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.

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.

Abstract: A stent graft (2) for placement in the thoracic arch of a patient has a first tubular body portion (6) with a first lumen therein for placement in the ascending aorta of a patient and a second tubular body portion (8) to extend along the thoracic arch and down the descending aorta. The second tubular body portion is of a lesser diameter than the first tubular body portion. There is a step portion (10) between the first body portion and the second body portion. The step portion is joined to and continuous with the first portion and the second portion. A first side of each of the first body portion, the step portion and the second body portion are substantially aligned so that there is a step (18) defined on a second side opposite to the first side of the body portion. There is an aperture (30) in the step portion and an internal tube (32) extending from the aperture towards the first body portion.

Abstract: A stent graft (2) for placement in the thoracic arch of a patient has a first tubular body portion (6) with a first lumen therein for placement in the ascending aorta of a patient and a second tubular body portion (8) to extend along the thoracic arch and down the descending aorta. The second tubular body portion is of a lesser diameter than the first tubular body portion. There is a step portion (10) between the first body portion and the second body portion. The step portion is joined to and continuous with the first portion and the second portion. A first side of each of the first body portion, the step portion and the second body portion are substantially aligned so that there is a step (18) defined on a second side opposite to the first side of the body portion. There is an aperture (30) in the step portion and an internal tube (32) extending from the aperture towards the first body portion.

Abstract: An introduction arrangement for a fenestrated or branched stent graft intended for deployment into the lumen of a vessel having a blind vessel extending from it. The introducer has a distal end intended to remain outside a patient in use and a proximal end with a nose cone dilator and an arrangement to retain the branched stent graft distally of the nose cone dilator. A sheath on the introducer extends over the branched stent graft to the nose cone dilator. An indwelling catheter extends from the distal end of the introducer and enters the fenestration or side arm and through to the nose cone dilator, the indwelling catheter has a guide wire extending through it. The guide wire can be extended beyond the nose cone dilator in use before the sheath is withdrawn from the branched stent graft so that it can be snared from the contra-lateral artery.

Abstract: A stent graft (2) for placement in the thoracic arch of a patient has a first tubular body portion (6) with a first lumen therein for placement in the ascending aorta of a patient and a second tubular body portion (8) to extend along the thoracic arch and down the descending aorta. The second tubular body portion is of a lesser diameter than the first tubular body portion. There is a step portion (10) between the first body portion and the second body portion. The step portion is joined to and continuous with the first portion and the second portion. A first side of each of the first body portion, the step portion and the second body portion are substantially aligned so that there is a step (18) defined on a second side opposite to the first side of the body portion. There is an aperture (30) in the step portion and an internal tube (32) extending from the aperture towards the first body portion.

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.

Abstract: An endoluminal prosthesis may include a tubular main graft body including a sidewall and proximal and distal ends. A first stent may be positioned near the proximal end of the main graft body. A second stent may be positioned adjacent to and distal of the first stent. An opening in the sidewall may be positioned longitudinally between a peak of the first stent and a valley of the second stent. A tubular branch may be disposed in the opening. The branch may include first and second end openings. The branch may be flexibly orientable between a retrograde configuration in which the first end opening is oriented toward the distal end and the second end opening is oriented toward the proximal end and an antegrade configuration in which the first end opening is oriented toward the proximal end and the second end opening is oriented toward the distal end.

Abstract: A pre-loaded delivery device that facilitates accurate placement of a stent graft assembly in the aorta is disclosed. A stent graft is carried on the delivery device and held in a pre-deployment configuration by a sheath. A split in the sheath facilitates the pre-cannulation of one or more branch arteries extending from the aorta before the stent graft is fully released in the aorta. The stent graft comprises a tubular body having at least one scalloped fenestration formed in one end of the graft material and at least one fenestration formed in the graft material of the main tubular body. A helical internal side branch extends from the fenestration within the lumen of the main tubular body. The helical side branch is configured to curve at least partially around the scalloped fenestration. The assembly further comprises a connection stent graft extending from the fenestration into a branch vessel.

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.

Abstract: An endoluminal prosthesis comprises a prosthetic trunk having a trunk lumen and a trunk wall, a first prosthetic branch having a first branch lumen and a branch wall, and a second prosthetic branch having a second branch lumen. The first branch lumen and the second branch lumen are both in fluid communication with the trunk lumen through the trunk wall and the second branch lumen is in fluid communication with the first branch lumen through the branch wall. Additional devices, systems, and methods are disclosed.

Abstract: A computer implemented method for determining a centerline of a three-dimensional tubular structure is described. The method includes providing an edge-detected data set of voxels that characterize a boundary of the tubular structure according to a three-dimensional voxel data set for the tubular structure. A gradient field of a distance transformation is computed for the edge-detected dataset. A voxel data set corresponding to a centerline of the tubular structure is computed according to derivative of gradient field. A trajectory within the tubular structure is computed based on the centerline.

