Abstract: An introduction arrangement for a fenestrated or branched stent graft (13) intended for deployment into the lumen of a vessel having a blind vessel extending from it. The introducer (1) has a distal end intended to remain outside a patient in use and a proximal end with a nose cone dilator (11) and an arrangement to retain the branched stent graft distally of the nose cone dilator. A sheath (15) on the introducer extends over the branched stent graft to the nose cone dilator. An indwelling catheter (22) 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 (29) 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 The guide wire can be extended beyond the nose cone dilator in use before the sheath is withdrawn from the branched stent graft so that it can be snared from the contra-lateral artery.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 self expanding stent (10) formed from a resilient wire. The resilient wire comprises a zig zag form including an odd number of struts (12) such as seven struts and a bend (14) between each strut. There is first loop (18) of the resilient wire at the terminal end of a first strut and a second loop (18) of the resilient wire at the terminal end of a last strut. The stent as formed is substantially planar but in use is formed into a substantially cylindrical form (20) by being stitched onto a tubular body of a biocompatible graft material with at least the first strut and the last strut overlapping.

Abstract: An introduction arrangement for a fenestrated or branched stent graft (13) intended for deployment into the lumen of a vessel having a blind vessel extending from it. The introducer (1) has a distal end intended to remain outside a patient in use and a proximal end with a nose cone dilator (11) and an arrangement to retain the branched stent graft distally of the nose cone dilator. A sheath (15) on the introducer extends over the branched stent graft to the nose cone dilator. An indwelling catheter (22) 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 (29) 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 The guide wire can be extended beyond the nose cone dilator in use before the sheath is withdrawn from the branched stent graft so that it can be snared from the contra-lateral artery.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: An introduction arrangement for a fenestrated or branched stent graft (13) intended for deployment into the lumen of a vessel having a blind vessel extending from it. The introducer (1) has a distal end intended to remain outside a patient in use and a proximal end with a nose cone dilator (11) and an arrangement to retain the branched stent graft distally of the nose cone dilator. A sheath (15) on the introducer extends over the branched stent graft to the nose cone dilator. An indwelling catheter (22) 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 (29) 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 introducer (1) has a distally opening capsule (5) on a nose cone dilator (3) and a plug device (17; 53) in the capsule. The plug device (17; 53) is movable longitudinally within the capsule (5) to move to a distal end (7) of the capsule (5) to extend from the capsule (5) whereby to provide a smooth transition from the otherwise distal opening (7) of the capsule (5) to enable retraction of the nose cone dilator (3) through a deployed stent graft (35). The capsule (5) includes an in-turned distal end (7) and the plug device (17; 53) has a proximal shoulder (25) whereby to prevent the plug device (17; 53) from being completely withdrawn from the capsule (5). The plug device (17; 53) has a distal linearly tapered surface (27) or a distally facing bullet shaped surface (57). There can be an arrangement (72; 80) to prevent subsequent retraction of the plug device (53; 17).

Abstract: A stent graft delivery system in which a stent graft (6) is retained on a delivery device (2) such that a longitudinal portion of the stent graft is releasably retained on the delivery device to bend therewith. The delivery device (2) has a guide wire catheter (3) and the stent graft is retained onto the guide wire catheter by a release wire (24) which can be withdrawn. The release wire is wound around the guide wire catheter and through the stent graft or suture loops engage around the guide wire catheter and release wire.

Abstract: A stent graft (1) has a tubular body (3) defining a main lumen and a side tube (5) defining a side tube lumen and in fluid communication with the main lumen and defining a junction (13) between the tubular body and the side tube. The junction includes an acute angle of attachment (?). A first zig-zag stent (15) is wrapped around the tubular body such that a V portion of the first zig-zag stent is engaged about the acute angle of the junction and a second zig-zag stent (23) is wrapped around the side tube, such that a V portion of the second zig-zag stent is engaged about the acute angle of the junction, whereby the main lumen and the side tube are each kept open, independently, allowing fluid to flow freely therethrough.

Abstract: A stent graft introducer has a pusher, a nose cone, a region between the pusher and the nose cone for a stent graft, a sleeve extending over the pusher and proximally to the nose cone to cover the stent graft when retained in the region. An indwelling auxiliary catheter with a pre-curved proximal end is fitted into the introducer. The nose cone has an elongate groove and the auxiliary catheter has its proximal end in the elongate groove. In a partially retracted position of the sleeve the curved proximal end of the indwelling auxiliary catheter is exposed and uncovered by the sleeve and in an advanced position of the sleeve the curved proximal end of the indwelling auxiliary catheter is straightened, extends along the length of the groove in the nose cone and is covered by the sleeve.

Abstract: A self expanding stent (10) formed from a resilient wire. The resilient wire comprises a zig zag form including an odd number of struts (12) such as seven struts and a bend (14) between each strut. There is first loop (18) of the resilient wire at the terminal end of a first strut and a second loop (18) of the resilient wire at the terminal end of a last strut. The stent as formed is substantially planar but in use is formed into a substantially cylindrical form (20) by being stitched onto a tubular body of a biocompatible graft material with at least the first strut and the last strut overlapping.

Abstract: A composite stent graft has a balloon expandable stent portion (3), a tubular graft material portion (1) inside or outside of the balloon expandable stent portion and self expanding stents (5) associated with the tubular graft material portion. Part (7) of the balloon expandable stent portion can extend beyond the proximal end (9) of the tubular graft material portion. The tubular graft material can be polytetrafluoroethylene, dacron, polyamide, sub intestinal mucosa or any other suitable biocompatible material. A method of deploying which includes flaring a part (7) of the balloon expandable stent portion is also discussed.

