US20020091439A1 - Graft assembly having support structure - Google Patents

Abstract

A delivery catheter having an inner catheter assembly, an inferior capsule catheter, and a capsule jacket assembly for use in deploying a graft having a compressible and expandable attachment systems in the thoracic region of an aorta. The graft is comprised of a tubular member having superior and inferior ends, each having an attachment system with wall engaging members secured thereto and is crimped along its midsection to resist kinking and elongation. The delivery catheter includes an inferior capsule assembly for releasably retaining the inferior attachment system of the graft and a superior capsule assembly for releasably retaining the superior attachment system of the graft as well as a releasing system for maintaining the attachment systems in a compressed configuration and for facilitating expansion of the attachment systems. The delivery catheter also includes an anti-elongation wire attached to the inner catheter assembly to prevent stretching of the delivery catheter during deployment of the graft within the aorta. Upon removing the attachment systems from the capsule, the releasing system functions to allow the attachment systems to assume their expanded configuration and engage the walls of the aorta. The graft and attachment systems remain in the vessel after the delivery catheter is withdrawn.

Description

• This application is a continuation-in-part of application Ser. No. 102,576 filed Aug. 5, 1993, which is a continuation-in-part of application Ser. No. 553,530 filed on Jul. 13, 1990, which is a continuation-in-part of application Ser. No. 166,093 filed on Mar. 9, 1988, now U.S. Pat. No. 5,104,399, which is a continuation-in-part of application Ser. No. 940,907 filed on Dec. 10, 1986, now U.S. Pat. No. 4,787,899 which is a continuation of application Ser. No. 559,935 filed on Dec. 9, 1983, now abandoned. The contents of each of these applications are hereby incorporated by reference.[0001]
BACKGROUND OF THE INVENTION
• This invention relates to a system for implanting a prosthesis, and more particularly, to a delivery catheter for placing a graft having an attachment system within a corporeal lumen.[0002]
• It is well established that various fluid conducting body or corporeal lumens, such as veins and arteries, may deteriorate or suffer trauma so that repair is necessary. For example, various types of aneurysms or other deteriorative diseases may affect the ability of the lumen to conduct fluids and, in turn, may be life-threatening. In some cases, the damaged lumen is repairable only with the use of a prosthesis such as an artificial vessel or graft. For repair of vital vessels such as the aorta, repair may be significantly life-threatening. Techniques known in the art which tend to minimize dangers to the patient include a procedure in which a graft resembling the natural vessel is placed within the diseased or obstructed section of the natural vessel.[0003]
• More specifically, it is known within the art to provide a prosthesis for intraluminal repair of a vessel. In intraluminal vessel repair, the prosthesis is advanced intraluminally through the vessel to the repair site using a delivery catheter and deployed within the vessel so that the prosthesis traverses the diseased portion to thereby repair the vessel.[0004]
• Generally speaking, varied concerns arise when repairing the different deteriorated disease that may affect a vessel. For instance, thoracic aneurysms differ from other aortic aneurysms in several respects. As may well be expected, due to their proximity to the heart, there are concerns specific to thoracic aneurysms that are not evident in the repair of other types of aortic aneurysms. Moreover, the size and shape of the thoracic aneurysms differ and are often more varied than other types of aortic aneurysms[0005]
• In particular, thoracic aneurysms are often close to what are typically called the great arteries, such as the left subclavian artery, or may be found to occur proximal to the celiac trunk. These lumens, which branch away from the thoracic region of the aorta, are critical to the body's circulatory system and carry high volumes of blood to various parts of the body. Consequently, these lumens generally cannot be occluded by a prosthesis used to intraluminally repair a thoracic aneurysm unless additional procedures are performed to bypass the occluded lumen.[0006]
• In addition, thoracic aneurysms have diameters that are typically larger and have shapes perhaps more variable than other aortic aneurysms. The average neck diameter of thoracic aneurysms is on the order of 34-36 mm and the average length approximately 10 cm with a range of 5-16 cm. To complicate matters, due to the curvature of the aortic arch, the superior neck of thoracic aneurysms are often at a different angle from that of the inferior neck. Also, among the myriad of shapes they may take on, thoracic aneurysms may be fusiform in shape, or comprise giant penetrating ulcers.[0007]