Abstract: A pre-loaded stent graft delivery device and stent graft, the stent graft delivery device. The stent graft has at least one fenestration or side arm and the fenestration is preloaded with an indwelling guide wire. The indwelling guide wire are configured to receive the access sheaths. A handle assembly at a distal end of the guide wire catheter. The handle includes a multiport manifold with access ports to the auxiliary lumens in the pusher catheter. Upon deployment of the stent graft into the vasculature of a patient, the indwelling guide wire can be used to facilitate catheterization of a side branch or target vessel through the fenestration or be used to stabilize the access sheath during catheterization, advancement of the access sheath into the target vessel and deployment of a covered or uncovered stent therein through the access sheath.

Abstract: A computer implemented method for determining a centerline of a three-dimensional tubular structure is described. The method includes providing an edge-detected data set of voxels that characterize a boundary of the tubular structure according to a three-dimensional voxel data set for the tubular structure. A gradient field of a distance transformation is computed for the edge-detected dataset. A voxel data set corresponding to a centerline of the tubular structure is computed according to derivative of gradient field. A trajectory within the tubular structure is computed based on the centerline.

Abstract: A stent graft (2) for placement in the thoracic arch of a patient has a first tubular body portion (6) with a first lumen therein for placement in the ascending aorta of a patient and a second tubular body portion (8) to extend along the thoracic arch and down the descending aorta. The second tubular body portion is of a lesser diameter than the first tubular body portion. There is a step portion (10) between the first body portion and the second body portion. The step portion is joined to and continuous with the first portion and the second portion. A first side of each of the first body portion, the step portion and the second body portion are substantially aligned so that there is a step (18) defined on a second side opposite to the first side of the body portion. There is an aperture (30) in the step portion and an internal tube (32) extending from the aperture towards the first body portion.

Abstract: The present disclosure relates to an endoluminal prosthesis, such as a stent graft that includes one or more fenestrations to accommodate endovascular disease, such as an aneurysm in cases where one or more side branches is involved. In one aspect, the prosthesis includes fenestrations that are pivotable to accommodate the dynamic geometry of the aortic branches. In another aspect, the pivotable fenestrations include a first perimeter, a band of flexible material attached and surrounding the first perimeter, a second perimeter attached to and surrounding the band of flexible material and a support frame disposed about a surface of the band of flexible material. The first perimeter, band of flexible material, and second perimeter have a geometric shape. The support frame includes a plurality of support units having curved segments. The curved segments of the support units may be concave with respect to an exterior surface of the prosthesis.

Abstract: A computer implemented method for determining a centerline of a three-dimensional tubular structure is described. The method includes providing an edge-detected data set of voxels that characterize a boundary of the tubular structure according to a three-dimensional voxel data set for the tubular structure. A gradient field of a distance transformation is computed for the edge-detected dataset. A voxel data set corresponding to a centerline of the tubular structure is computed according to derivative of gradient field.

Abstract: An introduction arrangement for a fenestrated or branched stent graft intended for deployment into the lumen of a vessel having a blind vessel extending from it. The introducer has a distal end intended to remain outside a patient in use and a proximal end with a nose cone dilator and an arrangement to retain the branched stent graft distally of the nose cone dilator. A sheath on the introducer extends over the branched stent graft to the nose cone dilator. An indwelling catheter extends from the distal end of the introducer and enters the fenestration or side arm and through to the nose cone dilator, the indwelling catheter has a guide wire extending through it. The guide wire can be extended beyond the nose cone dilator in use before the sheath is withdrawn from the branched stent graft so that it can be snared from the contra-lateral artery.

Abstract: A stent graft (2) for placement in the thoracic arch of a patient has a first tubular body portion (6) with a first lumen therein for placement in the ascending aorta of a patient and a second tubular body portion (8) to extend along the thoracic arch and down the descending aorta. The second tubular body portion is of a lesser diameter than the first tubular body portion. There is a step portion (10) between the first body portion and the second body portion. The step portion is joined to and continuous with the first portion and the second portion. A first side of each of the first body portion, the step portion and the second body portion are substantially aligned so that there is a step (18) defined on a second side opposite to the first side of the body portion. There is an aperture (30) in the step portion and an internal tube (32) extending from the aperture towards the first body portion.

Abstract: The present disclosure relates to an endoluminal prosthesis, such as a stent graft that includes one or more fenestrations to accommodate endovascular disease, such as an aneurysm in cases where one or more side branches is involved. In one aspect, the prosthesis includes fenestrations that are pivotable to accommodate the dynamic geometry of the aortic branches. In another aspect, the pivotable fenestrations include a first perimeter, a band of flexible material attached and surrounding the first perimeter, a second perimeter attached to and surrounding the band of flexible material and a support frame disposed about a surface of the band of flexible material. The first perimeter, band of flexible material, and second perimeter have a geometric shape. The support frame includes a plurality of support units having curved segments. The curved segments of the support units may be concave with respect to an exterior surface of the prosthesis.