Abstract:
An intravascular implant and methods of using the implant within the vasculature of the body, for example near a vascular aneurysm, are disclosed. A method of treating an aneurysm includes positioning a vascular graft comprising a tubular channel having a first end and a second end in a blood vessel, securing the vascular graft in place with an expandable anchoring member, and filling a seal cuff on the vascular graft, wherein the seal cuff extends radially outward beyond an exterior surface of the vascular graft, wherein the seal cuff comprises a first seal portion and a second seal portion and wherein the first seal portion is separated from the second seal portion by a first gap and a second gap along a circumference of the seal cuff.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation of U.S. patent application Ser. No. 15/284,381 filed Oct. 3, 2016, which is a continuation of U.S. patent application Ser. No. 13/666,756 filed Nov. 1, 2012 (now U.S. Pat. No. 9,615,912), which is a continuation of U.S. patent application Ser. No. 11/351,423 filed Feb. 10, 2006 (now abandoned), which is a continuation of U.S. patent application Ser. No. 10/778,870 filed Feb. 12, 2004 (now abandoned), which claims the benefit of U.S. Provisional Application No. 60/447,056 filed Feb. 12, 2003, the contents of all which are incorporated herein by reference in their entireties. 
     
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
       [0002]    The present invention relates generally to an intravascular 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 of a second implant, such as a vascular graft, to the intravascular implant. 
       2. Description of the Related Art 
       [0003]    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. 
         [0004]    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 proximal neck of the aneurysm can be diseased. This diseased tissue can by a calcified and/or irregularly shaped tissue surface for which the graft must to attach. Healthy, easily-attachable tissue is often a distance away from the aneurysm. For example, in AAAs the nearest healthy vascular tissue may be above the renal arteries. Even a healthy vessel can be so irregularly shaped or tortuous that a graft may have difficulty attaching and staying sealed. Furthermore, the proximal neck can shift locations and geometries over time, particularly over the course of aneurysm treatment and reformation of the aneurysmal sack. This shifting and shape changing of the vessel can result in partial or total dislodgement of the proximal end of a currently available stent graft. 
         [0005]    Devices have been developed that attempt to solve the issue of vascular graft attachment. International Publication No. WO 00/69367 by Strecker discloses an aneurysm stent. The stent has a securing mechanism that attaches to the vascular wall proximal to the renal arteries, which is typically where healthier vascular tissue is located when a patient has an AAA. The stent also has a membrane that is placed at the proximal end of a stent graft and forms a seal in the vessel. Strecker, however, discloses a securing mechanism with ball-ended struts which angle away from the seal. The ball-ends will reduce the pressure applied by the struts onto the vascular wall, and the struts are angled improperly to insure the best anchor. If the graft begins to dislodge into the aneurysm, the struts will tend to fold inward and slide with the graft instead of engaging frictionally into the vascular walls to prevent dislodgement. 
         [0006]    U.S. Pat. No. 6,152,956 to Pierce discloses a radially expandable collar connected by connecting wires to an expandable stent. The stent also has barbs with sharp ends that spring radially outward to embed into the walls of the vascular tissue. The stent, however, is expandable, but once expanded cannot be easily contracted. The stent, therefore, can not be repositioned if incorrectly placed during initial deployment. Further, the barbs do not angle toward the seal and will not engage into the vascular wall for additional anchoring force, should the prosthesis begin to become dislodged. 
         [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 attachment system has no way of being repositioned during deployment. Further, the stent is a substantially rigid, balloon expandable stent and therefore maintains a fixed diameter and resists deformation from forces imposed by the vascular environment. The stent, therefore, can not be easily repositioned during deployment and may not seal the graft under changing geometric conditions over time. 
         [0008]    There is thus a need for a device and method that can securely anchor a vascular graft within a vessel and can seal the graft regardless of the existence of diseased tissue at the sealing location. There is also a need for a device that can be deployed to the vasculature while minimizing bloodflow obstruction to the main vessel and to branching vessels. A need also exists for a device and method that can accomplish the above needs and adjust to tortuous vasculature. There is also a need for a device and method that can accomplish the above and have dimensions and a placement location that can be adjusted multiple times in vivo, even after the anchor has been fully deployed. There is also a need for a device that can be delivered through a low profile catheter. Additionally, there is a need for a device that can anchor into a different portion of tissue from which it seals, so as not to overstress any individual portion of vascular tissue or any elements of the implant, thus preventing fractures in the tissue and of the implant. 
