Endolumenal prothesis and method of use in bifurcation regions of body lumens

• US 20030167083A1
• Filed: 02/17/2003
• Published: 09/04/2003
• Est. Priority Date: 09/24/1997
• Status: Active Grant

• Current Assignee: Medtronic Vascular, Inc. (Medtronic Plc)
• Original Assignee: Medtronic Vascular, Inc. (Medtronic Plc)
• Inventors: Birdsall, Matthew J., Brooks, Dennis L., Haarstad, Philip J., Peacock, James C. III, Lashinski, Robert D., Colombo, Antonio
• Granted Patent: US 7,018,400 B2
• Time in Patent Office: Days
• US Class Current: 623/1.12
• CPC Class Codes: A61F 2/856 Single tubular stent with a side portal passage
• CPC Class Codes: A61F 2/91 made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes
• CPC Class Codes: A61F 2/915 with bands having a meander structure, adjacent bands being connected to each other
• CPC Class Codes: A61F 2/954 for placing stents or stent-grafts in a bifurcation
• CPC Class Codes: A61F 2/958 Inflatable balloons for placing stents or stent-grafts
• CPC Class Codes: A61F 2002/065 Y-shaped blood vessels
• CPC Class Codes: A61F 2002/91541 Adjacent bands are arranged out of phase
• CPC Class Codes: A61F 2002/91558 connected peak to peak
• CPC Class Codes: A61F 2250/0039 differing in diameter

Abstract

An endolumenal medical device assembly is provided for use in a bifurcation region of a body lumen. An expandable prosthesis, preferably an endolumenal support device such as a stent, is included in the assembly and is adjustable from a radially collapsed condition to a radially expanded condition. The expandable prosthesis further includes a prosthesis passageway and a side port through which the prosthesis passageway communicates externally of the prosthesis. A dilator or an access device is engaged within the prosthesis passageway and also through the side port while the expandable prosthesis is in the radially collapsed condition. By coupling a guidewire to an access device engaged within the side port and positioning the guidewire therein, the expandable prosthesis may be positioned in the bifurcation region such that its distal end portion is in a first branch lumen extending from the bifurcation, its proximal end portion is in a common proximal lumen of the bifurcation region, and the side port is aligned with an entrance zone to a second branch lumen extending from the bifurcation. When the expandable prosthesis is positioned at the bifurcation region in this orientation, the access device maintains percutaneous translumenal access to the second branch lumen through the prosthesis passageway and the side port while the expandable prosthesis is adjusted from the radially collapsed condition to the radially expanded condition. In addition, a dilator when engaged within the side port is adapted to expand the bore formed by the side port from an initial inner diameter to a larger expanded inner diameter. A second, lateral expandable prosthesis can also be coupled to the first expandable prosthesis at a location adjacent to the side port such that the dilator or access device extending through the side port is engaged within a lateral prosthesis lumen, extending through the lateral expandable prosthesis.

Claims

1. An endolumenal medical device assembly for engaging an interior surface of a body lumen wall at a bifurcation region of a body lumen, the bifurcation region including at least a first and a second branch lumen each having an entrance zone extending from a common branch lumen, comprising:

an expandable prosthesis having an elongate prosthesis body with a proximal end portion, a distal end portion, a length along a longitudinal axis extending between the proximal and distal end portions, a prosthesis passageway which extends along the length, and a side port which is positioned along the length and through which the prosthesis passageway communicates externally of the elongate prosthesis body, the expandable prosthesis further being adjustable from a radially collapsed condition, wherein the elongate prosthesis body has a collapsed outer diameter, to a radially expanded condition, wherein the elongate prosthesis body has an expanded outer diameter which is larger than the collapsed outer diameter;

a delivery member having a proximal end portion and a distal end portion which is coupled to the expandable prosthesis, the delivery member being adapted to deliver the expandable prosthesis to the bifurcation region in a percutaneous translumenal procedure by manipulating the proximal end portion of the delivery member;

an expansion member with a proximal end portion and a distal end portion which is removably engaged with the elongate prosthesis body, the distal end portion of the expansion member further being adapted to adjust the expandable prosthesis from the radially collapsed condition to the radially expanded condition when the elongate prosthesis body is engaged with the expansion member and is positioned at the bifurcation region; and

a dilator with a proximal end portion and a distal end portion which is engaged within the prosthesis passageway and also within the side port when the expandable prosthesis is in the radially collapsed condition, wherein the distal end portion of the dilator is adjustable from a first dilator position, wherein the side port has an initial inner diameter, to a second dilator position, wherein the side port is dilated to an expanded inner diameter which is larger than the initial inner diameter.

