Abstract:
An endoluminal prosthesis having a graft sleeve, a set of internal graft channels formed within the graft sleeve and a self-expanding wire stent. The graft sleeve forms a main fluid flow channel between a first open end and a second open end of the graft sleeve and includes an external surface and an internal surface. The self-expanding wire stent is coaxially mounted with the graft sleeve and affixed to the graft sleeve. The set of internal graft channels includes at least two internal graft channels parallel to the graft sleeve, each internal graft channel having an inner open end within the first open end of the graft sleeve and an outer open end within the second open end of the graft sleeve, thereby forming a set of fluid flow channels between the end openings of the graft sleeve.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    None 
       STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0002]    None 
       NAMES OF PARTIES TO A JOINT RESEARCH AGREEMENT 
       [0003]    None 
         [0004]    REFERENCE TO A “SEQUENCE LISTING” 
         [0005]    None 
       BACKGROUND OF THE INVENTION 
       [0006]    This invention relates generally to tubular prostheses, such as grafts, stents, stent-graft and like for implantation within a human or animal body for the repair of damaged vessels, ducts or other physiological passageways, and to methods of making and using such apparatus. 
         [0007]    The functional vessels of human and animal bodies, such as blood vessels and ducts, may occasionally weaken, increase in diameter and eventually rupture. For example, an abnormal dilatation of the wall of the aorta causes a sac, called aortic aneurysm. Upon further exposure to hemodynamic forces, such an aneurysm can rupture, with ensuing fatal hemorrhaging in a very short time. 
         [0008]    One surgical intervention for weakened, aneurysmal or ruptured vessels involves the use of an endoluminal prosthesis, such as a stent graft, to provide some or all the functionality of the original, healthy vessel. 
         [0009]    Briefly, a stent graft comprises two major components, a stent and a graft. The stent typically takes the form of a somewhat stiff tube-like structure inserted into an affected vessel and fixed in place. The stent may serve to maintain a patent vessel lumen, may serve as a structural support for the vessel, and/or may serve as attachment/seal for a graft. A graft typically takes the form of a flexible tube or sleeve which is at least somewhat fluid tight. When secured within a vessel using stents the graft becomes a surrogate vessel-within-a-vessel, and bears the brunt of the intravascular fluid pressure. It has become common practice to bridge damaged vessel segment using a sufficiently long graft secured within the vessel with stent segments. 
         [0010]    This clinical approach, which is significantly less invasive than the traditional surgical procedure, is known as endovascular grafting. Stent grafts are used for treatment of vasculature in the human or animal body to bypass a repair or defect in the vasculature. For instance, a stent graft may be used to span an abdominal aortic aneurysm. 
         [0011]    Complications arise, however, when vessel damage occurs near a vessel branch point, such as a mesenteric artery or a renal artery. Bypassing such an artery without providing blood flow into the branch artery can cause serious problems to the patient. 
         [0012]    In order to overcome some or all of these drawbacks, branched endovascular prostheses have been proposed which provide a fenestration in the wall of a stent graft which, when the stent graft is deployed, is positioned over the opening to the branch vessel. Another stent graft can be deployed through the fenestration into the branch vessel to provide a blood flow path to the branch artery. Proper matching of the prosthesis to the proximal neck of the aortic vessel and the branching blood vessels is critical to the treatment of an aneurysm. 
         [0013]    However a wide variation in vessel morphology has to be expected; for example, aortas vary in length, diameter and angulation between the renal artery region and the region of the aortic bifurcation. All possible combinations of these variables need to be considered, calling for large inventories of fenestrated prosthesis or for custom prosthesis. 
         [0014]    Moreover, in certain conditions, endovascular grafting must be performed in a short period of time, not always compatible with the time needed for designing and manufacturing custom prosthesis. 
