Abstract: A method includes covering an ostium of a branch vessel emanating from a main vessel with a proximal landing zone of a high metal to vessel ratio landing zone stent-graft, wherein a metal to vessel ratio of the proximal landing zone when deployed is sufficiently high to encourage tissue ingrowth around the proximal landing zone yet is sufficiently low to ensure perfusion of the branch vessel through the proximal landing zone. The method further includes covering an aneurysm of the main vessel with an exclusion zone of the high metal to vessel ratio landing zone stent-graft, the exclusion zone being formed of graft material. By forming the exclusion zone of graft material, excellent exclusion of the aneurysm is achieved.

Abstract: To facilitate the widespread use of the RF plasma catheter to provide in situ fenestration of a main stent-graft, potential side-effects of the fenestration are ameliorated using an electrode from a family of electrodes. Specifically, a family of electrodes is provided so that for a particular application, an appropriate electrode can be selected.

Abstract: Endolumenally sealing a zone around the puncture and dilation area of a stent-graft fenestration or sealing the juncture between two lumens with an expandable sealant delivery device. In exemplary embodiments, an expandable sealant delivery device includes a catheter mounted balloon, which has a microporous membrane or a plurality of pores suitable for delivering a surgical sealant.

Abstract: When a main stent-graft is placed in a vessel of a patient and a branch vessel is blocked by the main stent-graft, a RF plasma catheter is used to cut out a portion of the graft cloth of the main-stent graft adjacent to an ostium of the branch vessel to be perfused. To ameliorate possible adverse effects associated with the use of the RF plasma catheter, e.g., creation of coagulum, (desiccated, coagulated blood) or perhaps a cut stent strut, a special process using saline flushing, a novel RF plasma catheter with an insulated tip, or a combination of the two is used.

Abstract: Catheter based systems and methods for securing tissue including the annulus of a mitral valve. The systems and methods employ catheter based techniques and devices to plicate tissue and perform an annuloplasty.

Abstract: A method includes deploying a bloused stent-graft into a main vessel such that a bloused section of the bloused stent-graft covers a branch vessel emanating from the main vessel. The bloused section includes loose graft cloth. A pressure differential between the main vessel and the branch vessel causes the bloused section to be forced into an ostium of the branch vessel creating a pocket aligned with the branch vessel. A distal tip of a puncture device is located in the pocket and thus aligned with the branch vessel. An outward force is applied to the puncture device to cause the distal tip of the puncture device to fenestrate the bloused section thus creating a collateral opening in the bloused section precisely aligned with the branch vessel.

Abstract: A method includes deploying a bloused stent-graft into a main vessel such that a bloused section of the bloused stent-graft covers a branch vessel emanating from the main vessel. The bloused section includes loose graft cloth. A pressure differential between the main vessel and the branch vessel causes the bloused section to be forced into an ostium of the branch vessel creating a pocket aligned with the branch vessel. A distal tip of a puncture device is located in the pocket and thus aligned with the branch vessel. An outward force is applied to the puncture device to cause the distal tip of the puncture device to fenestrate the bloused section thus creating a collateral opening in the bloused section precisely aligned with the branch vessel.

Abstract: A branch prosthesis configured for placement in a branch vessel includes an expandable tubular body portion, an expandable annular flange attached to a proximal end of the body portion, and a sealing sleeve proximally extending from the annular flange. The sealing sleeve is adapted to deform to a generally straight cylindrical hollow shape during implantation. When deployed, the sealing sleeve rolls up to a tightly-wound coil that bears against the annular flange. When used in conjunction with a main prosthesis having a side opening and deployed within in a main vessel, the annular flange of the branch prosthesis engages an outer surface of the main prosthesis around a perimeter of the side opening and the sealing sleeve engages an inner surface of the main prosthesis around the perimeter of the side opening to form a fluid-tight seal between the main prosthesis and the branch 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 which 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 coupling deployment device is coupled to the coupling graft material to provide an extension force to extend the mobile external coupling from a collapsed configuration against the tubular body to an extended position wherein the mobile external coupling extends from the tubular body.

Abstract: An endovascular prosthesis includes a tubular body and a mobile external coupling. The tubular body includes a graft material and stents coupled thereto which 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 coupling deployment device is coupled to the coupling graft material to provide an extension force to extend the mobile external coupling from a collapsed configuration against the tubular body to an extended position wherein the mobile external coupling extends from the tubular body.

