Delivery catheter and method for positioning an intraluminal graft
First Claim
1. A delivery catheter comprising:
- (a) an elongate catheter having a first end and a second end;
(b) an intraluminal graft having a body disposed about the elongate catheter, the body having at a first end, disposed adjacent to the first end of the elongate catheter, a tubular portion, and at a second end a bifurcation into first and second tubular graft extensions, the elongate catheter extending up the first tubular graft extension and into the tubular portion; and
(c) a supplementary guidewire extending in a first direction through the first tubular graft extension and projecting in a second different direction into the second tubular graft extension.
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0 Petitions
Accused Products
Abstract
A delivery catheter and method for positioning an intraluminal graft within a branching vessel in a patient'"'"'s body and a delivery catheter for use in that method is described. The delivery catheter comprises an elongate catheter having preferably an inflatable balloon adjacent one end, an intraluminal graft disposed about the balloon that bifurcates into two short tubular extensions, and a thin supplementary catheter containing a guidewire that extends upstream through one of the first tubular extensions and downstream through the other of the short tubular extensions of the graft. The method for positioning the intraluminal graft using the delivery catheter is particularly applicable to the appropriate positioning of a trouser graft so that it bridges an aneurysm which extends from a single vessel, such as the aorta, into one or more divergent vessels, for example, an iliac artery.
314 Citations
48 Claims
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1. A delivery catheter comprising:
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(a) an elongate catheter having a first end and a second end; (b) an intraluminal graft having a body disposed about the elongate catheter, the body having at a first end, disposed adjacent to the first end of the elongate catheter, a tubular portion, and at a second end a bifurcation into first and second tubular graft extensions, the elongate catheter extending up the first tubular graft extension and into the tubular portion; and (c) a supplementary guidewire extending in a first direction through the first tubular graft extension and projecting in a second different direction into the second tubular graft extension. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41)
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42. A method for positioning an intraluminal graft into a branching vessel within a patient'"'"'s body, the vessel comprising a single pre-branching vessel branching into a pair of post-branching vessels, the method comprising:
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(a) introducing into one of the post-branching vessels a first intraluminal graft having a body having at a first end a tubular portion and a second end that is bifurcated into first and second tubular graft extensions, the body being disposed about a first elongate catheter, and there being positioned within the first intraluminal graft a supplementary guidewire which extends in a first direction through the first tubular graft extension and projects in a second different direction into the second tubular graft extension; (b) positioning the first end of the first intraluminal graft and the second tubular graft extension within the pre-branching vessel and expanding that graft until at least the first end thereof expands into contact with a circumferential wall of the pre-branching vessel; (c) extending the supplementary guidewire relative to the graft in the second different direction until it extends into the other of the post-branching vessels; and (d) introducing a second intraluminal graft, having an upstream end and downstream end, into the other of the post-branching vessels and, utilising the supplementary guidewire, or another guidewire positioned in its place, moving the second intraluminal graft until its upstream end is within or surrounds the second tubular graft extension and its downstream end is within the other of the post-branching vessels and causing the upstream end of the second intraluminal graft to form fluid conveying engagement with the second tubular graft extension. - View Dependent Claims (43, 44, 45, 46)
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47. A method for positioning an intraluminal graft across an aneurysm which extends from the aorta into at least one iliac artery within a patient'"'"'s body, the method comprising the steps of:
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(a) making an incision or puncture to expose one of the patient'"'"'s femoral arteries; (b) inserting a first guidewire through the exposed femoral artery, the corresponding iliac artery and the aorta such that it traverses the aneurysm; (c) guiding a first catheter sheath over the first guidewire until it traverses the aneurysm; (d) withdrawing the first guidewire; (e) inserting a second relatively stiff guidewire through the first catheter sheath until it traverses the aneurysm; (f) withdrawing the first catheter sheath; (g) guiding a second relatively larger diameter catheter sheath over the second guidewire until it traverses the aneurysm; (h) guiding a first elongate catheter, which has a uninflated balloon adjacent one end with a first intraluminal graft disposed about the balloon, over the second guidewire and within the second larger diameter catheter sheath, the first intraluminal graft having a body having at a first end a tubular portion and a second end that is bifurcated into first and second tubular graft extensions, there being positioned within the first graft a third catheter containing a third guidewire which extends in a first direction through the first tubular graft extension and in a second different direction into the second tubular graft extension; (i) positioning the first elongate catheter so that the first end of the first graft is upstream of the aneurysm; (j) partially withdrawing the second larger diameter catheter sheath to free the first intraluminal graft; (k) inflating the balloon and so expanding the first end of the first intraluminal graft until it engages against the wall of the aorta above the aneurysm; (l) deflating the balloon to allow blood to flow down the first graft distending the first and second tubular graft extensions; (m) guiding the third guidewire in the second direction downstream into the other of the iliac and femoral arteries; (n) making an incision or puncture and retrieving the third guidewire from the other femoral artery; (o) withdrawing the third catheter through the one femoral artery; (p) guiding a fourth catheter sheath over the third guidewire and through the other femoral and iliac arteries until it is within the first graft and reaches at least to the top of the second tubular graft extension; (q) withdrawing the third guidewire through the one femoral artery; (r) guiding a fourth relatively large diameter guidewire through the fourth catheter sheath until the guidewire reaches at least the top of the second tubular graft extension; (s) withdrawing the fourth catheter sheath through the other femoral artery; (t) guiding a fifth relatively larger diameter catheter sheath over the fourth guidewire until the fifth catheter sheath reaches at least the top of the second tubular graft extension; (u) guiding a second elongate catheter, which has a uninflated balloon adjacent one end with a second intraluminal graft, having an upstream end and a downstream end, disposed about the balloon, over the fourth guidewire and within the fifth larger diameter catheter sheath until the upstream end of the second graft is within the second tubular graft extension; (v) partially withdrawing the fifth catheter sheath to free the second intraluminal graft; (w) inflating the balloon on the second delivery catheter and so expanding the upstream end of the second intraluminal graft until it engages against the second tubular graft extension; (x) maintaining the inflation of the balloon while withdrawing the first elongate catheter from the one femoral artery; (y) once the first elongate catheter is removed from the one femoral artery deflating the balloon; (z) fully withdrawing the fifth catheter sheath through the other femoral artery; (aa) guiding a third elongate catheter, which has an uninflated balloon adjacent one end with a third intraluminal graft, having an upstream end and a downstream end, disposed about the balloon, over the second guidewire and within the second catheter sheath until the upstream end of the third graft is within the first tubular graft extension; (bb) partially withdrawing the second catheter sheath to free the third intraluminal graft; (cc) inflating the balloon on the third elongate catheter and so expanding the upstream end of the third intraluminal graft until it engages against the first tubular graft extension; (dd) deflating the balloon on the third elongate catheter; (ee) withdrawing the second elongate catheter through the other femoral artery and the third elongate catheter through the one femoral artery; (ff) withdrawing the fourth guidewire and the fifth catheter sheath through the other femoral artery and suturing the incision or puncture in that artery; (gg) withdrawing the second guidewire and second catheter sheath through the one femoral artery and suturing the incision or puncture in that artery. - View Dependent Claims (48)
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Specification