         [0015]    Also a problem exists in mapping the vasculature so that a fenestration is positioned correctly in relation to the branch vessel when a custom stent graft is constructed. Where the position of a fenestration with respect to a branch vessel is offset when the stent graft is deployed, it may be difficult to deploy guide wires and catheters from the stent graft into the branch vessel to enable correct positioning of the branch vessel stent graft. Also when the fenestration is offset from the branch and a stent graft is deployed into the branch vessel from a main stent graft, the branch vessel stent graft may be kinked to such an extent that blood flow will not occur through it. 
       DESCRIPTION OF THE BACKGROUND ART 
       [0016]    More elaborate, multi-components devices are required to both shield the damaged vessel portion while maintaining blood flow through the main and branch vessels. Such devices are described in the following patents and references cited therein. 
         [0017]    U.S. Pat. No. 5,632,772 describes a self-expanding endoluminal graft, preferably provided as a plurality of components that are deployed separately at the branching vessel location fitting in a telescoping manner. 
         [0018]    U.S. Pat. No. 5,984,955 describes a system and method for endoluminal grafting of a main anatomical conduit and various branch conduits, comprising a primary graft with openings and branch grafts. 
         [0019]    U.S. Pat. No. 5,653,743 describes a small bifurcated graft which may be placed in each hypogastric artery to maintain patency both to it and to the external iliac artery and the leg below. 
         [0020]    U.S. Pat. No. 5,824,040 describes a branching endoluminal prosthesis for using in branching body lumen systems including trunk and branch lumens, comprising radially expandable trunk and branch portions, and radially expandable Y-connector portion. 
         [0021]    U.S. Pat. No. 6,645,242 describes a bifurcated intravascular stent graft comprising a stent and a sleeve. The sleeve has an internal channel communicating with the side opening, thereby providing a branch flow channel from the main channel out through the side opening. 
         [0022]    U.S. Appl. 2004/0193254 describes a prosthetic trunk lumen extending therethrough comprising a wall and an anastomosis in the wall, wherein a prosthetic trunk branch is disposed. 
         [0023]    U.S. Appl. 2009/0048663 describes a system comprising a prosthetic device with a major lumen extending therethrough, a wall with one or more openings, and one or more branches extending into the major lumen. 
         [0024]    The branching stent-graft structures of the prior art have generally comprised uniform structures, in which the branch fenestrations are substantially orthogonal to the aortic portion when the prosthesis is at rest. Although these straight branching prostheses are intended to deform somewhat to accommodate the branch angles of body lumen systems, the imposition of substantial axial bends due to an offset between branch and fenestration on known endovascular stent-grafts tends to cause folding, kinking, or wrinkling which occludes the lumens of the stent-grafts and degrades their therapeutic value. Still another disadvantage of known bifurcated stent-grafts is that even when they are flexed to accommodate varying branch geometries, the prosthetic bifurcation becomes distorted, creating an unbalanced flow to the branches. To overcome these limitations, it has often been necessary to limit these highly advantageous, minimally invasive endovascular therapies to patients having vascular geometries and abdominal aortic aneurysms which fall within very narrow guidelines. 
         [0025]    Many of the prior-art devices are suitable for vessel branches where the branch vessel leaves the main vessel at a relatively small angle (less than about 45°, or example). For larger branching angles (as large as about 90° or even up to about 180°, for example) many prior art devices are not suitable. Such large branching angles occur at several potentially important repair sites (particularly along the abdominal aorta, at the renal arteries, celiac artery, superior and inferior mesenteric arteries, for example). Another drawback common to many devices of the prior-art is the need for transluminal access through the branch vessel from a point distal of the repair site. In many instances such access is either impossible (celiac artery, mesenteric arteries, renal arteries) or extremely difficult and/or dangerous (carotid arteries). Still other previous devices do not provide a substantially fluid-tight seal with the branch vessel, thereby partially defeating the purpose of the stent graft (i.e., shielding the repaired portion of the main vessel and/or branch vessel from intravascular fluid pressure). 
