Abstract: A method for implanting an end portion of a graft within the body of a patient during a bypass grafting procedure is disclosed. The body has a circulatory system which includes a femoral artery and an aorta. The method includes the steps of (i) making an incision in the body of the patient so as to expose the femoral artery and an inguinal ligament, (ii) advancing an endoscope between the femoral artery and the inguinal ligament until a distal end of the endoscope is positioned at a working site within the body, (iii) advancing the end portion of the graft between the femoral artery and the inguinal ligament to the working site, wherein said end portion advancing step includes the step of advancing the end portion of the graft through the endoscope, and (iv) forming an anastomosis between the end portion of the graft and the aorta at the working site.

Abstract: A vascular implant formed of a compressible foam material has a compressed configuration from which it is expansible into a configuration substantially conforming to the shape and size of a vascular site to be embolized. Preferably, the implant is formed of a hydrophilic, macroporous foam material, having an initial configuration of a scaled-down model of the vascular site, from which it is compressible into the compressed configuration. The implant is made by scanning the vascular site to create a digitized scan data set; using the scan data set to create a three-dimensional digitized virtual model of the vascular site; using the virtual model to create a scaled-down physical mold of the vascular site; and using the mold to create a vascular implant in the form of a scaled-down model of the vascular site. To embolize a vascular site, the implant is compressed and passed through a microcatheter, the distal end of which has been passed into a vascular site.

Abstract: Disclosed are methods for vascular reconstruction of diseased, non-aneurysmal arteries.

Abstract: Methods and apparatus are provided for forming a vascular graft in vitro by axially distending a blood vessel to induce growth. The apparatus comprises a chamber containing a tissue culture medium, an inlet cannula, an outlet cannula, and a means for moving the inlet cannula, the outlet cannula, or both, to axially stretch a donor blood vessel secured between the inlet cannula and the outlet cannula in a submerged position in the tissue culture medium, wherein the inlet cannula, the outlet cannula, and the donor blood vessel are secured together to form a conduit through which the tissue culture medium can flow.

Abstract: Methods and apparatus for making an anastomotic connection between first and second tubular fluid conduits are provided. For example, a connector may be configured for attachment to the first and second tubular fluid conduits and have an interior thereof substantially accessible to the interior of the first tubular fluid conduit. The connector may be configured for annular enlargement. An expandable structure is provided having a first portion configured to annularly enlarge the connector by engaging the interior of the connector. A second portion may be configured to extend through an opening in the medial portion of the first tubular fluid conduit.

Abstract: Method and apparatus for implanting radially expandable prostheses in the body lumens rely on tacking or anchoring of the prostheses with separately introduced fasteners. The prostheses may be self-expanding or balloon expandable. After initial placement, a fastener applier system is introduced within the expanded prostheses to deploy a plurality of fasteners at at least one prosthesis end, usually as each end of the prosthesis. The fasteners are usually helical fasteners which are delivered from a helical track in the fastener applier by rotation with a rotator wire. The fasteners will be applied singly, typically in circumferentially spaced-apart patterns about the interior of each end of the prosthesis.

Abstract: Endoluminal stent-grafts include several features which restrict dilation subsequent to installation but which allow the stent-grafts to be installed in the same manner as a conventional stent-graft. According to one embodiment, sutures are attached to an expanded stent-graft. The suture material is preferably braided PET or polypropylene and sutures are interwoven into the stent at substantially regular intervals. A second embodiment utilizes a band material in lieu of suture material. A third embodiment utilizes a warp knit tubular sheath with inlay yarn. The warp knit tubular sheath with inlay yarn may also act as the graft material. The invention includes a method of using these stent-grafts to prevent the dislodgment of an endoluminal stent-graft after deployment. The method includes the step of determining the maximum stent-graft diameter and related size of dilation restriction means to prevent excessive stent-graft shortening after initial deployment.