2. The endolumenal medical device assembly of claim 1, wherein the expanded inner diameter approximates an inner lumenal diameter at the entrance zone of one of the first and second branch lumens.

3. The endolumenal medical device assembly of claim 1, wherein the expanded inner diameter is within the range of 1.0 to 5.0 millimeters.

4. The endolumenal medical device assembly of claim 1, wherein the dilator further comprises:

a dilator inflation lumen extending between the proximal and distal end portions of the dilator, the distal end portion of the dilator further including an expandable balloon which is fluidly coupled to the dilator inflation lumen and which is also engaged within the side port, the proximal end portion of the dilator further including a fluid coupler which is in fluid communication with the dilator inflation lumen and which is adapted to couple with a pressurizeable fluid source,

whereby coupling a pressurizeable fluid source to the fluid coupler and pressurizing the expandable balloon with fluid, the expandable balloon may be expanded from an unexpanded condition, which characterizes the first dilator position, to an expanded condition, which characterizes the second dilator position.

5. The endolumenal medical device assembly of claim 4, wherein the dilator further comprises:

a guidewire with a proximal end portion and a distal end portion which is coupled to at least the distal end portion of the dilator, the distal end portion of the guidewire further including a shaped, radiopaque tip region which is steerable by torquing the proximal end portion of the guidewire.

6. The endolumenal medical device assembly of claim 4, wherein the dilator further comprises:

a guidewire tracking member extending at least along the distal end portion of the dilator, the guidewire tracking member further including a guidewire lumen which extends between a distal guidewire port located along the guidewire tracking member distally of the expandable balloon and a proximal guidewire port located along the guidewire tracking member proximally of the prosthesis passageway, the guidewire tracking member being adapted to track a guidewire slideably received within the guidewire lumen through the proximal and distal guidewire ports.

7. The endolumenal medical device assembly of claim 6, further comprising:

a guidewire which has a proximal end portion and a distal end portion with a shaped, radiopaque tip region which is steerable by torquing the proximal end portion of the guidewire, the distal end portion of the guidewire further being adapted to slideably engage within the guidewire lumen and through the proximal and distal guidewire ports.

8. The endolumenal medical device assembly of claim 1, wherein the dilator further comprises:

a taper having a distally reducing outer diameter from a large outer diameter portion to a small outer diameter portion, wherein the first dilator position the small outer diameter portion is engaged within the side port, and in the second dilator position the large outer diameter portion is engaged within the side port.

9. The endolumenal medical device assembly of claim 1, wherein the expandable prosthesis further comprises an endolumenal stent which is adapted to provide radial support to the body lumen wall when the expandable prosthesis is expanded from the radially collapsed condition to the radially expanded condition.

10. The endolumenal medical device assembly of claim 9, wherein the endolumenal stent comprises a tubular stent wall which is formed by a plurality of integrated support members, the tubular stent wall further including a plurality of gaps formed between portions of the integrated support members, the side port being formed at least in part by one of the gaps.

11. The endolumenal medical device assembly of claim 1, wherein the expandable prosthesis is balloon expandable, and wherein the expansion member further comprises an inflation lumen extending between the proximal and distal end portions of the expansion member, the distal end portion of the expansion member further including an expandable balloon which is fluidly coupled to the inflation lumen and which is engaged within the prosthesis passageway, the proximal end portion of the expansion member further including a fluid coupler which is fluidly coupled to the inflation lumen and which is adapted to couple to a pressurizeable fluid source.