         [0026]    It is therefore desirable to provide an endoluminal device to increase the number of vessel morphologies covered by a small number of prosthesis, especially in those cases where branched vessels are involved. It is also desirable to provide an endoluminal device which can be deployed within standard prosthesis in order to increase the vessel morphologies covered by these prosthesis. 
       BRIEF SUMMARY OF THE INVENTION 
       [0027]    The present invention provides radially expansible tubular prostheses, particularly grafts, stents, and stent-grafts, which are highly adaptable to varying luminal system geometries. The tubular prostheses, such as grafts, stents, stent-graft and like are for implantation within a human or animal body, secured in place by suture, stent or other suitable means, for the repair of damaged vessels, ducts or other physiological passageways. The prostheses of the present invention are suitable for a wide variety of therapeutic uses, including stenting of the vasculature, ureter, urethra, trachea, esophagus, biliary tract, and the like. 
         [0028]    These prostheses will generally be radially expansible from a narrow diameter configuration to facilitate introduction into the body lumen, typically during surgical cutdown or percutaneous introduction procedures. 
         [0029]    The prosthetic structures of the present invention will find their most immediate use as endovascular prostheses for the treatment of diseases of the vasculature, particularly aneurysms, stenoses, especially in those cases where the damaged or defected portion of the vasculature may include a branch vessel such as a mesenteric artery or a renal artery. 
         [0030]    The prosthetic structures of the present invention will find their most immediate use as endoluminal prostheses being implanted in a vessel or lumen, or inside the vessel of an implanted prosthesis, in order to split or divide the vessel into multiple smaller vessels. 
         [0031]    The prosthetic structures described herein below will find use in axially uniform cylindrical prostheses, in preassembled bifurcated prostheses, and as prosthetic modules which are suitable for selective assembly either prior to deployment, or in situ. 
         [0032]    In one aspect of the invention there is an endoluminal prosthesis that comprises a graft sleeve, a set of internal graft channels formed within the graft sleeve and a self-expanding wire stent. The graft sleeve forms a main fluid flow channel between a first open end and a second open end of the graft sleeve and includes an external surface and an internal surface. The self-expanding wire stent is coaxially mounted with the graft sleeve and affixed to the graft sleeve. The set of internal graft channels includes at least two internal graft channels parallel to the graft sleeve, each internal graft channel having an inner open end within the first open end of the graft sleeve and an outer open end within the second open end of the graft sleeve, thereby forming a set of fluid flow channels between the end openings of the graft sleeve. The set of internal graft channels are obtained by repeatedly bending or folding the internal surface of the graft sleeve along a longitudinal line extending along the inner surface and connecting the internal surface along a segment extending along the longitudinal line by means of sewing or other mechanical means. The self-expanding wire stent and the first open end of the graft sleeve are adapted for engaging an endoluminal surface of a first segment of a main vessel and forming a substantially fluid-tight seal therewith; and the self-expanding wire stent and the second open end of the graft sleeve are adapted for engaging an endoluminal surface of a second segment of a main vessel and forming a substantially fluid-tight seal. 
         [0033]    In an embodiment of the present invention, the endoluminal prosthesis comprises: a self-expanding wire stent and a graft sleeve. The graft sleeve comprises an upper tubular body defining a primary inlet, and a plurality of tubular legs, each leg defining an outlet, being the outlets of the legs in fluid communication with the inlet of the upper tubular body. The plurality of tubular legs are bended inside the upper tubular body, being the outlets of the plurality of tubular legs placed inside the primary inlet of the upper tubular body, defining a secondary inlet in the graft sleeve at the point where the plurality of tubular legs bended inside the upper tubular body, being the secondary inlet in fluid communication with the outlets of the plurality of legs. The self-expanding wire stent is coaxially arranged substantially internally to the upper tubular body and externally to the plurality of tubular legs, and it is affixed or operatively connected to the upper tubular body and to the plurality of tubular legs. The self-expanding wire stent and the primary inlet of the graft sleeve are adapted for engaging an endoluminal surface of a first segment of a main vessel and forming a substantially fluid-tight seal therewith; and the self-expanding wire stent and the secondary inlet of the graft sleeve are adapted for engaging an endoluminal surface of a second segment of a main vessel and forming a substantially fluid-tight seal. 