Abstract: Apparatus for reducing mitral regurgitation, by applying a force to the wall of the coronary sinus so as to force the posterior leaflet anteriorly and thereby reduce mitral regurgitation.

Abstract: An intraluminal prosthesis composed of a self-expandable stent and a biodegradable constraining element being capable of biodegrading in vivo over a predetermined period of time to permit radial expansion of the stent. The constraining elements are applied to the stent to produce a compressed configuration. Dissolution of the constraining elements in vivo allows for expansion of the stent to an expanded configuration.

Abstract: A graft for repairing defects in arteries is formed from a flexible graft and at least one attachment system. A device and method is disclosed for implanting a graft within the vasculature of a patient, in which the graft is inserted into the patient at a different stage than the attachment systems, and which allows for direct percutaneous insertion of the graft and attachment systems. The method permits control over the position of the graft in the vasculature during the course of deployment of the graft and attachment systems by providing for traction forces to be applied to opposing ends of the graft.

Abstract: An instrument for implanting an expandable cylindrical vascular prosthesis includes an outer tube and an inner tube which can be displaced relative to one another. The inner tube is longitudinally slotted on the distal end, at least in an area thereof, and ensheathes the stent with this area which includes the longitudinal slot. In order to implant the stent, the outer tube is retracted. The stent then expands with continuous retracting movement of the outer tube and the inner tube is pressed open along the longitudinal slot. Implantation is terminated, when the outer tube is retracted along the entire length of the stent. The implantation is reversible by pushing the outer tube forward, as long as the stent has not yet fully exited the instrument. In this way, the inner tube is constricted together with the stent, and compressed to an initial position.

Abstract: The present invention encompasses methods and apparatus for minimizing the risks inherent in endovascular grafting for blood vessel therapy and repair. The invention involves delivering adult stem cells, embryonic stem cells, progenitor cells, fibroblasts, or smooth muscle cells to the diseased blood vessel.

Abstract: An expandable stent designed to maintain a passageway through a body lumen of a patient is disclosed. The expandable stent is a tubular member that includes a thermoplastic material and woven or wound fibers at least partially in contact with the thermoplastic material, such that the thermoplastic material maintains the tubular member in at least one of an expanded state and a collapsed state.

Abstract: Ablation of the pulmonary veins causes damage to the tissue which may affect the viability of the tissue. By placing a stent, a vascular endoprosthesis, within a target pulmonary vein it is possible to protect the functionality of the veins after the ablation procedure. Placement of a stent, endoprosthesis or mere circuit interrupting structure into a target pulmonary vein, without ablation, prevents aberrant electrical activity in the pulmonary veins from interfering with the electrical activity of the left atrium. The stent, endoprosthesis or circuit interrupting structure may also be coated or comprised of a drug-eluting compound, loaded with a drug which inhibits arrhythmia.

Abstract: A first balloon catheter having a tip extends through the stem portion and first leg portion of a first expandable tubular member and a second balloon catheter having a tip through said stem portion and extends out of a branch aperture such that its tip is longer than that of the first balloon catheter. The first, expandable tubular member, first balloon catheter and second balloon catheter are delivered to a bifurcated vessel having a first lumen and a second lumen with the tip of the second balloon catheter leading the rest of the elements so that the tip of said second balloon catheter can be aligned with and enter into the second lumen before the first expandable tubular member and the tip of said first balloon catheter reach the area of said second lumen and interfere with the second balloon catheter.

Abstract: An endoluminal side branch graft comprises a generally tubular body having a proximal part with a proximal opening, a distal part with a distal opening, and a middle section extending between the proximal and distal parts, at least one of the proximal or distal parts has fixing means for fixedly positioning the side branch graft to a main branch graft, the fixing means having a delivery configuration and a stable fixing configuration. A primary graft is first introduced to a site in the body conduit having a side branch. The position of the side branch which has been closed off by the primary graft is mapped and an opening is provided in the primary graft at the mapped position of the side branch. A side graft is introduced into the side branch and fixed to the primary graft.

