Abstract:
Devices and methods for the endovascular repair of aneurysms approximate to side branch vessels and more particularly to devices and methods for placing an acutely angled bifurcated stent graft.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims priority to U.S. Provisional Application Ser. No. 61/560,395, which was filed on Nov. 16, 2011 and is hereby incorporated by reference in its entirety. 
    
    
     BACKGROUND 
     1. Field 
     The present disclosure generally relates to a delivery system and method for delivering an expandable endoluminal prosthetic device such as a stent graft and more particularly to a device and method for placing an acutely angled bifurcated stent graft. 
     2. Discussion of the Related Art 
     Expandable surgical devices such as stents or stent grafts are used in a variety of places in the human body to repair aneurysms and to support various anatomical lumens, such as blood vessels, respiratory ducts, gastrointestinal ducts, and the like. 
     Conventionally, these devices are deployed across an aneurysm or in the regions of a stenosis in the target body lumen to repair the aneurysm or to hold the lumen open. Because stent graft implantation is a relatively non-invasive procedure, it has been proven to be a favorable alternative to surgery in, for example, the repair of an aneurysm. Bifurcated devices with their trunk and branching configuration are particularly well suited for use in branching body lumen systems, such as in the coronary vasculature, and the peripheral vasculature. The coronary vasculature includes the right, left common, left anterior descending and circumflex arteries and their branches. The peripheral vasculature includes branches of the carotids, aorta, femoral, popliteal, internal iliac, or hypogastric and related arteries. Placement of such a bifurcated device often involves approaching the bifurcated section of the artery through at least two vessels. 
     There exists a need for a stent graft delivery system which would allow placement of multiple bifurcated and single lumen stent grafts into an acutely angled or “reverse direction” branches, as for example a repair of the hypogastric artery. A simplified surgical procedure, suitable for complex target sites, would decrease the number or size of incisions, reduce the required surgical steps, and thereby reduce patient trauma associated with a more complex medical procedure. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings are included to provide a further understanding of the present disclosure and are incorporated in and constitute a part of this specification, illustrate embodiments of the present disclosure, and together with the description serve to explain the principles of the present disclosure. 
         FIGS. 1-9  illustrate various embodiments of methods of deploying a branched stent assembly to branched vasculature. 
     
    
    
     DETAILED DESCRIPTION 
     Proximal as used herein indicates a position closest to a practitioner and distal indicates a position furthest from a practitioner. 
     In accordance with various embodiments, a method of endoluminally deploying a branched stent assembly to branched vasculature is generally illustrated in  FIGS. 1-9 . Methods of fabricating various branched and non-branched stent assemblies, as well as delivery devices and methods are disclosed in U.S. Pat. No. 6,520,986, U.S. Pat. No. 7,682,380, U.S. Pat. No. 6,352,561 and U.S. Publication 2008/0269866, hereby incorporated by reference in their entirety. 
     As shown in  FIG. 1 , the method includes positioning a first guidewire  100  through a first femoral artery  102  having a hypogastric side branch  104 . The first guidewire  100  passes an aortic bifurcation  106  and extends into a descending aorta  108 . A second guidewire  110  is positioned through the first femoral artery  102 , across the aortic bifurcation  106  and through a second femoral artery  112 . A first compacted, expandable, bifurcated device having a main body through lumen, a side branch lumen, an extended first branch and a contralateral leg is prepared for implantation external to the patient. The compacted device (not shown in  FIG. 1 ) is placed onto the first  100  and second  110  guidewire external to the access site  114 . The first guidewire  100  is routed into the compacted device main body through lumen. The second guidewire  110  is routed into the compacted device side branch lumen. 
     As shown in  FIG. 2 , the first compacted device  200  is advanced along the first and second guidewires  100 ,  110  within the first femoral artery  102  to a position adjacent to the aortic bifurcation  106 . 
     As shown in  FIG. 3 , the distal end  300  of the first compacted expandable device  200  is deployed, so that the compacted extended first branch  302  of the first compacted expandable device  200  is located within the first femoral artery  102  and the contralateral leg  304  of the first compacted expandable device  200  is exposed. 
     As shown in  FIG. 4 , a dilator  400  and delivery sheath  402  is advanced along the second guidewire, through the second femoral artery  112 , across the aortic bifurcation  106 , through the distal end  300  of the first expandable device  200  and through the exposed contralateral leg  304 . 
     As shown in  FIG. 5 , the dilator  400  (from  FIG. 4 ) and the second guidewire are withdrawn from the delivery sheath  402 . The delivery sheath  402  is further advanced to a position approximate the hypogastric side branch  104 . A third guidewire  500  is advanced through the delivery sheath  402  and into the hypogastric side branch  104  of the first femoral artery  102 . 
     As shown in  FIG. 6 , a second compacted, expandable device  600 , having a single main body through lumen is advanced through the delivery sheath  402  along the third guidewire, through the second femoral artery  112 , across the aortic bifurcation  106 , through the distal end of the expandable device  300 , through the exposed contralateral leg  304  and into the hypogastric side branch  104  of the first femoral artery  102 . 
     As shown in  FIG. 7 , the second compacted device  600  is deployed so that the second device  600  expands into the exposed contralateral leg  304  and into the hypogastric side branch  104  of the first femoral artery  102 . The proximal end  700  of the first compacted, expandable, bifurcated device  200  is deployed so that the extended first branch  702  is positioned into the first femoral artery  102  and crosses the hypogastric side branch  104  of the first femoral artery  102 . The delivery sheath  402  (from  FIG. 6 ) is fully withdrawn along the second femoral artery  112 . The third guidewire  500  is partially retracted along the second femoral artery  112  and then advanced past the aortic bifurcation  106  and into the descending aorta  108 . 
     As depicted in  FIG. 8 , the first guidewire  100  is partially retracted to a position approximate to the aortic bifurcation  106 . A third compacted, expandable, bifurcated device having a main body through lumen, a side branch lumen, an extended first branch and a contralateral leg is advanced over the third guidewire  500 , within the second femoral artery  112 , into the descending aorta  108  to a position distal to the aneurysm  800 . The third device  802  is deployed so that the main body  804  is expanded into the descending aorta  108  distal to the aneurysm  800  The contralateral leg  806  of the third device  802  is exposed and the extended first branch  808  of the third device  802  is expanded into the second femoral artery  112 . The first guidewire  100  is advanced past the aortic bifurcation  106  and into the exposed contralateral leg  806  of the third device  802 . 
     As shown in  FIG. 9 , a fourth compacted, expandable device having a single main body through lumen is advanced over the first guidewire  100  within the first femoral artery  102 , through the extended first branch  702  of the first expandable device  200 , through the distal end  900  of the first expandable device  200  and into the exposed contralateral leg  902  of the third device  802 . The fourth compacted device is deployed so that the fourth device  904  expands into the distal end  900  of the first device  200  and expands into the exposed contralateral leg  902  of the third device  802 . To complete the procedure, the first and third guidewires  100 ,  500  are fully withdrawn. 
     It will be apparent to those skilled in the art that various modifications and variations can be made in the present invention without departing from the spirit or scope of the invention. Thus, it is intended that the present invention cover the modifications and variations of this invention provided they come within the scope of the appended claims and their equivalents.