     
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
         [0034]      FIG. 1  is a schematic view of the multi-port endoluminal prosthesis in accordance with the present invention 
           [0035]      FIG. 2  is a schematic view of a prior art stent 
           [0036]      FIG. 3  is a perspective view of the multi-port endoluminal prosthesis in accordance with the present invention 
           [0037]      FIG. 4  is a schematic view of a tubular sleeve 
           [0038]      FIG. 5  shows the tubular sleeve being split or divided along a longitudinal line 
           [0039]      FIG. 6  shows the tubular sleeve split or divided along a longitudinal line forming two tubular bodies 
           [0040]      FIG. 7  shows the tubular sleeve coaxially mounted internally to the stent 
           [0041]      FIG. 8  shows a schematic view of the tubular sleeve with the stent positioned over the tubular sleeve. 
           [0042]      FIG. 9  shows an alternative embodiment of the multi-port endoluminal prosthesis 
           [0043]      FIG. 10  shows an alternative embodiment of the multi-port endoluminal prosthesis 
           [0044]      FIG. 11  shows an alternative embodiment of the multi-port endoluminal prosthesis 
           [0045]      FIG. 12  shows an alternative embodiment of the multi-port endoluminal prosthesis 
           [0046]      FIG. 13  shows an alternative embodiment of the multi-port endoluminal prosthesis with multiple tubular bodies 
           [0047]      FIG. 14  is a schematic view of a guide wire advanced through the iliac, the aorta and the stent graft 
           [0048]      FIG. 15  is a schematic view of a guide catheter advanced through the iliac, the aorta and the stent graft 
           [0049]      FIG. 16  is a schematic view of a rigid guide wire advanced through the iliac, the aorta and the stent graft 
           [0050]      FIG. 17  is a schematic view of a delivery catheter advanced through the iliac, the aorta and the stent graft 
           [0051]      FIG. 18  shows the multi-port endoluminal prosthesis deployed inside a stent graft 
           [0052]      FIG. 19  is a schematic view of a guide wire advanced through the subclavian, the aorta, stent graft, the multi-port endoluminal prostheses and the renal artery 
           [0053]      FIG. 20  is a schematic view of a guide catheter advanced through the subclavian, the aorta, stent graft, the multi-port endoluminal prostheses and the renal artery 
           [0054]      FIG. 21  is a schematic view of a stiffer guide wire advanced through the subclavian, the aorta, stent graft, the multi-port endoluminal prostheses and the renal artery 
           [0055]      FIG. 22  is a schematic view of a delivery catheter advanced through the subclavian, the aorta, stent graft, the multi-port endoluminal prostheses and the renal artery 
           [0056]      FIG. 23  shows a stent graft deployed between renal artery and the multi-port endoluminal prosthesis. 
           [0057]      FIG. 24  shows stent grafts deployed between renal artery, superior mesenteric artery, renal artery and the multi-port endoluminal prosthesis. 
           [0058]      FIG. 25  shows the multi-port endoluminal prosthesis deployed inside a stent graft 
           [0059]      FIG. 26  shows stent grafts deployed between renal artery, superior mesenteric artery, renal arteries and the multi-port endoluminal prostheses. 
           [0060]      FIG. 27  shows the multi-port endoluminal prostheses deployed inside a stent graft. 
           [0061]      FIG. 28  shows the multi-port endoluminal prostheses deployed inside a iliac artery. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0062]    The present invention relates to endoluminal vascular prostheses and methods of deploying such prostheses. Stylized drawings of human body parts are shown in frontal view, where the left side of the drawing corresponds to the right side of human body. 
         [0063]    It will be understood that the embodiments of the present invention described herein are illustrative of some of the applications of the principles of the present invention. Various modifications may be made by those skilled in the art without departing from the true spirit and scope of the invention. 