       BRIEF SUMMARY OF THE INVENTION 
       [0009]    One embodiment of the disclosed intravascular implant has a seal, a connector, and an anchor. The seal is configured to attach to a second implant. The connector has a first end and a second end. The first end is attached to the seal, and the second end is attached to the anchor. The anchor has an arm, and the arm is angled toward the seal as the arm extends radially away from the center of the anchor. The anchor can be formed of multiple radially extending tines or arms such as an uncovered umbrella structure, a hook and/or a barb. 
         [0010]    Another embodiment of the disclosed intravascular implant has a seal and a substantially cylindrical coil, where the coil is attached to, and extends from, the seal. The seal can also have a gasket. The seal can also have an inflatable collar. 
         [0011]    Yet another embodiment of the intravascular implant has a seal, a connector and an anchor. The seal is configured to attach to a second implant. The connector has a first end and a second end and may be flexible. The first end is attached to the seal, and the second end is attached to the anchor. The connector may be formed of a coil. The connector can be configured to allow for longitudinal adjustments. The distance between the seal and the anchor can be changed. The implant can also have a second anchor to assist in additional fixation. 
         [0012]    Another embodiment of the intravascular implant has a seal, a connector, an anchor, and a stop. The connector has a first end and a second end. The first end is attached to the seal, and the second end is attached to the anchor. The anchor has an arm and the arm is angled toward the seal as the arm extends radially from the center of the anchor. Radial extension of the arm is limited by the stop. The stop can be a mechanical interference. 
         [0013]    Yet another embodiment of the disclosed intravascular implant has a seal, a connector and an anchor. The connector has a flexible member, a first end and a second end. The first end is attached to the seal and the second end is attached to the anchor. The anchor has an arm. The arm angles toward the seal as the arm extends radially from the center of the anchor. The seal can have a gasket. The seal can have an inflatable collar. The connector can have a coil. The implant can also have a second anchor. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0014]      FIG. 1  is a front perspective view of an embodiment of the intravascular implant. 
           [0015]      FIGS. 2 and 3  are front perspective views of various embodiments of the seal. 
           [0016]      FIG. 4  is a top view of an embodiment of the seal ring. 
           [0017]      FIGS. 5-8  are front perspective views of various embodiments of the seal. 
           [0018]      FIGS. 9 and 10  are a top and a side view, respectively, of the embodiment of the seal ring shown in  FIG. 8 . 
           [0019]      FIGS. 11 and 12  are front perspective views of various embodiments of the seal ring. 
           [0020]      FIG. 13  illustrates an embodiment of cross-section A-A of the intravascular implant without the seal. 
           [0021]      FIG. 14  is a front perspective view of an embodiment of the intravascular implant. 
           [0022]      FIG. 15  is a perspective view of an embodiment of the attachment device. 
           [0023]      FIG. 16  illustrates an embodiment of cross-section B-B of the seal with the connectors. 
           [0024]      FIG. 17  is a front perspective view of an embodiment of the connector and the attachment device. 
           [0025]      FIGS. 18-20  illustrate embodiments of the connector. 
           [0026]      FIGS. 21-23  are front perspective views of various embodiments of the intravascular implant. 
           [0027]      FIGS. 24 and 25  are front perspective views of various embodiments of the anchor. 
           [0028]      FIG. 26  is a top view of an embodiment of the anchor. 
           [0029]      FIGS. 27-29  illustrate various embodiments of the intravascular implant. 
           [0030]      FIG. 30  illustrates an embodiment of a method for compressing the seal ring for deployment. 
           [0031]      FIGS. 31-33  illustrate an embodiment of a method for deploying the intravascular implant into a vascular site. 
           [0032]      FIGS. 34-37  illustrate various embodiments of radially contracting and expanding the anus of the anchor. 
           [0033]      FIG. 38  illustrates an embodiment of a method for deploying the intravascular implant into a vascular site. 
           [0034]      FIG. 39  illustrates an embodiment of a method for deploying the second implant with the intravascular implant. 
           [0035]      FIGS. 40-42  illustrate an embodiment of a method for attaching the seal to the attachment device. 
           [0036]      FIG. 43  illustrates an embodiment of the second implant. 
           [0037]      FIGS. 44 and 45  illustrate an embodiment of a method for attaching the seal to the attachment device. 
           [0038]      FIG. 46  illustrates an embodiment of the intravascular implant after deployment into a vascular site. 