12. The endolumenal medical device assembly of claim 1, wherein the expandable prosthesis is self-expandable from an elastically deformed condition in the radially collapsed condition to a resting condition in the radially expanded condition, and wherein the expandable prosthesis is radially constrained in the radially collapsed condition by the expansion member and is radially unconstrained by the expansion member in the radially expanded condition.

13. The endolumenal medical device assembly of claim 12, wherein the expansion member further comprises a sheath which forms a sheath lumen and which is adjustable from a constraining position, wherein the expandable prosthesis is coaxially confined and constrained in the radially collapsed condition within the sheath lumen, to a releasing position, wherein the expandable prosthesis is released from within the sheath lumen and is radially unconfined and self-expands to the resting condition in the radially expanded condition.

14. The endolumenal medical device assembly of claim 1, further comprising:

a lateral expandable prosthesis having a lateral elongate prosthesis body with a proximal end portion, a distal end portion, and a lateral prosthesis lumen extending between a proximal end port located along the proximal end portion of the lateral elongate prosthesis body and a distal end port located along the distal end portion of the lateral elongate prosthesis body,

the lateral expandable prosthesis being adjustable from a second radially collapsed condition, wherein the lateral elongate prosthesis body has a second collapsed outer diameter, to a second radially expanded condition, wherein the lateral elongate prosthesis body has a second expanded outer diameter,

the proximal end portion of the lateral elongate prosthesis body being coupled to the elongate prosthesis body at a location adjacent to the side port, and

wherein the distal end portion of the dilator is engaged within the lateral prosthesis lumen such that when the dilator is adjusted from the first dilator position to the second dilator position the lateral expandable prosthesis is expanded from the second radially collapsed condition to the second radially expanded condition.

15. The endolumenal medical device assembly of claim 14, wherein the dilator further comprises:

a dilator inflation lumen extending between the proximal and distal end portions of the dilator, the distal end portion of the dilator further including an expandable balloon which is fluidly coupled to the dilator inflation lumen and which is also engaged within the side port and also within the lateral prosthesis lumen, the proximal end portion of the dilator further including a fluid coupler which is in fluid communication with the dilator inflation lumen and which is adapted to couple with a pressurizeable fluid source,

whereby coupling a pressurizeable fluid source to the fluid coupler and pressurizing the expandable balloon with fluid, the expandable balloon may be inflated from a non-expanded condition, which characterizes the first dilator position, to an expanded condition, which characterizes the second dilator position.

16. The endolumenal medical device assembly of claim 14, wherein the expanded inner diameter and the second expanded outer diameter are each within the range of 1.0 to 5.0 millimeters when the distal end portion of the dilator is adjusted from the first dilator position to the second dilator position.

17. An endolumenal medical device assembly for engaging an interior surface of a body lumen wall at a bifurcation region of a body lumen, the bifurcation region including at least first and second branch lumens each having an entrance zone extending from a common branch lumen, comprising:

an expandable prosthesis having an elongate prosthesis body with a proximal end portion, a distal end portion, a length along a longitudinal axis extending between the proximal and distal end portions, a prosthesis passageway which extends along the length, and a side port which is positioned along the length and through which the prosthesis passageway communicates externally of the elongate prosthesis body, the expandable prosthesis further being adjustable from a radially collapsed condition, wherein the elongate prosthesis body has a collapsed outer diameter, to a radially expanded condition, wherein the elongate prosthesis body has an expanded outer diameter which is larger than the collapsed outer diameter;

a delivery member having a proximal end portion and a distal end portion which is coupled to the expandable prosthesis, the delivery member further being adapted to deliver the expandable prosthesis to the bifurcation region in a percutaneous translumenal procedure by manipulating the proximal end portion of the delivery member;

an expansion member with a proximal end portion and a distal end portion which is removably engaged with the elongate prosthesis body, the distal end portion of the expansion member further being adapted to actuate radial expansion of the expandable prosthesis from the radially collapsed condition to the radially expanded condition when the elongate prosthesis body is engaged with the expansion member and is positioned at the bifurcation region; and

an access device with a proximal end portion and a distal end portion, the distal end portion of the access device being engaged within the prosthesis passageway at least along the proximal end portion of the expandable prosthesis and also within the side port when the expandable prosthesis is in both the radially collapsed and radially expanded conditions,

whereby positioning the expandable prosthesis at the bifurcation region such that the distal end portion of the expandable prosthesis is located in the first branch lumen and the side port is aligned with the entrance zone to the second branch lumen, the access device is adapted to provide percutaneous translumenal access to the second branch lumen.