Abstract: Endothelialization of vascular surfaces. According to one aspect, the invention involves a technique for re-endothelializing an artery whose endothelial layer has been damaged by balloon angioplasty. The technique comprises, in one embodiment, introducing into the bloodstream of a patient, prior to performing the angioplasty, a quantity of a bispecific antibody, the bispecific antibody having a first antigen binding site directed against a surface marker common to both endothelial progenitor cells (EPCs) and endothelial cells (ECs) and having a second antigen binding site directed against a subendothelial epitope. The bispecific antibody is introduced in a quantity sufficient to bind a substantial percentage of circulating EPCs and circulating ECs. In this manner, once the angioplasty has been performed and the target epitopes on the subendothelium have been exposed, the bispecific antibodies that have already become bound to the circulating EPCs and ECs also then bind to the subendothelium.

Abstract: The present invention provides a sectional crimped graft that allows graft flexibility where required and limits the overall longitudinal extension. The present invention overcomes the disadvantage of fully crimped grafts by controlling the number of crimps per unit length, crimp height, crimp geometry and their location along the graft wall, dependent on the particular end-use application. In so doing, flexibility and elongation can be controllably tailored only in areas where significant anatomical angulation is present. It may also be useful in applications other than stent grafts such as surgical grafts for aortic and peripheral areas. Limiting the overall graft longitudinal extension also facilitates the deployment of the stent-graft into the blood vessel.

Abstract: A first catheter has a return bend formed near its distal free end and a first magnet is mounted on the distal free end. The first catheter is introduced through a sheath in a first common femoral artery into an elongate leg of a stent graft and pulled back until the return bend positions the first magnet near a truncate leg of the stent graft. A second catheter having a second magnet on its distal free end is introduced through a second common femoral artery and positioned near the first magnet so that the magnets become interconnected. The second catheter is pulled into the stent graft, a guide wire is inserted through it, and a second sheath is introduced into the stent graft. A contralateral limb is deployed through the second sheath and the second sheath is removed. In another embodiment, catheters with magnets pull a nephroureteral stent from a kidney.

Abstract: Improved methods of treatment of diseased or occluded vascular grafts in patients having undergone coronary artery bypass or other bypass surgery are disclosed. Deployment of a conduit in the myocardium at a site distal to the site of attachment of the coronary artery bypass graft allows oxygenated blood to flow from a chamber in the heart directly into the coronary artery, bypassing blockages in the coronary artery and the graft originally used to bypass the coronary artery. To ensure proper positioning, the conduit is delivered through the graft to the myocardium. A new lining for the existing vein graft and methods of delivery are also disclosed.

Abstract: Devices and methods are provided for forming a vascular graft by axially distending a blood vessel to induce growth. The device preferably comprises a stretching mechanism which includes (i) a rigid body; (ii) a pair of posts comprising a first post and a second post which are connected to the body; (iii) a driver element slidably secured to the body and disposed between the pair of posts; and (iv) a device for sliding the driver element away from the pair of posts to axially distend a blood vessel positioned between the pair of posts and the driver element. Preferably, the device is implanted, for example using endoscopic techniques, for use in vivo, although the device also can be used in vitro.

Abstract: Method and device for manufacturing of expandable cylindrical metal meshes for use in expandable stents and in particular for customized manufacturing. The method includes determining the type and size of the stent to be implanted, electrochemically forming the stent with desired pattern of meshes and implanting the stent into patient. The method comprises using a cathode with desired pattern of meshes and a tubular blank, from which the stent is formed. Between the cathode and the blank is delivered an electrolyte and the cathode and the blank are simultaneously rotated during electrochemical forming process.

Abstract: Devices and methods are provided for forming a vascular graft by axially distending a blood vessel to induce growth. The device preferably comprises a stretching mechanism which includes (i) a stabilization rod, (ii) a pair of rotatable elements, wherein each rotatable element is rotatably attached to the elongated body and has a channel substantially perpendicular to the axis of rotation, and (iii) a means for rotating each rotatable element to axially distend a blood vessel positioned in the channels of the rotatable elements. The elements can be rotated intermittently, cyclically, or continuously, over a period to distend or elongate the donor vessel. Preferably, the device is implanted, for example using endoscopic techniques, for use in vivo, although the device also can be used in vitro.