       
    
    
     DETAILED DESCRIPTION 
       [0039]      FIG. 1  illustrates an embodiment of an intravascular implant  2 . The implant  2  can have a connector  4  having a first end  6  and a second end  8 . The first end  6  can be attached to an anchor  10 . The anchor  10  can have a central tip  12 . The central tip  12  can be attached to the first end  6 . The anchor  10  can also have multiple tines or arms  14  extending radially from the central tip  12 , such as in an uncovered umbrella structure. The central tip  12  can be rotatably or flexibly attached to the arms  14 . Leaves  16  can be attached at two ends to adjacent anus  14 . A flow-through area  18  can be an open port defined by any leaf  16  and the arms  14  to which that leaf  16  attaches. 
         [0040]    The second end  8  can be attached to a seal  20 . The second end  8  can attach to the seal  20  through an attachment device  22 , for example struts. The attachment device  22  can be integral with the second end  8 , integral with the seal  20 , or an independent part. Attachment devices  22  can also be used to attach the connector  4  to the anchor  10 . The seal  20  can have a first proximal end  24  and a first distal end  26 . A second implant  28  can be attached to the seal  20 , for example at the distal end  26 , or the second implant  28  can be an integral part of the seal  20 . 
         [0041]      FIG. 2  illustrates a single gasket embodiment of the seal  20 . The seal  20  can have a first seal ring  30  at the proximal end  24 . The seal  20  can also have a second seal ring  32  at the distal end  26 . The seal rings  30  and  32  can have radially extending spring force elements or tissue mainstays  33 . The tissue mainstays  33  can be, for example a barb, spike, hook, peg, a coil, pigtail or leaf spring, or any combination thereof. The seal rings  30  and  32  can be made from nickel-titanium alloy (e.g., Nitinol), titanium, stainless steel, cobalt-chrome alloy (e.g., ELGILOY® from Elgin Specialty Metals, Elgin, Ill.; CONICHROME® from Carpenter Metals Corp., Wyomissing, Pa.), 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, extruded collagen, silicone, radiopaque materials, or any combination thereof. Examples of radiopaque materials are barium, sulfate, titanium, stainless steel, nickel-titanium alloys and gold. 
         [0042]    The seal  20  can have a first seal cover  34  attached at the proximal end  24  to the first seal ring  30  and at the distal end  26  to the second seal ring  32 . The seal cover  34  can be made from polymers such as polyester (e.g., DACRON® from E.I. Du Pont de Nemours and Company, Wilmington, Del.), polypropylene, PTFE, ePTFE, PEEK, nylon, polylactic acid (PLA), poly(lactic-co-glycolic acid) (PLGA), polyglycolic acid (PGA), polyurethane, polyethylene, vascular, valvular or pericardial tissue, extruded collagen, silicone, metal mesh, radiopaque materials, or any combination thereof. 
         [0043]    A seal flow port  36  can be the hole defined by the inner radii of the seal rings  30  and  32  and the seal cover  34 . The seal  20  can have a seal diameter  38  that can depend on the diameter of the vessel in a given patient. The seal diameter  38  can be from about 5 mm (0.2 in.) to about 50 mm (2.0 in.), for example about 30 mm (1.2 in.). The seal  20  can have a seal height  40  from about 1 mm (0.04 in.) to about 6 cm (2.4 in.). 
         [0044]      FIG. 3  illustrates an embodiment of the seal  20  that can have a first gasket  42  and a second gasket  44 . Such a design can incrementally decrease the pressure across a given length so no one gasket  42  or  44  endures the entire pressure. The first gasket  42  can be similar to a single gasket seal embodiment illustrated in  FIG. 2 , except that the first seal cover  34  can be attached to the second seal ring  32  at a first gasket distal end  46 . The second gasket  44  can have a second seal cover  48 . The second seal cover  48  can be attached at a second gasket proximal end  50  to the second seal ring  32  and/or the second seal cover  48  can be integral with the first seal cover  34 . The second seal cover  48  can also attach at the distal end  26  to a third seal ring  52 . 
         [0045]      FIG. 4  illustrates an embodiment of the seal rings  30 ,  32  and  52  (shown as  30 ). The seal ring  30  can have diametrically opposed thin sections  54  and diametrically opposed thick sections  56 . The seal ring  20  can have a seal ring thickness  58  that can vary from a minimum in the thin sections  54  to a maximum in the thick sections  56 . The seal ring  30  can also have a constant thickness along the entire circumference of the seal ring  30 . The seal ring  30  can also have a gap in the circumference of the seal ring  30 , forming a “c”-ring (not shown) as known to one having ordinary skill in the art. 