18. The endolumenal medical device assembly of claim 17, wherein the access device further comprises a guidewire which has a proximal end portion and a distal end portion with a shaped, radiopaque tip region which is steerable by torquing the proximal end portion of the guidewire, the distal end portion of the guidewire being engaged within the prosthesis passageway and extending distally through the side port when the expandable prosthesis is in both the radially collapsed and the radially expanded conditions.

19. The endolumenal medical device assembly of claim 17, wherein the access device further comprises:

a guidewire tracking member with a proximal end portion, a distal end portion which is engaged within the prosthesis passageway and when the expandable prosthesis is in both the radially collapsed and the radially expanded conditions, and a guidewire lumen which is formed at least in part by the distal end portion of the guidewire tracking member, the guidewire lumen communicating externally of the guidewire tracking member through a distal guidewire port located along the distal end portion of the guidewire tracking member at or adjacent to the side port and also through a proximal guidewire port located along the guidewire tracking member proximally of the prosthesis passageway, the guidewire tracking member further being adapted to track over a guidewire slideably received within the guidewire lumen through the proximal and distal guidewire ports.

20. The endolumenal medical device assembly of claim 19, further comprising:

a guidewire which has a proximal end portion and a distal end portion with a shaped, radiopaque tip region that is steerable by torquing the proximal end portion of the guidewire, the distal end portion of the guidewire further being adapted to slideably engage the guidewire tracking member within the guidewire lumen and through the proximal and distal guidewire ports.

21. The endolumenal medical device assembly of claim 17, wherein the expandable prosthesis further comprises:

an endolumenal stent which is adapted to provide radial support to the body lumen wall when the expandable prosthesis is expanded from the radially collapsed condition to the radially expanded condition.

22. The endolumenal medical device assembly of claim 21, wherein the endolumenal stent further comprises a tubular stent wall which is formed by a plurality of integrated support members, the tubular stent wall further including a plurality of gaps each being formed by a separation between at least a portion of adjacent integrated support members, the side port being formed at least in part by one of the gaps.

23. The endolumenal medical device assembly of claim 17, wherein the expandable prosthesis is balloon expandable, and wherein the expansion member further comprises an expansion member inflation lumen extending between the proximal and distal end portions of the expansion member,

the distal end portion of the expansion member further including an expandable balloon which is fluidly coupled to the expandable member inflation lumen and which is engaged within the prosthesis passageway,

the proximal end portion of the expansion member further including a coupler which is fluidly coupled to the expansion member inflation lumen and which is adapted to couple to a pressurizeable fluid source.

24. The endolumenal medical device assembly of claim 17, wherein the expandable prosthesis is self-expandable from an elastically deformed condition in the radially collapsed condition to a resting condition in the radially expanded condition, and wherein the expandable prosthesis is constrained in the radially collapsed condition by the expansion member and is unconstrained by the expansion member in the radially expanded condition.

25. The endolumenal medical device assembly of claim 24, wherein the expansion member further comprises a sheath which forms a sheath lumen and which is adjustable from a second constraining position, wherein the expandable prosthesis is coaxially confined within the sheath lumen, to a second releasing position, wherein the expandable prosthesis is released from within the sheath lumen and is radially unconfined and self-expands to the resting condition in the radially expanded condition.

26. A method of engaging an expandable prosthesis within an interior surface of a body lumen wall at a bifurcation region of the body lumen, the expandable prosthesis having a longitudinal axis, a length along the longitudinal axis, a prosthesis passageway which extends along the longitudinal axis, and a side port located along the length and through which the prosthesis passageway communicates externally of the expandable prosthesis, comprising:

engaging a distal end portion of a dilator within the prosthesis passageway and also within the side port while the expandable prosthesis is in a radially collapsed condition.