Abstract: The invention is directed to an expandable stent for implantation in a body lumen, such as an artery, and a method for making it from a single length of tubing. The stent consists of a plurality of radially expandable cylindrical elements generally aligned on a common axis and interconnected by one or more interconnective elements. The individual radially expandable cylindrical elements consist of ribbon-like material disposed in an undulating pattern. Portions of the expanded stent project outwardly into engagement with the vessel wall to more securely attach the stent.

Abstract: A bioprosthetic valve graft comprises a valve frame and valve flaps, the latter acting to open or close a valve aperture to directionally control fluid flow through the bioprosthesis. The bioprosthetic valve graft comprises a biomaterial suturelessly bonded to the valve frame, avoiding sutures and substantially reducing medical complications in implantations.

Abstract: The invention is directed to an expandable stent for implantation in a body lumen, such as an artery, and a method for making it from a single length of tubing. The stent consists of a plurality of radially expandable cylindrical elements generally aligned on a common axis and interconnected by one or more interconnective elements. The individual radially expandable cylindrical elements consist of ribbon-like material disposed in an undulating pattern. Portions of the expanded stent project outwardly into engagement with the vessel wall to more securely attach the stent.

Abstract: A stent is a device that is adapted to be implanted into narrowed portions of hollow vessels of a body. The stent (1) comprises a stent body (2) that has at least two different wall thicknesses (WE, WH). The different wall thicknesses result in different flexibility characteristics of the stent in the longitudinal direction. Thus the stent according to the invention prevents irritations of the wall of the vessel in the area of the implanted stent, whereby the risk of restenosis in said area can be reduced considerably.

Abstract: An intraluminal grafting system includes a hollow graft which has a proximal staple positioned proximate its proximal end and a distal staple adapted proximate its distal end. The system includes a capsule for transporting the graft through the lumen and for positioning the proximal end of the graft upstream in a lumen which may be a blood vessel or artery. A tube is connected to the capsule and extends to exterior the vessel for manipulation by the user. A catheter is positioned within the tube to extend from the cavity and through the graft to exterior the body. The catheter has an inflatable membrane or balloon proximate the distal end thereof which is in communication via a channel with inflation and deflation means located exterior the vessel. With the inflatable membrane deflated, the capsule is positioned in the lumen and manipulated to a desired location. The inflatable membrane is manipulated by the rod away from the graft.

Abstract: Minimally invasive techniques utilized in bypass grafting are disclosed. For instance, a method of implanting an end portion of a graft in the body of a patient during a bypass grafting procedure includes the steps of (i) advancing a medical instrument within a circulatory system of said body, (ii) guiding a distal end of said medical instrument out of said circulatory system through an opening defined in said circulatory system after said medical instrument advancing step, (iii) advancing said end portion of said graft within said medical instrument after said guiding step, and (iv) securing said end portion of said graft to a blood vessel of said circulatory system after said end portion advancing step.

Abstract: A venous valve device and method of formation are described to provide antegrade blood flow in the deep venous vessels of the leg or in other venous vessels of the body having incompetent or irreversibly dysfunctional valves. A venous valve is formed in situ from autologous vein conduit not having a valve present locally. An overlap region is formed by attaching two opposing walls of the vein together in a generally axial direction forming two tubular regions. One region provides antegrade blood flow and the other region provides a sinus cavity that is filled during the initiation of retrograde blood flow. A valve cusp is formed by attaching vessel wall together forming a commissure that extends between the two overlap regions. A single valve cusp moves toward the sinus cavity to allow antegrade blood flow and moves away from the sinus cavity to block retrograde blood flow. Inlet and outlet transition regions can be formed to provide hemodynamic antegrade blood flow through the valve.