         [0046]      FIG. 5  illustrates an embodiment of the seal  20  that can have a seal volume  60 . The seal volume  60  can be a bladder or collar filled by a fluid, for example saline, plasma, helium, oxygen, radiopaque materials (including small pieces of solids), blood, epoxy, glue, or any combination thereof. The bladder can be inflated in vivo by a method known to those having ordinary skill in the art. The seal volume  60  can also be a solid, for example polymers such as polyester (e.g., DACRON® from E.I. Du Pont de Nemours and Company, Wilmington, Del.), polypropylene, PTFE, ePTFE, PEEK, nylon, polylactic acid (PLA), poly(lactic-co-glycolic acid) (PLGA), polyglycolic acid (PGA), polyurethane, polyethylene, vascular, valvular or pericardial tissue, extruded collagen, silicone, radiopaque materials, or any combination thereof. 
         [0047]    A first and/or second seal flow ports  62  and  64 , respectively, can be defined, for example as cylinders, within the seal volume  60 . Once deployed, multiple seal flow ports  62  and  64  can attach to multiple second implants  28 , or multiple legs of the second implant  28  that can extend distal of the seal into the iliac arteries. A connector port  66  can also be defined, for example as a cylinder, within the seal volume  60 . The second end  8  of the connector  4  can be placed into the connector port  66 . The seal volume  60  can be inflated after the second end  8  is placed into the connector port  66  to constrict and pressure fit the connector port  66  around the second end  8 , thereby fixedly attaching the seal  20  to the connector  4 . 
         [0048]      FIG. 6  illustrates an embodiment of the seal  20  that can have a helical seal coil  68  having a first end  70  and a second end  72 . The ends  70  and  72  can be dulled, for example by attaching small balls as shown. The seal coil  68  can have a number of turns  74 , for example from about 1.25 turns  74  to about 50 turns  74 , for example about 5 turns  74 . 
         [0049]      FIG. 7  illustrates an embodiment of the seal  20  that can have a structure similar to the anchor illustrated in  FIG. 1  but with a vertically inverted orientation. 
         [0050]      FIG. 8  illustrates an embodiment of the seal  20  that can have a first seal ring  30  and a second seal ring  32  that are mechanically insulated from each other. This structure enables the seal rings  30  and  32  to fit to more easily fit and seal an irregularly shaped vessel. 
         [0051]    A first hub  76  can be fixedly attached or rotatably attached to first seal struts  78  and a center beam  80 . The first seal struts  78  can slidably connect on the outside or inside of the first seal ring  30  at free points  82 . The first seal struts  78  can be fixedly or rotatably attached to the second seal ring  32  at fixation points  84 . The first seal struts  78  can be fixedly attached or rotatably attached to a first collar  86 . The first collar  86  can be slidably attached to the center beam  80 . 
         [0052]    A second hub  88  can be fixedly attached or rotatably attached to second seal struts  90  and the center beam  80 . The second seal struts  90  can slidably connect on the outside or inside of the second seal ring  32  at the free points  82 . The second seal struts  90  can be fixedly or rotatably attached to the first seal ring  30  at the fixation points  84 . The second seal struts  90  can be fixedly attached or rotatably attached to a second collar  92 . The second collar  86  can be slidably attached to the center beam  80 . The seal struts  78  and  90 , the hubs  76  and  88 , and the collars  86  and  92  can be from the same materials as the seal rings  30 ,  32  and  52 . 
         [0053]    The seal rings  30  and  32  can be wave-shaped.  FIG. 9  illustrates a top view of one embodiment of the wave-shaped seal ring  30 , showing a circular shape from above.  FIG. 10  illustrates a side view of the wave-shaped seal ring  30  illustrated in  FIGS. 8 and 9 , showing two periods of smooth oscillation in a seal ring height  94 . 
         [0054]      FIG. 11  illustrates an embodiment of the seal ring  30  that can have sharp oscillations in the seal ring height  94 . Angled seal ring struts  96  can form the seal ring  30  into a zigzag.  FIG. 12  illustrates a seal ring  30  that can have a combination of alternating lock zones  98  and angled seal ring struts  96 . The lock zones  98  can be substantially parallel to the circumference of the seal ring  30 . 