27. The method of claim 26, wherein the expandable prosthesis further includes a proximal end portion and a distal end portion such that the side port is located between the proximal and distal end portions, and wherein the bifurcation region includes first and second branch lumens each having an entrance zone extending from a common branch lumen, the method further comprising:

positioning the expandable prosthesis within the bifurcation region such that the proximal end portion of the expandable prosthesis is located within the common branch lumen, the distal end portion of the expandable prosthesis is located within the first branch lumen, and the side port is aligned with the entrance zone to the second branch lumen.

28. The method of claim 27, wherein the side port has an initial inner diameter, further comprising:

after positioning the expandable prosthesis within the bifurcation region, dilating the side port with the distal end portion of the dilator from the initial inner diameter to an expanded inner diameter which is larger than the initial inner diameter.

29. The method of claim 28, wherein the distal end portion of the dilator includes an expandable balloon which is fluidly coupled to a pressurizeable fluid source, the method of dilating the side port further comprising:

pressurizing the expandable balloon with fluid from the pressurizeable fluid source such that the expandable balloon is expanded from a radially collapsed condition to a radially expanded condition, such that the side port is adjusted from the initial inner diameter to the expanded inner diameter.

30. The method of claim 28, further comprising:

before dilating the side port with the dilator, engaging a distal end portion of a guidewire within the prosthesis passageway, through the side port, and within at least the entrance zone of the second branch lumen.

31. The method of claim 30, wherein the distal end portion of the dilator further includes a guidewire tracking member which is positioned within the prosthesis passageway and also within the side port, the method further comprising slideably engaging the distal end portion of the guidewire within the guidewire tracking member.

32. The method of claim 28, wherein the expandable prosthesis is coupled to a distal end portion of an expansion member and is adjustable by the expansion member from a radially collapsed condition to a radially expanded condition, the method further comprising:

adjusting the expandable prosthesis with the expansion member from the radially collapsed condition to the radially expanded condition such that the distal end portion of the expandable prosthesis circumferentially engages an interior wall of the first branch lumen and such that the proximal end portion of the expandable prosthesis circumferentially engages an interior wall of the common branch lumen.

33. The method of claim 32, wherein the method of dilating the side port is performed before adjusting the expandable prosthesis from the radially collapsed condition to the radially expanded condition within the bifurcation region.

34. The method of claim 32, wherein the method of dilating the side port is performed during the adjusting of the expandable prosthesis from the radially collapsed condition to the radially expanded condition.

35. The method of claim 32, wherein the method of dilating the side port is performed after adjusting the expanded prosthesis from the radially collapsed condition to the radially expanded condition.

36. The method of claim 35, wherein the distal end portion of the dilator includes an expandable balloon which is positioned within the side port and which is also fluidly coupled to a pressurizeable fluid source, the method of dilating the side port further comprising:

pressurizing the expandable balloon with fluid from the pressurizeable fluid source such that the expandable balloon is adjusted from a radially collapsed condition to a radially expanded condition, and such that the side port is adjusted from the initial inner diameter to the expanded inner diameter.

37. The method of claim 36, further comprising:

before adjusting the expandable prosthesis to its respective radially expanded condition, advancing the expandable balloon distally beyond the side port and into the second branch lumen;

before or while adjusting the expandable prosthesis to its respective radially expanded condition, and after advancing the expandable balloon distally beyond the side port and into the second branch lumen, pressurizing the expandable balloon with fluid from the pressurizeable fluid source such that the expandable balloon is adjusted from its respective radially collapsed condition to its respective radially expanded condition which circumferentially engages an interior wall of the second branch lumen;

while the expandable balloon is adjusted to its respective radially expanded condition within the second branch lumen, adjusting the expandable prosthesis to its respective radially expanded condition within the first branch lumen and the common branch lumen; and

after adjusting the expanded prosthesis to its respective radially expanded condition within the first branch lumen and the common branch lumen, adjusting the expandable balloon from its respective radially expanded condition to its respective radially collapsed condition and then withdrawing the expandable balloon proximally until it is positioned at least partially within the side port.

