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 cathertization 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: The disclosure pertains to profile reduction seals associated with heart valve replacements which may reduce or eliminate paravalvular regurgitation and methods of fabricating such seals. The generally cylindrical multilayer seals of the disclosure include a crown-like end and reinforcing elements which facilitate compression of the seal and associated device by minimizing bunching of the seal as it enters a delivery system.

Abstract: Disclosed herein are removable devices adapted to allow localized and contained delivery of bioactive materials to a treatment site within a lumen such as a blood vessel such that the flow of fluid through the lumen is not blocked during bioactive material delivery.

Abstract: A tubular prosthetic device for implantation into a body lumen includes a first part including a tubular lumen and a second part including an attachment member. The second part is secured to the first part via various configurations, where the device is capable of being reduced to a diameter less than the diameter of traditional devices, for ease of use during implantation. Methods of using the device are also provided.

Abstract: For welding a polished component of one metal to a polished prosthesis of another metal, ramp surfaces are used, to compensate for loss of precise dimensions of the two components at the surfaces that face each other at the weld interface, during the respective polishing procedures for the two metals.

Abstract: A stentless support structure capable of being at least partly assembled in situ. The support structure comprises a braided tube that is very flexible and, when elongated, becomes very long and very small in diameter, thereby being capable of placement within a small diameter catheter. The support structure is preferably constructed of one or more thin strands of a super-elastic or shape memory material such as Nitinol. When released from the catheter, the support structure folds itself into a longitudinally compact configuration. The support structure thus gains significant strength as the number of folds increase. This radial strength obviates the need for a support stent. The support structure may include attachment points for a prosthetic valve.

Abstract: Exemplary embodiments of the present disclosure provide for multi-layered implantation materials, methods of making a multi-layered implantation material, methods of forming a multi-layered implantation material, methods of forming a multi-layered implantation material having a spiral roll cross-section, and the like.

Abstract: A circumferentially constraining suture for an endovascular prosthesis having a tubular body and a plurality of stents coupled to the tubular body includes a first thread coupled at a first end to one of the stents and a first thread loop disposed opposite the first end. The first thread extends only partially around a circumference of the tubular body in a radially expanded configuration. A second thread having a second thread loop is interlocked with the first thread loop and extends from the first thread loop around a remainder of the circumference of the tubular body. Pulling the second thread causes the first thread to circumferentially constrain the tubular body to a reduced diameter configuration. A trigger wire inserted through the first thread loop retains the first thread such that the tubular body is in the reduced diameter configuration after removal of the second thread.

Abstract: The invention relates to a method for producing a powder-filled ceramic coating made from a precursor ceramic compound (for example, a sol-gel), said coating having an advantageous surface roughness and wherein active ingredients may be eluted from the matrix or filler under physiological conditions and to an implant which can be produced according to the claimed method.

Abstract: A stent-graft including an inner stent having a wall structure including juxtaposed strut-patterns with interconnected struts and connectors connecting the strut-patterns is described. The wall structure of the inner stent has a predetermined length. An outer stent is coaxially arranged around the inner stent and has a wall structure including juxtaposed strut-patterns with interconnected struts and connectors connecting the strut-patterns. The wall structure of the outer stent has a predetermined length and a flexible stretchable material layer arranged between the inner stent and the outer stent. The wall structure of the inner stent has a design differing from the design of the wall structure of the outer stent and the length of the inner stent is equal to the length of the outer stent.

Abstract: A prosthetic heart valve configured to replace a native heart valve and having a support frame configured to be reshaped into an expanded form in order to receive and/or support an expandable prosthetic heart valve therein is disclosed, together with methods of using same. The prosthetic heart valve may be configured to have a generally rigid and/or expansion-resistant configuration when initially implanted to replace a native valve (or other prosthetic heart valve), but to assume a generally expanded form when subjected to an outward force such as that provided by a dilation balloon or other mechanical expander.