         [0055]      FIG. 13  illustrates an embodiment of cross-section A-A (shown in  FIG. 1 ) of the intravascular implant  2  without the seal  20 . The anchor  10  can have connectors  4  attached to the arms  14 . The second end  8  of each connector  4  can have an integral attachment device  22 . The attachment device  22  can be made of a slide  100  and an interference piece  102  defining a catch  104  there between. The slide  100  can have a slide angle  106  from about 90° to about 180°. The slide  100  can also have a slide height  108  from about 0.38 mm (0.015 in.) to about 6.35 mm (0.250 in.), for example about 3.18 mm (0.125 in.). The interference piece  102  can have an interference piece depth  110  from about 0.38 mm (0.015 in.) to about 4.95 mm (0.195 in.). The slide  100  and interference piece  102  can be from the same materials as the seal rings  30 ,  32  and  52  or seal covers  34  and  48 . 
         [0056]      FIG. 14  illustrates an embodiment of the intravascular implant  2 . The anchor  10  can have a solid ring, and can be fixedly or rotatably attached to about two or more connectors  4 . The seal ring  30  can be vertically surrounded by the slides  100  and the interference pieces  102 . The seal ring  30  can, therefore, be engaged in the catch  104  and fixedly attached to the connectors  4 . 
         [0057]      FIG. 15  illustrates an embodiment of the attachment device  22 . The attachment device  22  can have first and second slides  100   a  and  100   b , first and second interference pieces  102   a  and  102   b , a catch  104  defined by the slides  100   a  and  100   b  and the interference pieces  102   a  and  102   b . The attachment device  22  can also have a rod slot  112  defined between the first slide  100   a  and second slide  100   b , and between the first interference piece  102   a  and the second interference piece  102   b.    
         [0058]      FIG. 16  illustrates an embodiment of cross-section B-B (shown in  FIG. 6 ) of the seal  20 . The two turns of the coil  68  can define the catch  104 . The coil  68  can have a coil wire diameter  114  from about 0.03 mm (0.001 in.) to about 1.3 mm (0.050 in.), for example about 0.64 mm (0.025 in.). 
         [0059]      FIG. 17  illustrates an embodiment of the connector  4  that can be attached to the attachment devices  22 , that can be, in turn, attached to the seal  20 . The connector  4  can be a flexible wire, coil, rod or combinations thereof and can be hollowed. The connector  4  can also be threaded to rotatably fit the anchor  10  and seal  20  or attachment device  22 . The connector can be made from any material listed for the anchor  10 . 
         [0060]    The attachment devices  22  can be wires, coils, rods or combinations thereof. The connector  4  can also be directly attached to the seal  20 . The connector  4  can be attached to the attachment devices  22  at a connector interface  116 . The connector interface  116  can have a hub, slider, or collar. The connector interface  116  can be a direct attachment. The connector  4  and attachment device  22  can also be an integral part. The seal  20  and attachment device  22  can also be an integral part. 
         [0061]      FIG. 18  illustrates an embodiment of the connector  4  that can be made from a helical connector coil  118 . The connector coil  118  can be made from a wire, for example a guidewire, having a diameter from about 0.46 mm (0.018 in.) to about 2.54 mm (0.100 in.).  FIG. 19  illustrates an embodiment of the connector  4  that can be made from the connector coil  118  and a connector wire or rod  120 . The connector wire or rod  120  can also be made from a wire, for example a guidewire, having a diameter from about 0.46 mm (0.018 in.) to about 2.54 mm (0.100 in.).  FIG. 20  illustrates an embodiment of the connector  4  that can have sharp oscillations in connector width. Angled connector struts  124  can form the connector  4  into a zigzag. 
         [0062]      FIG. 21  illustrates an embodiment of the intravascular implant  2  that can a longitudinal axis  126 . The attachment device  22  can attach the connector  4  to the anchor  10  such that the first end  6  can be substantially on the longitudinal axis  126 . The second end  8  can attach to the seal  20  substantially along a radial perimeter of the seal  20 . 
         [0063]      FIG. 22  illustrates an embodiment of the intravascular implant  2  that can have the attachment device  22  attach the connector  4  to the seal  20  such that the second end  8  can be substantially on the longitudinal axis  126 . The first end  6  can attach to the anchor  10  substantially along a radial perimeter of the anchor  10 . 
         [0064]      FIG. 23  illustrates an embodiment of the intravascular implant  2  that can have multiple connectors  4 . The connectors  4  can rotatably or fixedly attach to each other near their centers at joint points  128 . Joined pairs of connectors  4  can form x-beams  128 . The x-beams  128  can define transverse flow ports  132 . 