         [0064]    A multi-port endoluminal prosthesis, generally referred to as numeral  100 , according to the present invention is illustrated in  FIGS. 1 and 3 . The multi-port endoluminal prosthesis  100  comprises a graft  131  and a stent  171 . The stent  171  comprises a first end  173  and a second end  175 , as shown in  FIG. 2 . 
         [0065]    The graft  131  comprises a hollow inlet  161  and a hollow outlet  163  as shown in  FIG. 3 . The graft  131  comprises a first tubular body  143  and a second tubular body  145  as shown in  FIG. 1  and  FIG. 3  The first tubular body  143  includes a first hollow inlet  181  and a first hollow outlet  183 . The second tubular body  145  includes a second hollow inlet  185  and a second hollow outlet  187 . The first and second tubular bodies  143  and  145  are in fluid communication with the hollow inlet  161  and the hollow outlet  163 . 
         [0066]    The multi-port endoluminal prosthesis  100  may be obtained with the method described below and illustrated in  FIG. 4-8 . It will be appreciated by those skilled in the art that other modifications could be made or different methods could be used to obtain the prosthesis of the invention without deviating from its spirit and scope as claimed. 
         [0067]    The graft  131  of the multi-port endoluminal prosthesis  100  may be obtained from a tubular sleeve  133 , as shown in  FIG. 4-8 . The sleeve  133  is preferably made of woven polyester graft material, like Dacron, polytetrafluoroethylene (PTF), expanded PTFE, and other synthetic materials known to those of skill in the art. The sleeve  133  comprises an inner surface  135 , an external surface  149 , a first open end  137  and a second open end  139 , as illustrated in  FIG. 4 . The inner surface  135  of the sleeve  133  can be bent along a longitudinal line  141  extending along the inner surface  135  as shown by the arrows in  FIG. 5 . 
         [0068]    A portion of the longitudinal line  141 , herein referred to as a connection segment  155 , comprises a first end  157  and a second end  159  as showed in  FIG. 6 . The inner surface  135  can be connected along the connection segment  155 , as shown in  FIG. 6 , by means of sewing or any other mechanical means that provide sealing between the first and second tubular bodies  143  and  145 . The connection segment  155  comprises a first end  157  and a second end  159 . 
         [0069]    The sleeve  133  is split or divided into the first tubular body  143  and the second tubular body  145 , not necessarily of the same diameter, in the central portion, while the first open end  137  and the second open end  139  keep a one-vessel configuration, as shown in  FIG. 6 . 
         [0070]    A first unsplit or undivided portion  151  of the sleeve  133  is therefore delimited from the first open end  137  and the first end  157  of the connection segment  155  of the inner surface  135 . A second unsplit or undivided portion  153  is therefore delimited from the second open end  139  and the second end  159  of the connection segment  155  of the inner surface  135 . 
         [0071]    The stent  171  is preferably a self-expanding stent, ideally comprising a shape memory alloy such as super-elastic Nitinol, or the like. The tubular sleeve  133  is coaxially mounted internally to the stent  171 , as shown in  FIG. 7 . The sleeve  133  may be operatively connected to the stent  171  by means of suturing the external surface  149  to the stent  171 , or by any other mechanical means. 
         [0072]    The first unsplit or undivided portion  151  is bent over the stent  171 , recovering it for some extension, as shown in  FIG. 8 . The first unsplit or undivided portion  151  may be operatively connected to the stent  171  by means of suturing. The second unsplit or undivided portion  153  is bent over the stent  171 , recovering it for some extension, as shown in  FIG. 8 . The second unsplit or undivided portion  153  may be operatively connected to the stent  171  by means of suturing. 
         [0073]    In an alternative embodiment of the present invention, the first unsplit or undivided portion  151  and second unsplit or undivided portion  153  may be directly connected to the stent  171 , without bending over the stent  171 , by means of suturing, adhesive or encapsulating the stent  171  as shown in  FIG. 9 . 
