Endoluminal prosthesis having multiple branches or fenestrations and methods of deployment

• US 10,722,342 B2
• Filed: 02/05/2018
• Issued: 07/28/2020
• Est. Priority Date: 04/28/2011
• Status: Active Grant

• Current Assignee: Cleveland Clinic Foundation, Cook Medical Incorporated (Cook Group Incorporated)
• Original Assignee: Cleveland Clinic Foundation
• Inventors: Greenberg, Roy K., West, Karl J., Resch, Timothy A., Roeder, Blayne A.
• Primary Examiner(s): Severson, Ryan J.
• Application Number:
  US15/888,710
• Publication Number:
  US 20180153680A1
• Time in Patent Office: 904 Days
• CPC Class Codes: A61F 2/06 Blood vessels
• CPC Class Codes: A61F 2/07 Stent-grafts
• CPC Class Codes: A61F 2/82 Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents stent-grafts for tubular structures of the body other than blood vessels A61F2/04; stent-grafts for blood vessels A61F2/07; instruments specially adapted for placement or removal of stents or stent-grafts A61F2/95; for closing wounds, or holding wounds closed A61B17/04 - A61B17/115; dilators A61M29/00
• CPC Class Codes: A61F 2/86 Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
• CPC Class Codes: A61F 2/89 the wire-like elements comprising two or more adjacent rings flexibly connected by separate members
• CPC Class Codes: A61F 2/95 Instruments specially adapted for placement or removal of stents or stent-grafts
• CPC Class Codes: A61F 2/954 for placing stents or stent-grafts in a bifurcation
• CPC Class Codes: A61F 2/962 having an outer sleeve
• CPC Class Codes: A61F 2002/061 provided with means for allowing access to secondary lumens
• CPC Class Codes: A61F 2002/072 Encapsulated stents, e.g. wire or whole stent embedded in lining
• CPC Class Codes: A61F 2002/075 the stent being loosely attached to the graft material, e.g. by stitching
• CPC Class Codes: A61F 2002/821 Ostial stents
• CPC Class Codes: A61F 2002/826 more than one stent being applied sequentially
• CPC Class Codes: A61F 2002/9665 with additional retaining means
• CPC Class Codes: A61F 2220/0075 sutured, ligatured or stitched, retained or tied with a rope, string, thread, wire or cable
• CPC Class Codes: A61F 2230/0091 helically-coiled or spirally-coiled, i.e. having a 2-D spiral cross-section
• CPC Class Codes: A61F 2250/0007 for adjusting length
• CPC Class Codes: A61F 2250/0017 differing in yarn density
• CPC Class Codes: A61F 2250/0018 differing in elasticity, stiffness or compressibility
• CPC Class Codes: A61F 2250/0039 differing in diameter

Abstract

A branched and fenestrated prosthesis may include a main tubular graft body including a proximal end opening, a distal end opening, a lumen, and a sidewall. A branch may extend from the sidewall and may include a first end opening, a second end opening, and a lumen. A fenestration may be disposed in the sidewall and positioned distal of the second end opening of the branch. The branched and fenestrated prosthesis may include a plurality of branches and a plurality of fenestrations.

Claims

1. A branched prosthesis comprising:

a tubular body of biocompatible graft material having a proximal end, a distal end, an internal lumen, a sidewall, and a longitudinal axis from the proximal end to the distal end;

a proximal portion having a first diameter;

a distal portion having a second diameter;

a tapered portion between the proximal portion and the distal portion;

a first fenestration in the sidewall;

at least one antegrade branch connected to and extending entirely longitudinally from the first fenestration in the sidewall and having a distally extending free open end, the at least one antegrade branch disposed at least partially in the tapered portion and configured to permit antegrade fluid flow therethrough;

at least one unbranched fenestration in the sidewall at least partially disposed distal of the tapered portion and distal of the free open end of the at least one antegrade branch.

2. The prosthesis of claim 1, further comprising a second fenestration and a second antegrade branch connected to and extending entirely longitudinally from the second fenestration in the sidewall and having a distally extending free open end.