Abstract: A plaque tack can be used for holding plaque against blood vessel walls such as in treating atherosclerotic occlusive disease. The plaque tack can be formed as a thin, annular band for holding loose plaque under a spring or other expansion force against a blood vessel wall. Focal elevating elements and/or other features, such as anchors, can be used to exert a holding force on a plaque position while minimizing the amount of material surface area in contact with the plaque or blood vessel wall and reducing the potential of friction with the endoluminal surface. This approach offers clinicians the ability to perform a minimally invasive post-angioplasty treatment and produce a stent-like result without using a stent.

Abstract: A pattern of graft material that allows for radial expansion and contraction that comprises a plurality of rows of folds with an undulating configuration with at least one apex and at least one trough and the rows of folds each have a ridge and a valley therein. At least one stent with an undulating configuration can be attached to the at least one row of folds.

Abstract: A delivery device can include a number of different features including, one or more of, but not limited to, the following. Shuttle and trigger retraction of an outer sheath. Arcuate movement of a trigger. An interlock device to prevent actuation of the trigger. An interlock device that can adjust the position of the outer sheath and the inner shaft. A retraction override switch and lock.

Abstract: An ultrasonic diagnostic apparatus includes an image generating unit, an acquiring unit, an extracting unit, a flap identifying unit, a first synthesizing unit, an alignment processing unit and a second synthesizing unit. The image generating unit generates an echocardiographic image including an aorta. The acquiring unit acquires a heart area image including the aorta. The extracting unit extracts an artery region based on the heart area image. The flap identifying unit identifies a flap region based on the artery region. The first synthesizing unit synthesizes information on the flap region onto the artery region to generate a first synthesized image. The alignment processing unit performs processing to align an imaging region in the echocardiography on the heart area image based on a positional data signal. The second synthesizing unit synthesizes information that indicates the imaging region processed for alignment onto the first synthesized image to generate a second synthesized image.

Abstract: Non water-soluble polymers with a comb structure and a (meth)acrylic skeleton on which are grafted side chains containing at least one hydrophobic monomer of the styrene or (meth)acrylic ester type on C1 to C4, and at least one hydroxy or methoxy polylakylene glycol monomer. The levels of monomers are such that the polymer is amphiphilic because it is both rich in hydrophobic monomer and polylakylene glycol monomer. These products, used in paper coating dispersions, enable an increase in their Brookfield™ viscosity, a reduction in their ACAV viscosity, and an improvement in their water retention, which makes them particularly well suited for dry extract and/or high deposit speed coatings.

Abstract: The present invention relates to a modular stent graft which is designed for introduction into a blood vessel in a patient and which has a stent connected by means of a graft material; the stent graft has a first stent graft module having a body, a proximal end and a distal end, as well as at least three tubular arms extending longitudinally in the distal direction from the distal end of the first stent graft module, said arms being integrally connected to the body of the first stent graft module; in addition, a second stent graft module is provided which has a second body, a proximal end and a distal end, as well as at least three tubular arms extending longitudinally in the proximal direction from the proximal end of the second stent graft module, said arms being integrally formed with the body of the second stent graft module; in the assembled state a modular stent graft is formed, the modules of which are situated in the same blood vessel.

Abstract: A medical valve implant (10a, 10b) for implantation in an animal body and/or human body, comprising a base body (12a, 12b) that includes a collar (16a, 16b) extending in circumferential direction (14a, 14b), wherein the collar (16a, 16b) includes at least one first cell structure (18a, 18b) which is provided to form, in the intended end state, an intended inner cross section (24a, 24b) of base body (12a, 12b) that is matched to an intended outer cross section (20a, 20b) of an implant structure (22a, 22b).

Abstract: A polymer of fluorinated monomers and hydrocarbon monomers is provided. It is also provided a polymer blend that contains a polymer-formed of fluorinated monomers and hydrocarbon monomers and another biocompatible polymer. The polymer or polymer blend described herein and optionally a bioactive agent can form an implantable device such as a stent or a coating on an implantable device such as a drug-delivery stent, which can be used for treating or preventing a disorder such as atherosclerosis, thrombosis, restenosis, hemorrhage, vascular dissection or perforation, vascular aneurysm, vulnerable plaque, chronic total occlusion, claudication, anastomotic proliferation for vein and artificial grafts, bile duct obstruction, ureter obstruction, tumor obstruction, or combinations thereof.