         [0065]      FIG. 24  illustrates an embodiment of the anchor  10  shaped as a helical anchor coil  134  having a first end  136  and a second end  138 . The ends  136  and  138  can be dulled, for example by attaching small balls as shown. The seal coil  134  can have from about 1 turn  140  to about 10 turns  140 , for example about 4 turns  140 . The anchor  10  can also have an anchor width  142  from about 5 mm (0.2 in.) to about 50 mm (2 in.). The anchor  10  can also have an anchor height  144 . 
         [0066]      FIG. 25  illustrates an embodiment of the anchor  10 . The anchor  10  can have the central tip  12 , the arms  14 , and the leaves  16  as shown and described in  FIG. 1 . The arms  14  can also extend radially beyond each attachment point  146  of each arm  14  and each leaf  16  to form a diminishing spring force element or tissue mainstay  148 . The spring force elements or tissue mainstays  148  on the anchor  10  can be the same material and design as the tissue mainstays  33  on the seal  20 , and vice versa. Anchor collar  150  can be slidably mounted to the connector  4  to radially extend or contract the arms  14  and to adjust the height between the anchor  10  and the seal  20  to better place the implant  2  with regard to the transverse vessels, for example the renal arteries, and vascular wall abnormalities. The anchor collar  150  can be fixedly or rotatably attached to arm supports  152 . The arm supports  152  can be fixedly or rotatably attached to the arms  14  at support points  154 . The arm supports  152  can also be an integral part of the anchor collar  150  and/or the arms  14 . The central tip  12 , arms  14 , leafs  16 , mainstays  148 , and arm supports  152  can be made from the same materials listed for the seal rings  30 ,  32  and  52 . 
         [0067]      FIG. 26  illustrates a top view of an embodiment of anchor  10 . Each leaf  16  can have a first leaf end  156  and a second leaf end  158 . The first leaf end  156  of one leaf  16  can merge with the second leaf end  158  of the neighboring leaf  16  and the intermediate arm  14  into a cover  160 . The cover  160  can be a cylinder with two open ends. The leaf  16 , first leaf end  156 , second leaf end  158  and cover  160  can be fixedly or rotatably attached. The first leaf end  156  and the second leaf end  158  can terminate within the cover  160 . When deployed, the leaf  16  can press against the vascular wall to maintain a substantially circular cross-section of the vessel. 
         [0068]      FIG. 27  illustrates an embodiment of the intravascular implant  2  having the arms  14  supported at support points  154  by the connectors  4 . The seal  20  can also be radially collapsible and expandable.  FIGS. 28 and 29  illustrate embodiments of the intravascular implant  2  that can have a first anchor  10  and a second anchor  162 . The second anchor can be fixedly or rotatably attached to connectors  4  at support points  154 . The second anchor  162  can also be vertically inverted with respect to the first anchor, as shown in  FIG. 29 . 
       Methods of Manufacture 
       [0069]    The tissue mainstays  33 , shown in  FIG. 2 , can be directly attached to the seal rings  30 ,  32  or  52  by, for example, melting, screwing, gluing, welding or use of an interference fit or pressure fit such as crimping, or combining methods thereof, to join the connector  4  to the seal  20 . The tissue mainstays  33  and the seal rings  30 ,  32  or  52  can be integrated, for example, by die cutting, laser cutting, electrical discharge machining (EDM) or stamping from a single piece or material. The connector interface  116 , shown in  FIG. 17 , can also directly attach to the connector  4  and the seal  20  or be integrated thereto by any method listed for the tissue mainstays  33  and the seal rings  30 ,  32  or  52 . The arm supports  152 , shown in  FIG. 25 , can also be integrated with the anchor collar  150  and/or the arms  14  by any method listed for the tissue mainstays  33  and the seal rings  30 ,  32  or  52 . As shown in  FIG. 26 , the leaf  16 , first leaf end  156 , second leaf end  158  and cover  160  can be fixedly or rotatably attached or integrally formed by any by any method listed for the tissue mainstays  33  and the seal rings  30 ,  32  or  52 . 
         [0070]    As shown in  FIG. 19 , the connector coil  118  and connector rod  120  can be attached at the first connector end  6  and the second connector end by methods known to one having ordinary skill in the art. 
         [0071]    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. 
         [0072]    Any elongated parts used in the intravascular implant  2  and the second implant  28 , for example the tip  12 , the arms  14 , the leafs  16 , the attachment devices  22 , the seal rings  30 ,  32  and  52 , the seal coil  68 , the connector coil  118 , the connector rod  120 , the connector strut  124 , the anchor coil  134  and the arm supports  152 , can be ovalized, or have an oval cross section where necessary, to ease crimping with other parts. 