3. The prosthesis of claim 2, wherein the distally extending free open ends of the at least one antegrade branch and second antegrade branches are circumferentially offset from each other.

4. The prosthesis of claim 2, wherein the distally extending free open ends of the at least one antegrade branch and second antegrade branches are longitudinally offset from each other.

5. The prosthesis of claim 2, wherein the distally extending free open ends of the at least one antegrade branch and second antegrade branches are both circumferentially and longitudinally offset from each other.

6. The prosthesis of claim 2, wherein the at least one unbranched fenestration comprises first and second unbranched fenestrations that are disposed distal of the tapered portion and distal of the free open ends of the at least one antegrade branch and second antegrade branches.

7. The prosthesis of claim 1, wherein the at least one unbranched fenestration comprises first and second unbranched fenestrations that are disposed distal of the tapered portion and distal of the free open end of the at least one antegrade branch.

8. The prosthesis of claim 7, wherein the first and second unbranched fenestrations are circumferentially offset from each other.

9. The prosthesis of claim 1, wherein the at least one antegrade branch is circumferentially offset from the at least one unbranched fenestration.

10. The prosthesis of claim 1, wherein the at least one antegrade branch is longitudinally in line with the at least one unbranched fenestration.

11. A stent graft comprising:

a tubular body of biocompatible graft material having a proximal end, a distal end, a sidewall between the proximal and distal ends, and an internal lumen;

a proximal portion having a first constant diameter;

an intermediate portion having a second constant diameter less than the first constant diameter;

a tapered portion between the proximal portion and the intermediate portion and having a variable diameter ranging from the first constant diameter of the proximal portion to the second constant diameter of the intermediate portion;

two entirely longitudinally extending antegrade branches disposed at least partially in the tapered portion and configured to permit antegrade fluid flow therethrough, each of the two antegrade branches having a proximal end and a free open distal end extending toward the distal end of the stent graft;

two unbranched fenestrations disposed in the sidewall in the intermediate portion and longitudinally spaced from the open distal ends of the two antegrade branches;

wherein the two distally extending antegrade branches are configured to receive a side branch graft.

12. The stent graft of claim 11, wherein a first of the two entirely longitudinally extending antegrade branches is disposed in the tapered portion and the second of the two distally extending antegrade branches is disposed at least partially in the intermediate portion.

13. The stent graft of claim 11, wherein the free open ends of the two entirely longitudinally extending antegrade branches are at least partially longitudinally offset from each other.

14. The stent graft of claim 11, wherein the two unbranched fenestrations are circumferentially offset from each other.

15. The stent graft of claim 11, wherein the two unbranched fenestrations are longitudinally and circumferentially offset from each other.

16. The stent graft of claim 11, wherein the two unbranched fenestrations are longitudinally offset from each other.

17. The stent graft of claim 11, wherein the two unbranched fenestrations each have a reinforcement frame about a perimeter of the unbranched fenestrations.

18. The stent graft of claim 11, wherein the open end of a first of the two entirely longitudinally extending antegrade branches is disposed in the tapered portion and the open end of a second of the two entirely longitudinally extending antegrade branches is disposed in the intermediate portion.

19. A stent graft comprising:

a tubular body of biocompatible graft material having a proximal end, a distal end, a sidewall between the proximal and distal ends, and an internal lumen;

a proximal portion having a first constant diameter;

an intermediate portion having a second constant diameter less than the first constant diameter;

a tapered portion between the proximal portion and the intermediate portion and having a variable diameter ranging from the first constant diameter of the proximal portion to the second constant diameter of the intermediate portion;

a plurality of entirely longitudinally extending antegrade branches disposed at least partially in the tapered portion and configured to permit antegrade fluid flow therethrough, each of the plurality of entirely longitudinally antegrade branches having a proximal end and an open distally facing end;

a plurality unbranched fenestrations disposed in the sidewall in the intermediate portion and longitudinally spaced from the open distally facing ends of the plurality of entirely longitudinally extending antegrade branches;

wherein at least one of the plurality of entirely longitudinally extending antegrade branches is both circumferentially and longitudinally offset from another of the plurality of entirely longitudinally extending antegrade branches.