Abstract: A membrane applied to the ostium of an atrial appendage for blocking blood from entering the atrial appendage which can form blood clots therein is disclosed. The membrane also prevents blood clots in the atrial appendage from escaping therefrom and entering the blood stream which can result in a blocked blood vessel, leading to strokes and heart attacks. The membranes are percutaneously installed in patients experiencing atrial fibrillations and other heart conditions where thrombosis may form in the atrial appendages. A variety of means for securing the membranes in place are disclosed. The membranes may be held in place over the ostium of the atrial appendage or fill the inside of the atrial appendage. The means for holding the membranes in place over the ostium of the atrial appendages include prongs, stents, anchors with tethers or springs, disks with tethers or springs, umbrellas, spiral springs filling the atrial appendages, and adhesives.

Abstract: The present invention relates to medicine and more particularly to neurosurgery, and can be used in the operative treatment of patients with parasagittal meningiomas. The present invention is directed to the provision of radical removal of a parasagittal meningioma, restoring and securing natural blood flow, obviating recurrent parasagittal meningioma. The object is accomplished by that semicircular incisions of the dura mater circumscribing the tumor contour are made toward the base of the upper sagittal sinus, the tumor is removed as a single block together with a segment of the upper sagittal sinus and a portion of the falx cerebri, whereafter the removed segment of the upper sagittal sinus is replaced with an implant prosthesis ensuring physiological blood flow. The prosthesis is a cynlindrical tubular member in which the end parts are provided with smooth, curvilinear, gently sloping bevels made on its internal generating surface or on both internal and external surfaces thereof.

Abstract: An intraluminal device implantable in a blood vessel having an aneurysm therein in the vicinity of a perforating vessel and/or of a bifurcation leading to a branch vessel. The intraluminal device includes a mesh-like tube of bio-compatible material having an expanded condition in which the tube diameter is slightly larger than the diameter of the blood vessel in which it is to be implanted, and the tube length is sufficient to straddle the aneurysm and to be anchored to the blood vessel on the opposite sides of the aneurysm. The mesh-like tube also has a contracted condition wherein it is sufficiently flexible so as to be easily manipulatable through the blood vessel to straddle the aneurysm.

Abstract: Methods and apparatus for making an anastomotic connection between first and second tubular fluid conduits are provided. For example, a connector may be configured for attachment to the first and second tubular fluid conduits and have an interior thereof substantially accessible to the interior of the first tubular fluid conduit. The connector may be configured for annular enlargement. An expandable structure is provided having a first portion configured to annularly enlarge the connector by engaging the interior of the connector. A second portion may be configured to extend through an opening in the medial portion of the first tubular fluid conduit.

Abstract: A method for implanting a medical set in a human blood vessel, the medical set comprising a prosthesis adapted to be introduced in the vessel, the prosthesis having a first end and a second end, and being adapted to be disposed against an inner wall of the vessel at least at one of the ends, the prosthesis comprising a tubular sleeve and a strap adapted to be disposed against the vessel at a location adjacent one of the ends of the tubular sleeve, the strap having a hemostatic covering for reducing any blood leakage at the location of the strap.

Abstract: Anastomotic stents for connecting a graft vessel to a target vessel, and methods of use thereof. The anastomotic stents of the invention are suitable for use in a variety of anastomosis procedures, including coronary artery bypass grafting. One embodiment of the invention comprises a large vessel anastomotic stent for use with large diameter target vessels such as the aorta or its major side branches. Another embodiment of the invention comprises a small vessel anastomotic stent for use on a target vessel which has a small diameter such as a coronary artery. Another aspect of the invention involves applicators for use with the stents of the invention.