38. The method of claim 37, wherein the method of dilating the side port with the dilator is performed after withdrawing the expandable balloon from the second branch lumen and proximally within the side port.

39. A method of engaging an expandable prosthesis within an interior surface of a body lumen wall at a bifurcation region of a body lumen, the expandable prosthesis having a longitudinal axis, a length along the longitudinal axis, a prosthesis passageway which extends along the longitudinal axis, and a side port located along the length and through which the prosthesis passageway communicates externally of the expandable prosthesis, comprising:

positioning a distal end portion of an access device within the prosthesis passageway and also within the side port while the expandable prosthesis is in a radially collapsed condition.

40. The method of claim 39, wherein the access device comprises a guidewire.

41. The method of claim 39, wherein the access device comprises a tubular member which forms a guidewire lumen extending between a distal access port located along the distal end portion of the access device and a proximal access port located along the access device proximally of the expandable prosthesis, the guidewire lumen being adapted to slideably receive a guidewire within the guidewire lumen and through the distal and proximal access ports, and wherein the method of positioning the distal end portion of the access device further comprises positioning the distal guidewire port distally of the side port.

42. The method of claim 41, further comprising slideably engaging a guidewire within the guidewire lumen and through the distal and proximal guidewire ports.

43. The method of claim 42, wherein the expandable prosthesis further includes a proximal end portion and a distal end portion such that the side port is located between the proximal and distal end portions, and wherein the bifurcation region includes first and second branch lumens each having an entrance zone extending from a common branch lumen, the method further comprising:

after engaging the distal end portion of the access device within the prosthesis passageway and side port of the expandable prosthesis, positioning the expandable prosthesis within the bifurcation region and while in the radially collapsed condition such that the proximal end portion of the expandable prosthesis is located within the common branch lumen, the distal end portion of the expandable prosthesis is located within the first branch lumen, and the side port is aligned with the entrance zone to the second branch lumen.

44. The method of claim 43, wherein the expandable prosthesis is further coupled to a distal end portion of an expansion member which is adapted to adjust the expandable prosthesis from the radially collapsed condition to a radially expanded condition, the method further comprising:

after positioning the expandable prosthesis within the bifurcation region, adjusting the expandable prosthesis with the expansion member from the radially collapsed condition to the radially expanded condition such that the distal end portion circumferentially engages the first branch lumen and the proximal end portion circumferentially engages the common branch lumen.

45. The method of claim 44, wherein the expandable prosthesis is self-expandable and wherein the expansion member is a radially confining sheath which includes a sheath lumen and which is adjustable from a first position, wherein the expandable prosthesis is coaxially engaged within the sheath lumen and is thereby radially confined in the radially collapsed condition, to a second position, wherein the expandable member is removed from the sheath lumen and self-expands to the radially expanded condition, the method further comprising:

during the positioning of the expandable member within the bifurcation region, adjusting the radially confining sheath to the first position relative to the expandable prosthesis; and

during the adjusting of the expandable member to the radially expanded condition within the bifurcation region, adjusting the radially confining sheath to the second position relative to the expandable member.

46. The method of claim 44, wherein the expandable prosthesis is balloon expandable and wherein the expansion member includes along its distal end portion an expandable balloon which is fluidly coupled to a pressurizeable fluid source and which is adjustable from a radially collapsed condition to a radially expanded condition, the method further comprising:

during the positioning of the expandable member within the bifurcation region, adjusting the expandable balloon to its respective radially collapsed condition which characterizes the respective radially collapsed condition for the expandable prosthesis; and

during the adjusting of the expandable member to the radially expanded condition within the bifurcation region, adjusting the expandable balloon with the pressurizeable fluid source to its respective radially expanded condition to thereby adjust the expandable member to its respective radially expanded condition.