         [0074]    Referring to  FIG. 10-12  an alternative embodiment of the multi-port endoluminal prosthesis is described, generally to as numeral  200 . The multi-port endoluminal prosthesis  200  comprises a graft  231  and a stent  271 . 
         [0075]    The graft  231  comprises a hollow inlet  255  and hollow outlet  257  as shown in  FIG. 10 . The graft  231  comprises a trunk component  261 , a first leg  263  and a second leg  265 , as shown in  FIG. 11 . The first leg  263  and the second leg  265  are in fluid communication with the hollow inlet  255 . The first leg  263  and the second leg  265  are bended inside the trunk component  261  as shown in  FIG. 12 . 
         [0076]    The stent  271  is preferably a self-expanding stent, ideally comprising a shape memory alloy such as super-elastic Nitinol, or the like. The graft  231  is coaxially mounted internally the stent  271 , as shown in  FIG. 12 . The graft  231  may be operatively connected to the stent  271  by means of suturing or any other mechanical means. 
         [0077]    In an alternative embodiment the number of tubular bodies may vary to three or more.  FIG. 13  shows a three legs multi-port endoluminal  400  prosthesis comprising a first tubular body  401 , a second tubular body  403  and a third tubular body  405 . 
         [0078]    The multi-port endoluminal prostheses of the present invention is particularly well-suited for repair of main vessel segments where one or more branch vessels leave the main vessel at an angle approaching 90°. Previous bifurcated stent graft devices enable repairs where a branch vessel leaves the main vessel at a substantially smaller angle of less than about 45°. This limitation in the prior art does not allow for repair at several potentially important locations within the vasculature, ureter, urethra, trachea, esophagus, biliary tract, and the like. 
         [0079]    Other previous devices enable repair at such high angled branches only when transluminal access to a distal portion of the branch vessel is possible. In many instances such access is either impossible (celiac artery, mesenteric arteries, renal arteries) or extremely difficult and/or dangerous (carotid arteries). Still other previous devices do not provide a substantially fluid-tight seal with the branch vessel, thereby partially defeating the purpose of the stent graft (i.e., shielding the repaired portion of the main vessel and/or branch vessel from intravascular fluid pressure). 
         [0080]    The prostheses of the present invention, in contrast, addresses these issues. As shown in  FIG. 14 , a bifurcated stent graft  301  (for instance as the stent graft described in patent U.S. 2011/0130828) may be delivered transluminally to repair an aneurysmatic site  303  of a main vessel  305  (for instance by the method as described in U.S. 2011/0130828). The bifurcated stent graft  301  in  FIG. 14  has an upper tubular body  316  which defines a hollow inlet  318 , and a lower bifurcation  320  which includes a first tubular leg  324  defining a first outlet  322  and a second tubular leg  326  which is shorter than the first tubular leg  324  and defines a second outlet  323 . The first and second tubular legs  324  and  326  are in fluid communication with the hollow inlet  318 . 
         [0081]    As shown in  FIG. 14  a flexible guide wire  307  extends through the second tubular leg  326  and second outlet  323  of the lower bifurcation  320  of the bifurcated stent graft  301 , extending to an iliac artery  349  so that it can function to guide the advancement of a guide catheter through the iliac artery  349  and into the second tubular leg  326  of the bifurcated stent graft  301  in order to guide a stiffer guide wire which is distally advanced into the second tubular leg  326  of the bifurcated stent graft  301 . As further discussed below, the guide catheter is then removed and a catheter delivery system is advanced over the stiffer guide wire through the iliac artery  349  and into the second tubular leg  326  of the stent graft within the aorta  350  to facilitate delivery and deployment of the endoluminal multi-port prostheses therein. 