• Further, access to thoracic aneurysms through connecting arteries is limited and methods for implanting a prosthesis must take into account the physiology of and effects to the heart. Specifically, the femoral as well as the iliac arteries may be too narrow to pass a catheter for delivering a thoracic prosthesis or graft. Often, surgical repair of a thoracic aortic aneurysm requires thoracotomy. Also, it is not desirable for catheters delivering a thoracic graft to comprise a balloon since the use of the balloon to implant the graft would temporarily stop blood flow, thereby placing potentially dangerous loads upon the heart. Finally, due to high pressures existing in the area of a thoracic aneurysm, the attachment system of a graft for repairing a thoracic aneurysm must be sufficient to prohibit migration of the graft. It is also to be noted that there is typically a lack of calcification in the area of thoracic aneurysms. Consequently, the attachment systems of grafts for repairing thoracic aneurysms generally need not be placed within the lumen with forces overcoming such hardening of tissue.[0008]
• Thus, what has been needed and heretofore unavailable is a graft and a delivery catheter system therefor, wherein the graft is designed specifically to repair thoracic aortic aneurysms and the delivery system functions to precisely position a graft within an aorta to thereby completely repair the thoracic aneurysm. The graft is to be configured to conform to the various possibilities of shapes of the thoracic aneurysm and to have an attachment system which effectively affixes the graft within the aorta. In addition, the delivery catheter is to effectively operate within the unique anatomical constraints of the thoracic portion of the aorta. The present invention accomplishes these goals.[0009]
SUMMARY OF THE INVENTION
• Briefly, and in general terms, the present invention provides a new and improved graft and delivery catheter and a novel method for their use in repairing a lumen. The graft is configured for repairing a diseased condition of the lumen. The delivery catheter is configured to introduce the graft within or between vessels or corporeal lumens of an animal, such as a human, and to facilitate the deployment of the graft at the repair sites.[0010]
• The present graft has a diameter that is larger than that of conventional grafts so that relatively larger lumens may be repaired and its walls are thinner to facilitate packing it within the delivery catheter. The attachment system of the present graft is expandable and is stiffer and has hooks with greater angles from radial than conventional attachment systems. Also, in addition to being secured to the ends of the graft, the attachment system is secured by its apices to the graft to prevent relative motion of the attachment system and graft. Further, the novel attachment system of the present graft enables it to self expand quickly and forcefully without the aid of a balloon catheter as well as enables it to securely hold the graft within lumens carrying high volume of blood.[0011]
• The present delivery catheter includes structure for quickly deploying the graft within the lumen to be repaired. Further, by not employing a balloon catheter, the delivery catheter may be utilized to repair lumens located near the heart without placing undue stress on the heart and is configured for packing a larger diameter graft within the delivery catheter. Additionally, the delivery catheter is configured to hold the attachment systems affixed to the ends of the graft within capsules and by not placing the entire graft within a single capsule, larger diameter grafts may be packed within the delivery catheter. Moreover, the delivery catheter is longer which enables it to reach an aortic arch and employs a novel releasing system cooperating with the capsules which, in conjunction, operate to facilitate loading as well as deployment of the graft. The releasing system includes a release wire cooperating with releasable ties attached to the exterior of the graft to maintain the attachment systems of the graft in a collapsed configuration and to facilitate the expansion of the attachment systems so that they properly and quickly engage the walls of the lumen.[0012]
• The present invention provides a prosthesis or graft for intraluminal placement in a fluid conducting corporeal lumen. The graft is hollow and has a pre-selected cross-section, length and wall thickness. The graft is deformable to conform substantially to the interior surface of the corporeal lumen or other body part to be repaired. The midsection of the graft may be crimped to resist kinking and facilitate placement accuracy and may comprise radiopaque markers attached along its length to help orient the graft using fluoroscopy or X-ray techniques. Tufts of yarn are sewn into the graft at its ends to facilitate healing and placement of the graft within the corporeal lumen. Preferably, the graft comprises woven polyester or another material suitable for permanent placement in the body such as PTFE. The superior and inferior ends of the graft are positioned within the corporeal lumen and the graft is configured such that it traverses the diseased or damaged portion of the vessel. To anchor the graft to the wall of the corporeal lumen, attachment systems are secured to the superior and inferior ends of the graft.[0013]