47. An endolumenal medical device assembly for engaging an interior surface of a body lumen wall at a bifurcation region of a body lumen, comprising:

an expandable prosthesis having an elongate prosthesis body with a proximal end portion, a distal end portion, a length along a longitudinal axis extending between the proximal and distal end portions, a prosthesis passageway which extends along the length, and a side port which is positioned along the length and through which the prosthesis passageway communicates externally of the elongate prosthesis body, the expandable prosthesis further being adjustable from a first radially collapsed condition, wherein the elongate prosthesis body has a first collapsed outer diameter, to a first radially expanded condition, wherein the elongate prosthesis body has an first expanded outer diameter which is larger than the first collapsed outer diameter; and

a lateral expandable prosthesis having a lateral prosthesis body with a proximal end portion, a distal end portion, and a lateral prosthesis lumen extending between a proximal lateral port located along the proximal end portion of the lateral prosthesis body and a distal prosthesis port located along the distal end portion of the lateral prosthesis body, the lateral expandable prosthesis further being adjustable from a second radially collapsed condition, wherein the lateral prosthesis body has a second collapsed outer diameter, to a second radially expanded condition, wherein the lateral prosthesis body has a second expanded outer diameter,

wherein the proximal end portion of the lateral prosthesis body is coupled to the elongate prosthesis body at a location adjacent to the side port such that the proximal lateral port is aligned and in communication with the side port.

48. The endolumenal medical device assembly of claim 47, wherein the expandable prosthesis comprises:

a plurality of generally circular members, each formed of a plurality of substantially straight segments connected at axial bends;

at least one pair of aligned axial bends between adjacent generally circular members;

the at least one pair of aligned axial bends between adjacent generally circular members are connected together; and

wherein at least one of the generally circular members defines the side port and a portion of the proximal end portion of the lateral expandable prosthesis is coupled to an axial bend of one of the plurality of generally circular members defining the side port.

49. The endolumenal medical device assembly of claim 48, wherein the side port is defined by gaps between two substantially straight segments of one of the plurality of generally circular members.

50. The endolumenal medical device assembly of claim 48, wherein the side port is defined by a gap between adjacent generally circular members.

51. The endolumenal medical device assembly of claim 47, wherein the lateral expandable prosthesis comprises:

a plurality of generally circular members, each formed of a plurality of substantially straight segments connected at axial bends;

at least one pair of aligned axial bends between adjacent generally circular members;

the at least one pair of aligned axial bends between adjacent generally circular members are connected together; and

wherein the generally circular member defining the proximal portion of the lateral expandable prosthesis has an axial bend coupled to the elongate prosthesis body at a location adjacent to the side port such that the proximal lateral port is aligned and in communication with the side port.

52. The endolumenal medical device assembly of claim 48, wherein the lateral expandable prosthesis comprises:

a plurality of generally circular members, each formed of a plurality of substantially straight segments connected at axial bends;

one of the plurality of generally circular members defining the proximal end portion of the lateral expandable prosthesis and another of the plurality of generally circular members defining the distal end portion of the lateral expandable prosthesis;

at least one pair of aligned axial bends between adjacent generally circular members;

the at least one pair of aligned axial bends between adjacent generally circular members are connected together; and

wherein an axial bend of the generally circular member defining the proximal end portion of the lateral expandable prosthesis is coupled to an axial bend of one of the plurality of generally circular members defining the side port along the expandable prosthesis.

53. The endolumenal medical device assembly of claim 47, wherein the endolumenal prosthesis has a first longitudinal axis and the lateral expandable prosthesis has a second longitudinal axis, and wherein the lateral expandable prosthesis is further adjustable from first lateral position, which is adjacent to the distal end portion of the endolumenal prosthesis such that the second longitudinal axis is substantially parallel to the first longitudinal axis, to a second lateral position, which is radially displaced from the first lateral position such that the second longitudinal axis diverges distally from the first longitudinal axis.

54. The endolumenal medical device assembly of claim 53, the bifurcation region further including at least a first and a second branch lumen each having an entrance zone extending from a common branch lumen such that the first and second branch lumens diverge at a bifurcation angle, and wherein the second lateral position the second longitudinal axis diverges from the first longitudinal axis at an angle which approximates the bifurcation angle.

55. The endolumenal medical device assembly of claim 53, wherein in the second lateral position the second longitudinal axis diverges from the first longitudinal axis at an angle which is at least 15 degrees.