Abstract: A prosthetic heart valve includes a collapsible and expandable stent having a proximal end, a distal end, an annulus section adjacent the proximal end and an aortic section adjacent the distal end. The stent is formed of a plurality of struts. A cuff is coupled to the stent. The cuff has one or more features configured to reduce abrasion and/or perivalvular leakage.

Abstract: A device for treating disease along a main vessel and at least one branch vessel extending from the main vessel includes a branch member for deployment in the branch vessel, the branch member having a branch lumen; and a main body for deployment in the main vessel. The main body has a generally tubular wall extending generally longitudinally between opposite first and second ends. The wall has an internal surface defining a main lumen and an opposite outer surface. The wall has a recessed portion that is recessed relative to the outer surface of the wall and positioned between the first and second ends of the main body. The main body has an opening formed in the recessed portion of the wall for receiving the branch member therethrough such that the branch lumen is in fluid communication with the main lumen.

Abstract: The endovascular prosthesis includes a first expandable framework and a first jacket for the first framework, the first framework and the first jacket forming a first channel when the first framework is in the expanded state. The first framework and the first jacket each have at least one opening, which openings are arranged substantially opposite one another and through which a sleeve is received, the sleeve having a first end and a second end, the perimeter of the first end being attached to the perimeter of the opening of the first jacket, while the second end extends inside the first channel.

Abstract: To provide simple yet accurate stent graft fenestration, a patient-specific fenestration template is used as a guide for graft fenestration. To generate the fenestration template, a patient's medical imaging data such as CT scan data may be used to generate a 3-D digital model of an aorta lumen of the patient. The aorta lumen may encompass one or more branch vessels, which may be indicated on the 3-D digital model. Based on the 3-D digital model or a segment thereof, the fenestration template may be generated, for example, using 3-D printing technology. The fenestration template may include one or more holes or openings that correspond to the one or more branch vessels. To fenestrate a stent graft, the fenestration template is coupled to the stent graft so that the holes or openings on the fenestration template indicate the fenestration locations.

Abstract: A method for the prophylaxis or treatment of restenosis comprising administering a therapeutically effective amount of Annexin A5 or a functional analog or variant thereof to a patient in need of such treatment. A method for the treatment of stenosis in a patient comprising performing an intervention for the treatment of stenosis in conjunction with administering a therapeutically effective amount of Annexin A5 or a functional analog or variant thereof. A pharmaceutical composition comprising a therapeutically effective amount of Annexin A5 or a functional analog or variant thereof for the prophylaxis or treatment of restenosis. A drug eluting stent, wherein the drug is Annexin A5 or a functional analog or variant thereof, and a method of making such a stent.

Abstract: A visceral double-barreled main body stent graft and methods for its use, the stent graft comprises, a main body stent graft having distal and proximal ends, the main body stent graft's length ranges from about 100-120 mm and diameter at the proximal end ranges from about 30-45 mm, first and second lumens defined at the main body stent graft's distal end, the first lumen's diameter ranges from about 18-20 mm, the second lumen's diameter ranges from about 16-18 mm, the first and second lumens have about the same length from about 50-70 mm, the first lumen is secured to the second lumen along a shared length, and the main body stent graft defines a tubular wall that is contiguous with the first and second lumens such that any fluid entering the main body must exit through one of the first or second lumens.

Abstract: A braided stent having an integral retrieval and/or repositioning loop includes a plurality of wires having first and second ends interbraided in a braided pattern to form a tubular stent having opposed atraumatic first and second open ends with each open end having a circumference. The first and second wires ends are disposed at the second stent open end and the wires are looped at the second stent open end so that none of the first or second wires ends are exposed at the circumference of second stent open end. The at least of two of said wires are formed into a repositioning and/or retrieval loop having an elongated portion circumferentially disposed at the first opposed open end. The reposition and/or retrieval loop also includes two sections which run adjacent to each other prior to crossing to permit grabbing of both sections simultaneously by a practitioner.