• The preferred attachment system includes wall engaging members. The wall engaging members of the superior attachment systems are angled toward the inferior end of the graft. Similarly, the wall engaging members of the inferior attachment systems are angled toward the superior end of the graft. Specifically, the angles of both the superior and inferior wall engaging members are in the range of 60-80° from radial. The wall engaging members of both attachment systems have sharp tips for engaging the corporeal lumen wall. The preferred attachment systems are formed into a staggered V-shape lattice or framework, the apices of which comprise helical torsion springs. The frame of the attachment systems allows for elastic radial deformation resulting in a spring-like effect when a compressed attachment system is allowed to expand as the graft is released from the capsules, and by having a high stiffness, they function to quickly and forcefully seat the graft within the lumen.[0014]
• Preferably, the delivery catheter of the present inventor is flexible and includes an elongate cylindrical jacket overlaying a superior capsule assembly and an inferior capsule assembly, each of which are adapted to releasably retain an end of the graft. The superior capsule assembly further includes an elongated flexible conical-shaped or tapered nose cone adapted to facilitate the advancement of the delivery catheter through a patient's vasculature. Attached at the most proximal end of the inferior capsule assembly is an elongate outer shaft, comprising an inferior capsule catheter, which is adapted to receive a multi-lumen inner shaft. The lumens of the inner shaft are conduits for a guidewire, one or two release wires, an anti-elongation wire and a control wire that cooperates with the superior capsule assembly. Attached to the inner shaft and distal to the outer shaft/inferior capsule assembly junction is a conical-shaped knob that cooperates with the superior capsule assembly. Also attached to the inner shaft is an anti-elongation wire that functions to minimize elongation of the inner shaft during deployment of the graft. The jacket is capable of moving relative to the rest of the catheter and thus can be withdrawn, thereby exposing the capsules and graft. Similarly, the capsules can be caused to move relative to the inner shaft and the structure attached thereto, which, in conjunction with the operation of the releasing system, thereby causes the deployment of the graft within a lumen. The length of the delivery catheter is sufficient for use in reaching the thoracic portion of the aorta and has a diameter suited for encasing a graft for use in repairing a thoracic aneurysm.[0015]
• Deployment of the graft comprises a series of steps which begins with introducing the delivery catheter into the corporeal lumen using well known surgical techniques. The delivery catheter is manipulated so that the graft retained by the superior and inferior capsule assemblies is positioned at a desired location within the corporeal lumen. Once the graft is in the desired location, the jacket is retracted and the superior and inferior capsule assemblies are removed from the graft to expose the superior and inferior attachment systems of the graft. After this is accomplished, the releasing system is employed to thereby allow the attachment systems self-expand and seat the graft within the lumen.[0016]
• Two methods are contemplated for placing the graft within a lumen. As a first step in each method, the jacket is moved proximally to expose the graft retained by the superior and inferior capsules. In the first method, the superior capsule assembly is moved distally to expose the superior end of the graft and the inferior capsule assembly is moved proximally to expose the inferior end of the graft. The releasing system is then employed to release the superior attachment system, thereby allowing the superior attachment system to affix the superior end of the graft within the lumen. Thereafter, the releasing system is employed to release the inferior attachment system to thereby allow the inferior attachment system to affix the inferior end of the graft within the lumen. In the second method, these steps are reordered so that the inferior end of the graft is first seated within the lumen and thereafter, the superior end is seated.[0017]
• Other features and advantages of the present invention will become apparent from the following detailed description, taken in conjunction with the accompanied drawings, which illustrate, by way of example, the features of the invention.[0018]
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a top plan view of the delivery catheter and graft incorporating the present invention.[0019]
• FIG. 2 is a top plan view of a an anti-elongation wire of the present invention.[0020]
• FIG. 3 is a top plan view of a release wire of the present invention.[0021]
• FIG. 4 is a top plan view of a guidewire to be used with the delivery catheter of the present invention.[0022]
• FIG. 5 is a top plan view of an inner catheter assembly of the present invention.[0023]
• FIG. 6 is a top plan view of a superior capsule assembly, control wire, hypotube and control wire handle assembly of the present invention.[0024]
• FIG. 7 is a top plan view of an inferior capsule and capsule catheter of the present invention.[0025]
• FIG. 8 is a top plan view of a capsule jacket assembly of the present invention.[0026]
• FIG. 9 is a top plan view of a graft for use with the delivery catheter of the present invention.[0027]
• FIG. 10 is a cross-sectional view taken along the line[0028]10-10 of FIG. 1.