Abstract: A venous valve prosthesis includes a hollow conduit (40) defining a central passageway through which blood may flow. Opposing, pliable leaflet members (30) are located within the conduit and move back and forth between a first, open position, whereby blood may flow through the central passageway in a first direction, and a second, closed position, whereby blood is prevented from backflowing through the central passageway in a second direction which is opposite the first direction. A hollow and generally cylindrical support member (10, 20) retains the leaflet members and is coaxially disposed within the conduit. The support member includes opposing cutaway regions (18) defining two axially extending struts (16) supporting the leaflet members. The cutaway regions, in cooperation with the struts, allow the leaflet members to collapse inwardly to the closed position.

Abstract: A covered stent assembly comprising a tubular, expandable stent having a metallic framework covered with a cylinder of biocompatible, non-thrombogenic expandable material, such as heterologous tissue. In a preferred embodiment, the metallic framework is positioned coaxially within a cylinder of bovine pericardial tissue. A catheter may be used to deliver the stent assembly to a desired region in the lumen of a patient. The metallic framework is then expanded to seat the assembly within the lumen.

Abstract: A plastically deformable stent for implantation within a body passage includes a plurality of cylindrical segments, and a plurality of connectors extending between adjacent segments. Each segment has an alternating pattern of curvilinear elements extending about its circumference, including first and second sets of curvilinear elements having different resistances to expansion, and preferably defining “U” shapes with alternating lengths that are connected to one another to define a substantially sinusoidal pattern. The connectors define a sinusoidal shape adapted to extend and compress axially substantially evenly when the adjacent segments are subjected to bending. The stent may be delivered on a device including an elongate member with a nose cone, an expandable member, and a proximal shoulder thereon, and an outer sheath for slidably receiving the elongate member therein. The outer sheath and/or nose cone may have perfusion holes for allowing continued perfusion of fluid during stent delivery.

Abstract: Methods and apparatus for delivering and installing a new length of tubing between two sections of a patient's existing body organ tubing and at least partly outside of that existing structure. For example, the new length of tubing may be for the purpose of providing the patient with a coronary bypass. The new tubing may be an artificial graft, a natural graft (harvested elsewhere from the patient), or both. The new tubing is installed at the operative site primarily by providing at least one graft location with instrumentation inserted through the patient's existing tubular body organ structure. Assistance in installing the new tubing may be provided by minimally invasive surgical access openings in the patient's chest. The tubing may be delivered through the patient's existing tubular body structure or, alternatively, through the surgical access openings.

Abstract: Methods and apparatus for delivering and installing a new length of tubing between two sections of a patient's existing body organ tubing and at least partly outside of that existing structure. For example, the new length of tubing may be for the purpose of providing the patient with a coronary bypass. The new tubing may be an artificial graft, a natural graft (harvested elsewhere from the patient), or both. The new tubing is delivered to and installed at the operative site primarily by working through the patient's existing tubular body organ structure. This avoids the need for any significant surgery on the patient.

Abstract: A method for inhibiting hyperplasia at an anastomotic junction of a vascular fistula or vascular graft comprises exposing the anastomotic junction to vibrational energy at a mechanical index and for a time sufficient to inhibit hyperplasia. Kits are described comprising the catheter or a probe suitable for performing the methods together with instructions for use setting forth the methods. The methods and kits are particularly suitable for treating anastomotic junctions formed to provide vascular access for hemodialysis, hemofiltration, and the like. The methods and kits are also suitable for treating other vascular grafts, such as those formed during cardiac bypass graft surgery, vascular repair, and the like.

Abstract: A method for implanting an end portion of a graft within the body of a patient during a bypass grafting procedure is disclosed. The body has a circulatory system which includes a femoral artery and an aorta. The method includes the steps of (i) making an incision in the body of the patient so as to expose the femoral artery and an inguinal ligament, (ii) advancing an endoscope between the femoral artery and the inguinal ligament until a distal end of the endoscope is positioned at a working site within the body, (iii) advancing the end portion of the graft between the femoral artery and the inguinal ligament to the working site, wherein said end portion advancing step includes the step of advancing the end portion of the graft through the endoscope, and (iv) forming an anastomosis between the end portion of the graft and the aorta at the working site.