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. Indwelling access sheaths are provided within auxiliary lumens of a pusher catheter and dilators are preloaded into the access sheaths along with the indwelling guide wire. 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 cathertisation of a side branch or target vessel through the fenestration or be used to stabilise the access sheath during catheterisation, advancement of the access sheath into the target vessel and deployment of a covered or uncovered stent therein through the access sheath.

Abstract: A stent graft introducer for intraluminal deployment of a stent graft (26), the introducer comprising a stent graft release mechanism (6) to allow partial release of the stent graft (26) when carried on the introducer, whereby control of the stent graft can be maintained while allowing access into the lumen of the stent graft from at least one end of the stent graft. The partial release can comprise partial release of one end of the stent graft.

Abstract: A multi-port stent graft delivery device (100) has an annular access lumen (107) between a delivery catheter (112) and a main sheath (106), at least one indwelling access sheath (118, 122) within the access lumen, and an indwelling guide wire (138, 146) within the or each access sheath and a stent graft (131) retained in the delivery device. Upon deployment of the stent graft into the vasculature of a patient the indwelling guide wire can be used to facilitate stabilisation of the access sheath during cathertisation of a side branch and deployment of a side arm covered or uncovered stent therein through the advanced access sheath. A two part handle enables withdrawal of a nose cone dilator before final placement of the side arm stents. A manifold (114) associated with a proximal handle portion provides a plurality of access ports (116, 120).

Abstract: An endoscopic or laparoscopic conduit delivery device (1) comprises first and second separately manipulable introducers (3, 5) with a laparoscopic conduit (80) having first and second ends (83, 84) and an intermediate portion being mounted onto the introducers in a substantially U shape. The first end and a first portion of the laparoscopic conduit is retained onto the first introducer and the second end and a second portion of the laparoscopic conduit is retained on the second introducer and the intermediate portion extends between the first and second introducers. A main sheath (42) is over the first and second introducers. The endoscopic or laparoscopic conduit delivery device is introduced to a body cavity through an endoscopic or laparoscopic port (50).

Abstract: A highly flexible delivery device (2) for a stent graft (6) particularly for deployment into the thoracic arch of a patient. The delivery device has a distal handle (7), a pusher catheter (4) extending proximally from the handle to a proximal nose cone dilator (11), a guide wire catheter (3) extending from the proximal nose cone dilator to the pusher catheter. To give flexibility the guide wire catheter comprises a nitinol tube, the nose cone dilator has a high flexibility and the pusher catheter has a graded flexibility being more flexible at its proximal end than at its distal end. The graded flexibility can be provided by joined segments (4a, 4b and 4c) of different flexibility or by a inner metal tube (72) to give rigidity over some of the length. Alternatively the graded flexibility can be provided by tapering the wall thickness (80, 80a) of the pusher catheter.

Abstract: A composite stent graft has a balloon expandable stent portion (3), a tubular graft material portion (1) inside or outside of the balloon expandable stent portion and self expanding stents (5) associated with the tubular graft material portion. Part (7) of the balloon expandable stent portion can extend beyond the proximal end (9) of the tubular graft material portion. The tubular graft material can be polytetrafluoroethylene, Dacron, Thoralon™, polyamide, small intestine submucosa, collagenous extracellular matrix material, or any other suitable biocompatible material. A method of deploying which includes flaring a part (7) of the balloon expandable stent portion is also discussed.

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. Indwelling access sheaths are provided within auxiliary lumens of a pusher catheter and dilators are preloaded into the access sheaths along with the indwelling guide wire. 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: An endovascular delivery device (1) has a portion, such as the nose cone dilator (8), being formed from a radiopaque material and that portion has a selected transverse profile such as a notch (26) so that in a selected rotational orientation of the endovascular delivery device the nose cone dilator can be observed by radiographic means during an endovascular procedure to be in that selected rotational orientation. The selected transverse profile can be a notch, protrusion or aperture. The notch or aperture can be filled with a radio-transparent material to provide a sooth outer surface.

Abstract: A stent graft for endovascular introduction into the pararenal region of the descending aorta. The stent graft has an elongate tubular body (10) with a proximal portion (12), a distal portion (16) of a diameter less than the proximal portion and a tapered central portion (14). A notional transverse clock face on the tubular body has 12 o'clock at a notional anterior longitudinal datum line. The stent graft has a scalloped cut out (26) centered at about 12:30 o'clock and a fenestration (28) at about 12:00 o'clock in the proximal portion and first and second fenestration assemblies which can be low profile side arms at about 2:15 o'clock and about 10:00 o'clock in the tapered central portion. The tapered central portion can have an arcuate side wall (30) so that the tapered portion has an outer face which is concave.

Abstract: A hybrid stent graft device for treatment of a Type A dissection having a first tubular portion for placement into the ascending aorta and a second tubular portion for extending around the thoracic arch and down the descending aorta is disclosed. The first tubular portion is connectable to the aorta between the sinotubular junction and the brachiocephalic artery so that it essentially replaces the ascending aorta. A temporary bypass tube allows perfusion during an operation. The second tubular portion has an elongate recess outside of the second tubular portion and an aperture defining a fluid flow path into the recess. The recess is intended to engage an outer curve of the thoracic arch to enable blood flow into the arteries of the thoracic arch. An introduction device in combination with the hybrid stent graft described above is also disclosed.