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 stent graft system and method of use includes a stent graft for fixation at an attachment site with graft material defining at least one opening having an opening perimeter; a support attached to the graft material; a guide rail attached around the opening perimeter; and a helical anchor having a plurality of coils with a point at one end. The plurality of coils are rotatable around the guide rail to cause the pointed end of the coils to penetrate the graft material and the adjacent tissue in contact with the stent graft to sew the stent graft to the attachment site.

Abstract: RF power is applied to a circular RF electrode cutting a side opening in a graft material of a main stent-graft in situ. As the side opening is formed by the applied RF power and the associated plasma discharge, the side opening is formed with a minimal application of force to the graft material. Further, the side opening is circular and has a fused edge.

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. The coupling graft material is a woven fabric with warp yarn which run generally parallel to a longitudinal axis of the mobile external coupling including a shape memory material.

Abstract: An endovascular prosthesis includes a tubular body and a flexible springy mobile external coupling. The tubular body includes a graft material and stents coupled thereto with 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 helically shaped stent may be coupled to the coupling graft material to make it flexible and springy.

Abstract: A method of prosthesis delivery comprises advancing first, second and third guidewires through a first vessel, positioning the second guidewire in a second vessel that branches from the first vessel, positioning the third guidewire in a third vessel that branches from the first vessel, advancing a prosthesis over the first, second, and third guidewires to the vicinity of one of the second and third vessels, and deploying the prosthesis. The prosthesis can comprise a tubular stent-graft having a first eyelet adapted to receive a guidewire and a second eyelet adapted to receive a guidewire.

Abstract: A branch prosthesis configured for placement in a branch vessel includes an expandable tubular body portion, an expandable annular flange attached to a proximal end of the body portion, and a sealing sleeve proximally extending from the annular flange. The sealing sleeve is adapted to deform to a generally straight cylindrical hollow shape during implantation. When deployed, the sealing sleeve rolls up to a tightly-wound coil that bears against the annular flange. When used in conjunction with a main prosthesis having a side opening and deployed within in a main vessel, the annular flange of the branch prosthesis engages an outer surface of the main prosthesis around a perimeter of the side opening and the sealing sleeve engages an inner surface of the main prosthesis around the perimeter of the side opening to form a fluid-tight seal between the main prosthesis and the branch prosthesis.

Abstract: A method and system for real-time continuous impedance monitoring along the surface of a graft implanted within a main vessel to aid in optimally positioning an electrode at a branch vessel ostium. Due to the conductivity differences among various kinds of solid tissue and blood, a fenestration catheter system uses impedance monitoring as a tool to detect the location of branch ostia through graft cloth. Such information enables the fenestration electrode to be properly positioned for creation of a fenestration in the graft cloth in situ. In addition, the fenestration catheter system may utilize impedance information to avoid contact between the electrode and metal stent structures used to anchor the graft during an in situ fenestration procedure. The fenestration catheter system includes a catheter shaft, an electrode, one or more reference or indifferent electrodes, an impedance analyzer, a power source and an electrode position reference to record impedance measurements in relation to position.

Abstract: An endovascular stapler delivery apparatus having a continuous geometrically non-symmetrical delivery rail operable to guide a stapling device to one or more stapling locations within a body vessel is disclosed. The delivery rail includes a first elongated leg, a second elongated leg in parallel with the first leg, and a self-expanding distal loop extending between a distal end of the first leg and a distal end of the second leg. The distal loop self-expands at a delivery site within the vessel at an angle with a longitudinal axis of the vessel and includes at least first and second portions that abut the vessel at opposing and longitudinally offset locations of a wall of the vessel. The self-expanding distal loop operates to press and align the stapling device against one or more stapling locations.

Abstract: A tubular prosthesis comprises a tubular graft; and an undulating stent having a plurality of apexes, a first end defined at least in part by a first group of the apexes, and a second end defined at least in part by a second group of the apexes, the first group of apexes being pivotally attached to the tubular graft so as to form a plurality of circumferentially arranged hinges about which the stent can pivot so that the second group of apexes can move between a position where they are inside the tubular graft and a position where they are outside the tubular graft.