Abstract: A base fabric for a stent graft is a woven fabric constituted by a fiber having a total fineness of 1 to 40 decitex and a single yarn fineness of 0.1 to 2.0 decitex and has a yarn density of 150 strands/2.54 cm or more in both longitudinal direction and lateral direction, a thickness of 1 to 90 ?m, and a tensile strength of 50.0 N/cm or more in both longitudinal direction and lateral direction. According to the present invention, the base fabric for a stent graft having thinness, high strength, low permeability, durability, and flexibility can be obtained.

Abstract: An apparatus for loading material into a stent strut can comprise a cover sleeve. The cover sleeve is elastic so that it can reduce in diameter so as to press against the stent strut, and expand in diameter so as to be spaced apart from the stent strut. The stent strut can include a lumen into which material is injected. When pressed against the stent strut, the cover sleeve seals side openings to the lumen and prevents injected material from leaking out of the side openings during the injection process.

Abstract: Provided is a stent graft that has superior prevention of endoleakage due to being resistant to creasing, and has superior prevention of graft migration as a result of promoting cell infiltration into gaps among microfibers in a dispersed state and forming an integrated structure with the cells in the landing zone of the stent. The stent graft according to the present invention is a stent graft comprising a stent graft fabric that has microfiber bundles consisting essentially of microfilaments having a filament linear density of 0.5 dtex or less, and said microfiber bundles having a total linear density of 10 to 60 dtex/120 to 3000 filaments, for the warp and/or weft, and in which the porosity of the microfiber bundles is 30% to 95%, wherein said stent graft has said stent graft fabric being located in at least 1 cm range from the central end.

Abstract: An intravascular stent is provided to be implanted in coronary arteries and other body lumens. The transverse cross-section of at least some of the stent struts have a ratio of polar and bending moments of inertia, which results in optimal resistance to stent twisting. This resistance to twisting ratio for the stent struts minimizes out of plane twisting of the struts or projecting edges of the struts when the stent is expanded from a compressed diameter to an expanded diameter in a coronary artery.

Abstract: Embodiments of the present invention provide medical devices and methods for treating a target site within the body, such as for treating vascular abnormalities. For example, one embodiment provides a stent graft including an occlusive material having a preset, overlapping configuration comprising at least three inverted overlapping layers that are folded over one another. The at least three inverted overlapping layers are configured to be separated and disposed within a catheter in a non-overlapping configuration and return to the preset, overlapping configuration when deployed from the catheter.

Abstract: A stented prosthetic heart valve including a stent, a plurality of leaflets, and a coupling apparatus. The stent includes a plurality of struts combining to define a generally tubular body, with the struts forming strut segments. The leaflets are mounted to the stent, and include a leaflet provided as part of a first leaflet layer that further forms a tab region. The coupling apparatus is configured for connecting the first leaflet layer to the stent, and includes a backing layer, a guide plate, and a pin. The guide plate and the pin are formed apart from the stent. In this regard, a portion of the backing layer and the tab region are secured between the guide plate and the pin. Further, another portion of the backing layer is attached to at least one of the strut segments to mount the leaflet of the first leaflet layer to the stent.

Abstract: This invention relates generally to medical devices, and more particularly, to endovascular grafts and methods for treating branched vessels in diverse patient populations including those with shorter than average common iliac arteries. A bifurcated stent graft as described herein comprises adjacent facing fenestrations formed in the graft legs in order to permit proper placement of an “up-and-over sheath” and a side branch which may be proximally located in order to properly align the side branch with the opening of the branch vessel such as the internal iliac artery while keeping the graft bifurcation seated near the aortic bifurcation.

Abstract: Controlled release vascular implants, such as vascular grafts, stents, wraps, and gels comprising a biocompatible polymer and all trans retinoic acid (ATRA), or its derivatives, can be used to treat, prevent, or inhibit thrombosis and/or neointimal hyperplasia which may otherwise be induced by prosthetic implantation. In particular, the implants herein can inhibit smooth muscle cell proliferation, neointimal hyperplasia, and upregulate antithrombotic genes and nitric oxide production in the vasculature. Further, the implants are capable of delivering controlled and predictable localized concentrations of ATRA.