         [0082]    Turning to  FIG. 15 , a guide catheter  351  is advanced over the flexible guide wire  307 . The flexible guide wire  307  guides the guide catheter  351  through the iliac artery  349 , through a portion of the aorta  350 , and into the second tubular leg  326  of the bifurcated stent graft  301 . The surgeon can advance the guide catheter  351  over the guide wire  307 , and the guide wire  307  will guide the distal end of the guide catheter  351  into the second outlet  323  of the second tubular leg  326 . 
         [0083]    Once the guide catheter  351  is disposed inside the second tubular leg  326  of the bifurcated stent graft  301 , the flexible guide wire  307  is retracted proximally through the second tubular leg  326 , the aorta  350 , the iliac artery  349 , and out of the patient, while the guide catheter  351  remains advanced within the second tubular leg  326 . 
         [0084]    A stiffer guide wire  355  ( FIG. 16 ) may then be advanced through the guide catheter  351  to the distal end of the guide catheter  351  inside the second tubular leg  326 , and the guide catheter  351  may be removed, leaving the stiffer guide wire  355  in place. 
         [0085]    Turning to  FIG. 17 , with the stiffer guide wire  355  in place, a catheter delivery system  364  may be provided with the multi-port endoluminal prostheses  400  with three internal channels and a stent delivery device  365  and may be introduced into the patient and distally advanced over the stiffer guide wire  355 , which guides the catheter delivery system  364  through the iliac artery  349  and aorta  350 , and into the second tubular leg  326  of the bifurcated stent graft  301 . 
         [0086]    The multi-port endoluminal prostheses  400  can then be deployed from the catheter delivery system  364  inside the second tubular leg  326  of the bifurcated stent graft  301  (e.g., the delivery catheter is refracted proximally relative to the stent delivery device  365 , which is held longitudinally fixed, which deploys the multi-port endoluminal prostheses  400 ). The stiffer guide wire  355  may be removed from the patient before or after deployment of the multi-port endoluminal prostheses  400 . The catheter delivery system  364  can be operated to deploy the multi-port endoluminal prostheses  400  between the second outlet  323  of the second tubular leg  326  and the lower bifurcation  320  as shown in  FIG. 18 . 
         [0087]    Turning to  FIG. 19  a thin guide wire  343  is inserted through a left subclavian artery  344  and advanced through a portion of the aorta  350 , through the hollow inlet  318  of the bifurcated stent graft  301 , through the second tubular leg  326 , through the first tubular body  401  of the multi-port endoluminal prostheses  400  and through the right renal artery  353 . 
         [0088]    Turning to  FIG. 20 , a guide catheter  345  is advanced over the thin guide wire  343 . The thin guide wire  343  guides the guide catheter  345  through the left subclavian artery  344 , through a portion of the aorta  350 , through the hollow inlet  318  of the bifurcated stent graft  301 , through the second tubular leg  326 , through the first tubular body  401  of the multi-port endoluminal prostheses  400  and through the right renal artery  353 . The surgeon can advance the guide catheter  345  over the thin guide wire  343 , and the thin guide wire  343  will guide the distal end of the guide catheter  345  into the right renal artery  353  as shown in  FIG. 20 . 
         [0089]    Once the guide catheter  345  is disposed inside the right renal artery  353  the thin guide wire  343  is retracted, while the guide catheter  345  remains advanced within the right renal artery  353 . A stiffer guide wire  347  ( FIG. 21 ) may then be advanced through the guide catheter  345  to the distal end of the guide catheter  345  inside the right renal artery  353  and the guide catheter  345  may be removed, leaving the stiffer guide wire  347  in place. 
         [0090]    Turning to  FIG. 22 , a catheter delivery system  358  provided with a stent graft  361  (like a Viabhan) is advanced over the stiffer guide wire  347  through the left subclavian artery  344 , through a portion of the aorta  350 , through the hollow inlet  318  of the bifurcated stent graft  301 , through the second tubular leg  326 , through the first tubular body  401  of the multi-port endoluminal prostheses  400  and through the right renal artery  353 . 