Abstract: An improved prosthetic graft for the bypass, replacement or repair of vessels and organs that are in contact with blood flow is disclosed. The prosthetic graft includes a porous prosthetic implant and adherent cells adhered to the outer surface of the implant. The adherent cells are transfected with at least one recombinant nucleic acid molecule encoding at least one protein that enhances patency of the graft. The prosthetic graft has a long-term patency and success rate that is superior to other previously described prosthetic grafts designed for such use. Also disclosed are methods of making and using such a graft.

Abstract: Methods of artificially lining a vessel, especially an artery, of a medical patient to address the existence of a flow-inhibiting atheroma and to significantly alleviate the probability of restenosis, and the resulting products.

Abstract: A method is provided for forming an autologous graft by distending a donor blood vessel and harvesting the distended portion of the vessel. Also provided is a device for in vivo or in vitro vessel distension. Typically the device is implanted, for example using endoscopic techniques, in a patient sometime prior to another surgery on that patient which includes implanting a vascular graft. The device includes a stretching mechanism which is attached to a donor blood vessel, means for operating the stretching mechanism to cause the vessel to distend, and a controller, preferably externally located, for controlling the operating means. In a preferred embodiment, the device includes a pair of opposed straps, attached to a healthy, small-diameter donor blood vessel such as a femoral artery in the leg. The straps are displaced from each other over a period of time to continuously distend or elongate the donor vessel. The distended portion of the donor vessel is excised at the time of the bypass surgery.

Abstract: An intraluminal grafting system having a balloon catheter assembly, a capsule catheter assembly and capsule jacket assembly is used for deploying in the vessel of an animal body a bifurcated graft having a plurality of attachment systems. The deployment catheters contain an ipsilateral capsule assembly, a contralateral capsule assembly and a distal capsule assembly, wherein the attachment systems of the bifurcated graft are disposed within the three capsule assemblies. A removable sheath of the capsule jacket assembly covers the bifurcated graft and capsule assemblies to provide a smooth transition along the length of the deployment catheters. The bifurcated graft is comprised of a main tubular member and two tubular legs, having attachment systems with wall engaging members secured to the superior end of the main tubular member and the inferior ends of the tubular legs. An inflatable membrane configured on the balloon catheter is used to firmly implant the attachment systems within the vessel.

Abstract: Modular endoluminal stent-grafts include at least two different sized stent-grafts which are deployed one within the other. According to one embodiment of the invention, a first stent-graft is provided having a flared end which is expandable to a first diameter and a midsection which is expandable to a second diameter smaller than the first diameter. A second stent-graft is also provided having an end which is expandable to a diameter which engages the midsection of the first stent-graft. The first embodiment of the invention is deployed by expanding the first stent-graft such that its flared end engages a large diameter vessel, then expanding the second stent-graft inside the midsection of the first stent graft and inside a small diameter vessel such that the second stent graft engages the small diameter vessel and the midsection of the first stent-graft.

Abstract: Improved methods of treatment of diseased or occluded vascular grafts in patients having undergone coronary artery bypass or other bypass surgery are disclosed. Deployment of a conduit in the myocardium at a site distal to the site of attachment of the coronary artery bypass graft allows oxygenated blood to flow from a chamber in the heart directly into the coronary artery, bypassing blockages in the coronary artery and the graft originally used to bypass the coronary artery. To ensure proper positioning, the conduit is delivered through the graft to the myocardium. A new lining for the existing vein graft and methods of delivery are also disclosed.

Abstract: Disclosed is a tubular endoluminal vascular prosthesis, useful in treating, for example, an abdominal aortic aneurysm. The prosthesis comprises a self-expandable wire support structure having a tubular main body support and first and second branch supports. The support structure may include sliding links to permit flexibility while maintaining patency of the central lumen. The branch supports may articulate with the main body to permit the branches to pivot laterally from the axis of the main body throughout a substantial range of motion.