part of the suprarenal aorta  188 , the first and second iliac arteries  190  and  192 , the internal iliac (i.e., hypogastric) arteries  194 , and the renal arteries  196 , all in cross-section.  
         [0128]     Vascular access devices  197  can be inserted into the patient&#39;s blood system, for example, into the femoral or iliac arteries  190  and  192 . The guidewire  152  can be fed through the vascular access devices  197 , across the first iliac artery  190  and the second iliac artery  192 , as shown by the arrow in  FIG. 72 . A snare (not shown), as known to one having ordinary skill in the art, can be used to steer the guidewire  152 , for example, to pull it into the second iliac artery  192 .  
         [0129]     The guidewire  152  can be fed through the lumen  178  in the temporary fixator shaft  176 . The graft  8 , for example in a collapsed configuration and perhaps surrounded by the delivery catheter  146 , can be deployed, as shown by the arrow in  FIG. 73 , over the guidewire  152 .  
         [0130]     After the graft  8  is completely deployed in the iliac arteries  190  and  192 , the first delivery catheter  146  can be removed from the graft. The second graft leg  128  can deploy into the second iliac artery  192 . The guidewire  152  can be pulled back, as shown by the arrow in  FIG. 75 , toward the first iliac artery  190  so that the end of the guidewire  152  is near, and can access, the aneurysm  150 .  
         [0131]     The guidewire  152  can be deployed across the aneurysm and into the suprarenal aorta  188 , as shown by arrow in  FIG. 76 . In  FIG. 77 , the graft body  124  (and the intravascular graft anchoring assembly  2  that can still be in a delivery catheter  146 ) can be deployed over the guidewire  152 . The second delivery catheter  146  (or the remainder of the first delivery catheter  146 ) can be removed from the graft  8 , as shown by FIG.  78 . The first graft leg  126  can deploy into the first iliac artery  190 . Graft leg end delivery catheters  146  can be over the ends of the graft legs  126  and  128 .  
         [0132]      FIG. 79  illustrates that the intravascular graft anchoring assembly  2  can be deployed, for example, in and near the suprarenal aorta  188 . The intravascular graft anchoring assembly  2  can be attached to the graft  8 . The length of the first and second graft legs  126  and  128  can be cut to a desired size, for example so as not to minimize impairment of the flow of the internal iliac arteries  194 . Once the graft legs  126  and  128  are initially deployed in the vessel, for example, in the iliac arteries  190  and  192 , the ends of the graft legs  126  and  128  can be cut, for example, by an intravascular or transvascular severing device. Examples of intravascular and transvascular severing devices include those as disclosed in U.S. Pat. Nos. 6,328,749 and 5,843,102 both to Kalmann et al., which are herein incorporated by reference in their entireties. Some transvascular severing devices can be scaled down to permit use as an intravascular severing device. The graft legs  126  and  128  can be cut by extending the ends of the graft legs  126  and  128  to extend the ends of the graft legs  126  and  128  into the vascular access devices  197  and/or out of the body entirely, to gain sufficient access to cut the graft legs  126  and  128  to a desired length with, for example, a suture or scissors. Energy can be transmitted (e.g., electrical current, RF radiation, heat) to the graft legs  126  and  128  to cut or assist cutting.  
         [0133]     Excess material remaining on the graft legs  126  and  128  can then be corrugated into or near the iliac arteries  190  and  192 . Intravascular graft anchoring assemblies  2  can be deployed at the ends of the graft legs  126  and  128 . Other expandable vascular prostheses, for example stents, can be deployed at the ends of the graft legs  126  and  128 .  
         [0134]      FIG. 80  illustrates a method of deploying the intravascular graft anchoring assembly  2  that can be deployed using the delivery catheter  146  as prepared, for example, as shown in FIGS.  70  or  71 . The delivery catheter  146  can be deployed into the first iliac artery  190 . The guidewire  152  can be deployed into or toward the neck  166  of the aneurysm  150 .  
         [0135]     As illustrated in  FIG. 81 , the intravascular graft anchoring assembly  2  that can be compressed, the delivery catheter  146  and/or the graft  8  can be propelled along the guidewire  152  until the intravascular graft anchoring assembly  2  and the graft  8  are properly positioned, as shown in  FIG. 82 .  FIG. 82  also illustrates that the delivery catheter  146  can begin to be withdrawn, as shown by arrows, leaving the intravascular graft anchoring assembly in the supra-aneurysm and/or suprarenal aorta  188  and exposing the proximal end of the graft body  124 .  
         [0136]      FIG. 83  illustrates a the use of the graft  8  and delivery catheter  146  illustrated in  FIG. 71 . As the delivery catheter  146  is withdrawn from the aneurysm  150 , as shown by arrows, the second graft leg  128  can emerge from the delivery catheter  146  in a potentially corrugated configuration. The open end of the second graft leg  128  can be pointing distally. A snare  198  can be introduced to a location near the open end of the second graft leg. The snare  198  can be introduced from the vascular access device  197  on the second iliac artery  192 . The snare  198  can attach to the second graft leg  128  and pull the second graft leg  128  to desired location, for example, as shown in  FIG. 79 .  
         [0137]      FIG. 84  illustrates a the use of the graft  8  and delivery catheter  146  illustrated in  FIG. 70 . As the delivery catheter  146  is withdrawn from the aneurysm  150 , as shown by arrows, the second graft leg  128  can emerge from the delivery catheter  146  in a potentially corrugated configuration. The open end of the second graft leg  128  can be directed proximally or distally. As the delivery catheter  146  is withdrawn from the patient&#39;s body, the tether  186  attached to the delivery catheter  146  and the second graft leg  128  can pull the open end of second graft leg  128  to point distally. The snare  198  can be introduced from the vascular access device  197  on the second iliac artery  192 . The snare  198  can attach to the second graft leg  128  and/or the tether  186  and pull the second graft leg  128  to desired location, for example, as shown in  FIG. 79 . The tether  186  can then be detached from the graft  8  and the delivery catheter  146 .  
         [0138]     It is apparent to one skilled in the art that various changes and modifications can be made to this disclosure, and equivalents employed, without departing from the spirit and scope of the invention. Elements shown with any embodiment are exemplary for the specific embodiment and can be used on other embodiments within this disclosure.