Abstract: The invention relates to a balloon catheter for the placement of stent grafts (1) with a proximal (7) and at least one distal balloon (8), a multi-lumen shaft (5a) having one lumen (6) sized to accommodate a guidewire and at least two lumina (5a, 5b) for individually applying hydraulic pressure to the balloons, with lumina (5b, 6) accommodating the guidewire and one or several distally arranged balloons (8) being passed through the proximal balloon (7) and the stent graft (1) being crimped onto the balloons (7, 8).

Abstract: Disclosed herein are an anti-biofilm composition and a method to inhibit or prevent cell adhesion and/or biofilm formation by a microorganism, in which use of 1,2,3,4,6-penta-O-galloyl-D-glucopyranose (PGG) is involved therein.

Abstract: An endovascular stapler for securing an endograft to a vessel is disclosed. The stapler includes a staple housing adapted for storing at least one staple therein, the staple housing having an exit area for discharge of the at least one staple therethrough, an actuating assembly adapted for discharging the at least one staple through the exit area, and a displacement mechanism in operative association with the staple housing near the exit area. The displacement member is operative for pushing the exit area against the endograft when discharging the at least one staple therethrough. The discharged staple forms a plurality of opposed loops connected by a central element upon discharge. Also disclosed are staples and displacement mechanisms adapted for use with surgical instruments such as the present endovascular staplers. The staples may be formed from memory metal or other metal. The displacement mechanisms disclosed include balloons and rigid offsetting devices.

Abstract: A vascular repair device includes a tubular graft body and a structural framework having at least two stents. A first stent of the stents is connected to the tubular graft body along an entirety of the first stent and a second of the stents includes a periodically changing shape that defines proximal apices having a first radii of curvature and distal apices having a second radii of curvature that is less than the first radii of curvature. The second stent is connected to the tubular graft body at the distal apices.

Abstract: A stent graft (10) has a tubular body of a biocompatible material and a side arm (20) fastened to the tubular body. A tubular extension piece (24) is sealingly joined to the end of the side arm and extends from it. It can be joined with adhesive or stitching. The extension piece can be formed from an elastomeric biocompatible material such as Thoralon™. The extension piece can have a resilient reinforcement 44 embedded into it and extending longitudinally. The extension piece is tucked back into the side arm during deployment of the stent graft into a body lumen.

Abstract: A stent (1) comprises a central section (2), a first intermediate section (3), a first end section (4), a second intermediate section (5), and a second end section (6). The stent (1) is movable between a collapsed delivery configuration and an expanded deployment configuration. In the delivery configuration the central section (2), the first intermediate section (3), the first end section (4), the second intermediate section (5), and the second end section (6) are all cylindrically shaped. In the deployment configuration the central section (2) is helically shaped, while the first end section (4) and the second end section (6) remain cylindrically shaped. Each intermediate section (3, 5) acts as a blended region to provide a smooth transition from the helical shape of the central section (2) to the cylindrical shape of the unstented blood vessel. The radial stiffness of the stent (1) varies gradually along part of the length of the stent (1).

Abstract: An areal implant comprises a flexible, porous basic structure which is non-resorbable or partly resorbable and which contains non-resorbable colored elements arranged in a stripe-like pattern. Furthermore, resorbable colored elements arranged in a stripe-like pattern are provided.

Abstract: A joining arrangement between a main tube (3) and a side arm (5) in a side arm stent graft (1). The side arm (5) is stitched into an aperture (11) in the main tube and is in fluid communication with it. The aperture is triangular, elliptical or rectangular and the side arm is cut off at an angle to leave an end portion having a circumferential length equal to the circumference of the aperture. The side arm can also include a connection socket (76) comprising a first resilient ring (79) around the arm at its end, a second resilient ring (80) spaced apart along the arm from the first ring and a zig zag resilient stent (82) between the first and second rings. The zig-zag resilient stent can be a compression stent. Both the main tube and the side arm are formed from seamless tubular biocompatible graft material.