       Method of Use 
       [0073]    The intravascular implant  2  can be collapsed or compressed into a deployment configuration to enable minimally invasive implantation into the vasculature of a patient.  FIG. 30  illustrates one embodiment of compressing the seal ring  30 , as shown in  FIG. 4 , by applying outward radial forces, as shown by arrows  164 , to the thin sections  54  and/or by applying an inward radial force, as shown by arrows  166 , to the thick sections  56 . Other embodiments can be compressed by applying inward radial forces spread around the circumference of the implant and/or other methods known to those having ordinary skill in the art. 
         [0074]    The intravascular implant  2  can be loaded into a delivery catheter  168  by methods known to those having ordinary skill in the art. Because the design of the intravascular implant  2  can separate the anchor  10  from the seal  20 , a low profile catheter can be used to deliver the intravascular implant  2 . As illustrated in  FIG. 31 , the delivery catheter  168  can be positioned, as shown by the arrow, at a vascular site  170  using a guidewire (not shown) and an “over-the-wire” delivery method, known to those having ordinary skill in the art. A control line  172  can also extend distally from the implant  2 . The control line  172  can include controls used to manipulate any part of the intravascular implant  2  such as rotating the seal  20 , expanding or contracting the arms  14 , or separating delivery devices from the implant  2 , and/or to deliver a substance such as a medication or radiopaque material, and/or to receive signals such as optical or electrical signals. The vascular site  170  can be adjacent to a vascular aneurysm  174 , for example an abdominal aortic aneurysm, having a proximal neck  176  and transverse vessels  180 , for example renal arteries, proximal to the vascular aneurysm  174 . 
         [0075]      FIG. 32  illustrates that the catheter  168  can be partially distally retracted, as shown by arrows  182 , thereby exposing the arms  14  while retaining the seal  20 . Once exposed, the arms  14  can expand radially, as shown by arrows  184 . Expansion of the arms  14  can occur due to resilient material expansion or mechanical manipulation. The tissue mainstays  148  can seat in the wall of the vascular site  170  proximal to the transverse vessels  180 , preventing the anchor  14  from moving distally. Multiple, independent arms  14  can adjust to the surrounding vasculature geometry to fit as needed for secure attachment to the vascular wall. The distance between the central tip  12  and the seal  20  can be an effective connector length  186 . The effective connector length  186  can be adjusted after the tissue mainstays  148  have been seated in the wall of the vascular site  170 . The effective connector length  186  can be adjusted by rotating the seal  20 , as shown by arrows  188 , along a threaded connector  4 . 
         [0076]      FIG. 33  illustrates that the arms  14  can be contracted, as shown by arrows  190 . The anchor  10  can then be easily repositioned, as shown by arrows  192 . The intravascular implant  2  can be made from or combined with radiopaque materials and markers to aid the placement, adjustments and repositioning of the intravascular implant  2  and associated parts with the use of an angiogram. 
         [0077]      FIG. 34  illustrates an embodiment of the connector  4  and the anchor  10  that can have a contraction line  193  releasably connected to the anchor collar  150 . Contraction line  193  can be formed of coaxial hypotubes. Contraction line  193  can also be part of control line  172 . The arms  14  can be biased to radially expand or radially contract.  FIG. 35  illustrates that the contraction line  193  can be pulled, as shown by arrow  194 , which can result in a distal movement of the anchor collar  150 , as shown by arrow  196 . The distal movement of the anchor collar  150  can cause the arm supports  154  and, in turn, the arms  14  to rotate inward and radially contract, as shown by arrows  198 . The above process can be reversed and the arms  14  can be radially expanded. The contraction line can be separated from the anchor collar  150  when placement of the anchor  10  is finalized. 
         [0078]      FIG. 36  illustrates an embodiment of the connector  4  and the anchor  10  that can have a fixed hub  200  that is fixedly held in space, for example by the seal  20 , the delivery catheter  168  and/or the control line  172 , distal to the anchor collar  150 . The fixed hub  200  can also be slidably connected to the connector  4 .  FIG. 37  illustrates that the connector  4  can be pulled distally, as shown by arrow  202 , which can cause the anchor collar  150  to butt against the fixed hub  200  and be forced proximally with respect to the connector  4 , as shown by arrow  204 . The proximal movement of the anchor collar  150  can cause outward rotation and radial expansion of the arm supports  154  and, in turn, the arms  14 , as shown by arrows  206 . The above process can be reversed and the arms  14  can be radially contracted. The arms  14  can be locked into place by methods known to those having ordinary skill in the art. 
