Abstract: A guidewire having flexible or floppy proximal and distal end portions is used for percutaneously accessing a branch vessel through a deployed prosthesis having at least one fenestration near an ostium of the branch vessel. The prosthesis is delivered and deployed via a first percutaneous access site. The guidewire extends over the outside surface of the deployed prosthesis and extends through the at least one fenestration. The flexible distal end portion is snared via a second percutaneous access site and is pulled in a direction towards the second percutaneous access site until the flexible proximal end of the guidewire is located adjacent to the branch vessel. A guide catheter is then advanced over the guidewire until it cannulates the branch vessel. The flexible proximal end of the guidewire may then be advanced into the branch vessel and used for delivery of a branch vessel prosthesis.

Abstract: An endovascular prosthesis includes a tubular body and a mobile external coupling. The tubular body includes a graft material and stents coupled thereto, a forms a lumen therethrough. The mobile external coupling extends outwardly from the tubular body. The mobile external coupling includes a graft material and is generally frustoconically shaped. The mobile external coupling includes a base coupled to the tubular body, a top spaced from the tubular body, and a coupling lumen disposed between the base and the top, wherein the coupling lumen is in flow communication with the body lumen. A cylindrical sealing cuff of graft material is attached to and extends from the top of the mobile external coupling towards the tubular body within the coupling lumen. The sealing cuff is configured to contact a portion of a branch vessel prosthesis and thereby provides an elongated interference seal between the branch vessel prosthesis and the mobile external coupling.

Abstract: A guidewire having flexible or floppy proximal and distal end portions is used for percutaneously accessing a branch vessel through a deployed prosthesis having at least one fenestration near an ostium of the branch vessel. The prosthesis is delivered and deployed via a first percutaneous access site. The guidewire extends over the outside surface of the deployed prosthesis and extends through the at least one fenestration. The flexible distal end portion is snared via a second percutaneous access site and is pulled in a direction towards the second percutaneous access site until the flexible proximal end of the guidewire is located adjacent to the branch vessel. A guide catheter is then advanced over the guidewire until it cannulates the branch vessel. The flexible proximal end of the guidewire may then be advanced into the branch vessel and used for delivery of a branch vessel prosthesis.

Abstract: A delivery device for a bifurcated stent-graft includes a first catheter portion with a first tip and a second catheter portion with a second tip. The first and second tips each include a generally curved and tapered outer surface and complementary surfaces that face each other. The first and second tips together form a generally continuous substantially smooth shaped outer surface, for example a bullet-shaped combined tip. An outer sleeve is disposed around the first catheter portion and the second catheter portion such that at least a portion of the first tip and a portion of the second tip extend distally beyond a distal end of the outer sleeve. An inner sleeve maintains the stent-graft in a compressed configuration during delivery to the target site. The delivery device is tracked over two guidewires to the target location with the tips acting as a unit.

Abstract: A method includes tethering a first pop up branch structure of a tethered pop up branch structure stent graft to a second pop up branch structure of the tethered pop up branch structure stent graft with a tether. The tethered pop up branch structure stent graft is deployed into a main vessel such that the first pop up branch structure is near a first branch vessel emanating from the main vessel and the second pop up branch structure is near a second branch vessel emanating from the main vessel. A first guide is passed through a first collateral opening in the first pop up branch structure and into the first branch vessel. A second guide is passed through a second collateral opening in the second pop up branch structure and into the second branch vessel.

Abstract: A delivery system for an endoprosthesis includes a spindle having a spindle body and spindle pins extending radially outward from the spindle body. The delivery system further comprises a tip comprising a sleeve, the spindle pins extending from the spindle body toward the sleeve. The endoprosthesis includes a proximal anchor stent ring having spindle pin catches and anchor pins. The spindle pins of the spindle extend into the spindle pin catches and the sleeve radially constrains the anchor pins.

Abstract: A method includes tethering a first pop up branch structure of a tethered pop up branch structure stent graft to a second pop up branch structure of the tethered pop up branch structure stent graft with a tether. The tethered pop up branch structure stent graft is deployed into a main vessel such that the first pop up branch structure is near a first branch vessel emanating from the main vessel and the second pop up branch structure is near a second branch vessel emanating from the main vessel. A first guide is passed through a first collateral opening in the first pop up branch structure and into the first branch vessel. A second guide is passed through a second collateral opening in the second pop up branch structure and into the second branch vessel.

Abstract: An endovascular prosthesis includes a tubular body and a mobile external coupling. The tubular body includes a graft material and stents coupled thereto, a forms a lumen therethrough. The mobile external coupling extends outwardly from the tubular body. The mobile external coupling includes a graft material and is generally frustoconically shaped. The mobile external coupling includes a base coupled to the tubular body, a top spaced from the tubular body, and a coupling lumen disposed between the base and the top, wherein the coupling lumen is in flow communication with the body lumen. A cylindrical sealing cuff of graft material is attached to and extends from the top of the mobile external coupling towards the tubular body within the coupling lumen. The sealing cuff is configured to contact a portion of a branch vessel prosthesis and thereby provides an elongated interference seal between the branch vessel prosthesis and the mobile external coupling.

Abstract: A delivery device for a bifurcated stent-graft includes a first catheter portion with a first tip and a second catheter portion with a second tip. The first and second tips each include a generally curved and tapered outer surface and complementary surfaces that face each other. The first and second tips together form a generally continuous substantially smooth shaped outer surface, for example a bullet-shaped combined tip. An outer sleeve is disposed around the first catheter portion and the second catheter portion such that at least a portion of the first tip and a portion of the second tip extend distally beyond a distal end of the outer sleeve. An inner sleeve maintains the stent-graft in a compressed configuration during delivery to the target site. The delivery device is tracked over two guidewires to the target location with the tips acting as a unit.

Abstract: A delivery system for an endoprosthesis includes a spindle having a spindle body and spindle pins extending radially outward from the spindle body. The delivery system further comprises a tip comprising a sleeve, the spindle pins extending from the spindle body toward the sleeve. The endoprosthesis includes a proximal anchor stent ring having spindle pin catches and anchor pins. The spindle pins of the spindle extend into the spindle pin catches and the sleeve radially constrains the anchor pins.