Abstract: The present embodiments provide an endoluminal prosthesis comprising a first membrane having a lumen for allowing fluid flow, and a stent having contracted and expanded states. At least one surface enhancement member, separate from the stent, is secured to the stent prior to a coxial overlapping state of the stent and the first membrane. The at least one surface enhancement member has stronger bonding properties with the first membrane, relative to bonding properties of bare surfaces of the stent with the first membrane, when the stent and the first membrane are in the coaxially overlapping state.

Abstract: A flexible stent graft for deployment in a body vessel at a treatment site includes a tubular body, at least a first portion of which comprises a graft material and a coiled stent comprising a plurality of helical turns with spacings between the turns. The coiled stent is affixed to the graft material of the first portion. The first portion has a first portion diameter and the coiled stent has a helix diameter which is substantially the same as the first portion diameter. The coiled stent comprises a ratio of helical pitch to helix diameter of from about 1:2 to about 1:20, where the helical pitch is the spacing between adjacent turns of the coiled stent.

Abstract: Disclosed is a stent that is useful for treating a vascular bifurcation, the stent having a plurality of segments extending coaxially end to end along a longitudinal axis of the stent from a first end to a second end of the stent, each segment having a plurality of struts extending in a zig-zag pattern around the circumference of the stent, wherein the stent is expandable from reduced diameter to an expanded diameter, the second end of the stent having a larger diameter than the first end when expanded; and an eyelet integrally formed with the segment positioned adjacent the second end, and configured to receive a radiopaque marker therein. The stent provides an improvement over prior stents for treating a vascular bifurcation by allowing the stent to be deployed in the widened transitional zone of a bifurcation such that the second end of the stent is accurately positioned at the carina.

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 device for filtering emboli from blood flowing through a lumen defined by the walls of a vessel in a patient's body. The device including a filter element being expandable from a collapsed configuration when the filter element is restrained to an expanded configuration when the filter element is unrestrained, and an elongate support member, the filter being carried on a portion of the elongate support member. The filter element has proximal and distal portions and a central portion, the filter element having a shape in the expanded configuration which defines a cavity having a proximal facing opening, and the proximal portion of the filter element includes a radiopaque element in the form of a discontinuous loop extending around a portion of a perimeter of the proximal facing opening, the discontinuous loop having a gap and the gap being proximate to the elongate support member.

Abstract: The present invention relates to an anchor configured for minimally-invasive implantation and sized to remain securely positioned within at least a portion of the gastrointestinal tract of an animal. The anchor includes a radial spring formed from an elongated resilient member shaped into an annular wave pattern about a central axis. The anchor defines a central lumen and provides an outward radial force, while allowing for substantial flexure about its perimeter. The anchor is generally removable, but can include fasteners, such as barbs, to further secure it to the surrounding anatomy. In some embodiments, the anchor includes a connector coupling a fixed portion to a removable portion. Further, the anchor can be used to secure a medical device within the body, such as a flexible sleeve within the intestine.

Abstract: A device is disclosed that provides for the protection of intestinal anastomosis sites and other body sites from bodily fluids and contaminants. Additionally, the device provides the ability to create negative pressure at the site of the obstruction to ensure that contaminants flow from the visceral compartment into the inner lumen of the bowel. Further, the device provides the sectional forces through natural constrictions of the intestinal muscles through peristaltic action.

Abstract: The present embodiments provide stents and stent-grafts for use in medical procedures. In one embodiment, a stent comprises a series of proximal apices, a series of distal apices, and at least one imaging element. A first suture bore is disposed in a surface of the stent at a location distal to the imaging element, and is adapted to receive a suture for coupling a portion of the stent to a graft material. A distal region of the stent, including the series of distal apices and the first suture bore, overlaps with the graft material, while a proximal region of the stent, including the series of proximal apices and at least one barb, is disposed proximally beyond the graft material. In an alternative embodiment, a stent-graft comprises a graft, a first stent and a second stent, in which a series of proximal apices of the first stent are each disposed distal to the proximal end of the graft, and a series of proximal apices of the second stent are each disposed proximally beyond the proximal end of the graft.