         [0079]      FIG. 38  illustrates that the catheter  168  can be retracted distally of the seal  20 , as shown by arrows  208 . Retracting the catheter  168  can expose the seal  20 , allowing the seal  20  to radially expand, as shown by arrows  210 . The seal  20  can be placed to seat in the proximal neck  176 . When fully deployed, the intravascular implant  2  can have an open-walled structure, and can therefore be placed adjacent to the transverse vessels  180  without interfering with the flow through the transverse vessels  180 . 
         [0080]      FIG. 39  illustrates the intravascular implant  2  that can be implanted in the vascular site  170 . The distal end  26  can be attached to a second implant  28 , for example a vascular graft such as an abdominal aortic aneurysm graft, for example a gel weave aortic graft. The second implant  28  can have two branching legs  212 . 
         [0081]      FIG. 40  illustrates a cross-section of an embodiment of the attachment device  22  and second end  8  of the seal  4 . The seal ring  30  can be proximal to the slides  100 . The seal cover  34  or the second implant  28  can extend from the seal ring  30 .  FIG. 41  illustrates pulling the seal ring  30  along the slides  100 , as shown by arrows  214 . Movement of the seal ring  30  along the slides  100  can cause the seal ring to radially contract, as shown by arrows  216 . Once the seal ring  30  is distally clear of the slides  100 , the seal ring  30  can radially expand, as shown by arrows  218 , and seat into the catch  104 . Once in the catch  104 , the seal ring  30  can be held vertically in place by the distal side of the slide  100  and the proximal side of the interference piece  102 . 
         [0082]    As illustrated in  FIG. 43 , the second implant  28  can be attached to the seal ring  30  at the proximal end of the second implant  28 . The seal ring  30  can be releasably attached to deployment rods  220 . 
         [0083]    As illustrated in  FIG. 44 , the deployment rods  220  can be used to position the seal ring  30  proximal to the attachment device  22  and so that the deployment rods  220  align into the rod slots  112 . (The second implant  28  is not shown in  FIG. 44  for clarity). The deployment rods  220  can be pulled distally, as shown by arrow  222 , thereby moving the seal ring  30  distally. As illustrated in  FIG. 45 , the seal ring  30  can then seat into the catch  104 . The deployment rods  220  can be detached from the seal ring  30  and removed from the vascular site  170 . The control line  172  can be removed from the vascular site  170  whenever removal is deemed appropriate during the implantation procedure. 
         [0084]      FIG. 46  illustrates an embodiment of the intravascular implant  2  deployed at a vascular site  170 . The vascular site  170  can have a severely tortuous region over which the implant  2  is placed. The flexibility of the connector  4  compensates for the contortion in the vascular site, enabling the arms  14  to intersect the wall of the vascular site  170  at a substantially perpendicular angle, and enabling the seal  20  to seat into the proximal neck  176  to open into the at a substantially parallel angle to the body of the second implant  28 . Stress and fractures in the intravascular implant  2  and in the tissue at the vascular site  170  can be minimized due to the anchor  10  being mechanically insulated from the seal  20  by use of the connector  4 . Additionally, stresses can be reduced because the tissue in the vascular site  170  adjacent to the anchor  10  does not need to seal, and the tissue in the vascular site  170  adjacent to the seal  20  does not need to anchor. Additional intravascular implants  2 , as shown, can be deployed at the distal ends  224  of the second implant  2 , for example in the iliac arteries, to additionally secure the second implant  2 . 
         [0085]    The arms  14  and/or the seal  20  can apply chronic stress to the adjacent tissue in the vascular site  170  causing a controlled migration of the arms  14  and/or seal  20  into the wall of the vascular site  170  to a specified depth predetermined by the tissue mainstays  33  and/or  148 . The predetermined depth can be the length of the tissue mainstay  33  and/or  148 , or a force exerted by the tissue mainstay  33  and/or  148 . The controlled migration is then halted by either a distribution of force along the greater surface area between the tissue mainstay  33  and/or  148  and the wall of the vascular site or the diminishing force on the same surface area once the radially central end (with respect to the anchor  10 ) of the tissue mainstay  33  and/or  148  has reached the wall of the vascular site  170 , or a combination of both. Tissue can then ingrow around the tissue mainstay  33  and/or  148  providing a biologic seal or anchor so that the integrity of the seal or anchor is not purely mechanical. 
         [0086]    It is apparent to one having ordinary skill 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.