         [0091]    The stent graft  361  can then be deployed from the catheter delivery system  358  inside the right renal artery  353 . (e.g., the delivery catheter is refracted proximally relative to the stent delivery device  363 , which is held longitudinally fixed, which deploys the first stent graft  361 ). The stiffer guide wire  347  may be removed from the patient before or after deployment of the first stent graft  361 . The catheter delivery system  358  can be operated to deploy the stent graft  361  between the right renal artery  353  and the first tubular body  401  of the multi-port endoluminal prostheses  400 , as shown in  FIG. 23 . 
         [0092]    Using the same method described above, by means of guide wires, guide catheters and stent delivery devices, a stent graft  371  can be deployed between the superior mesenteric artery  375  and the second tubular body  403  of the multi-port endoluminal prostheses  400 , as shown in  FIG. 24 . Similarly a stent graft  381  may be deployed between the celiac trunk  385  and the third tubular body  405  of the multi-port endoluminal prostheses  400 . 
         [0093]    With a similar procedure, by means of guide wires, guide catheters and stent delivery devices the multi-port endoluminal prostheses  100  comprising the first tubular body  143  and the second tubular body  145  may be deployed inside the first tubular leg  324  of the bifurcated stent graft  301  between the first outlet  322  of the first tubular leg  324  and the lower bifurcation  320  as shown in  FIG. 25 . 
         [0094]    As shown in  FIG. 26  a stent graft  387  can be deployed between left renal artery  389  and the first tubular body  143  of the multi-port endoluminal prostheses  100 , by means of guide wires, guide catheters and stent delivery devices. A stent graft  391  can be deployed in the second tubular body  145  of the multi-port endoluminal prostheses  100  and a bifurcated stent graft  393  can successively be deployed between the stent graft  391  and the iliac arteries  348  and  349 , as shown in  FIG. 25   
         [0095]    It will be appreciated that the stent grafts  361 ,  371 ,  381 ,  387 ,  391  and  393  together with the multi-port prosthesis  400  and  100  will now define passageways for blood flow from the aorta  350  upstream of the aneurysmatic site  303  to the left renal arteries  389  and the right renal arteries  353 , to the superior mesentheric artery  375 , to the celiac trunk  385  and to the iliac arteries  348  and  349 , downstream of the aneurysmatic site  303  while excluding the damaged or otherwise unhealthy portion (e.g., the aneurysmatic site  303 ) of the aorta  350 . 
         [0096]    In  FIG. 27  a stent graft  501  is deployed close to the iliac bifurcation  510 . The multi-port endoluminal prosthesis  100  is deployed in a leg  503  of a bifurcated stent graft  501 . In case of aneurysm of distal part of external iliac artery  509  contralateral access is gained and two stent grafts  505  and  507  are deployed between the multi-port endoluminal prosthesis  100  and the external and internal iliac arteries, as shown in  FIG. 27 . 
         [0097]    In  FIG. 28  a stent graft  601  is deployed close to the iliac bifurcation  510 . The multi-port endoluminal prosthesis  100  is deployed in the external iliac artery  603 . In case of aneurysm  609  of distal part of external iliac artery  603  ipsilateral access is gained and a stent graft  605  is deployed between a leg  607  of the stent graft  601  and the external iliac artery  603 . A second stent graft  611  is deployed between the multi-port endoluminal prosthesis  100  and the internal iliac artery, as shown in  FIG. 27 . 
         [0098]    Additional stent grafts may be applied to one or more blood vessels as needed. There have been described and illustrated herein several embodiments of an apparatus and a method of repairing abdominal aortic aneurysms. While particular embodiments of the invention have been described, it is not intended that the invention be limited thereto, as it is intended that the invention be as broad in scope as the art will allow and that the specification be read likewise. It is also intended that all the embodiments illustrated herein may be used in the applications presented. Thus, while particular shaped and sized stent grafts have been disclosed, it will be appreciated that other shapes and sizes may be used as well. It will therefore be appreciated by those skilled in the art that yet other modifications could be made to the provided invention without deviating from its spirit and scope as claimed.