• FIG. 11 is an alternate embodiment of the view depicted in FIG. 10.[0029]
• FIG. 12 is a partial cross-sectional view of the inferior capsule, superior capsule and capsule jacket assemblies and the anti-elongation wire, release wire and graft.[0030]
• FIG. 13 is an enlarged perspective view showing a presently preferred embodiment of the distal end of the control wire, superior cap insert, superior cap and nose cone.[0031]
• FIG. 14 is an enlarged cross-sectional view of the superior capsule assembly.[0032]
• FIG. 15 is a cross-sectional view taken along the line[0033]15-15 of FIG. 14.
• FIG. 16 is a partial cross-sectional view of the control wire and control handle mechanism of FIG. 1.[0034]
• FIG. 17 is a cross-sectional view taken along the line[0035]17-17 of FIG. 16.
• FIG. 18 is a cross-sectional view taken along the line[0036]18-18 of FIG. 16.
• FIG. 19 is a cross-sectional view taken along the line[0037]19-19 of FIG. 16.
• FIG. 20 is a cross-sectional view taken along the line[0038]20-20 of FIG. 16.
• FIG. 21 is a partial cross-sectional view of the graft and attachment system of the present invention.[0039]
• FIG. 22 is a cross-sectional view taken along the line[0040]22-22 of FIG. 21.
• FIG. 23 is an enlarged perspective view showing a superior attachment system.[0041]
• FIG. 24 is an enlarged perspective view showing an inferior attachment system.[0042]
• FIG. 25 is a perspective view showing an alternate embodiment of the graft.[0043]
• FIG. 26 is an enlarged perspective view showing an alternate embodiment of the wall engaging members of the attachment system.[0044]
• FIG. 27 is an enlarged perspective view showing an alternate embodiment of the wall engaging member of the present invention.[0045]
• FIG. 28 is an enlarged perspective view showing another view of the alternate embodiment of FIG. 27.[0046]
• FIG. 29 is a perspective view showing another embodiment of the graft.[0047]
• FIG. 30 is a cross-sectional view of the graft depicted in FIG. 29.[0048]
• FIG. 31 is a perspective view showing yet another embodiment of the graft.[0049]
• FIG. 32 is a cross-sectional view of the graft depicted in FIG. 31.[0050]
• FIG. 33 is a partial cross-sectional view of the delivery catheter and graft, illustrating a releasing system of the delivery catheter.[0051]
• FIG. 34 is a cross-sectional view taken along the line of[0052]34-34 of FIG. 33.
• FIG. 35 is a partial cross-sectioned view of the delivery catheter and graft, illustrating another embodiment of the releasing system of the delivery catheter.[0053]
• FIG. 36 is a partial cross-sectional view of the delivery catheter and graft positioned within the corporeal lumen.[0054]
• FIG. 37 is a partial cross-sectional view of the delivery catheter and graft shown in FIG. 33, wherein the capsule jacket has been retracted proximally relative to the delivery catheter.[0055]
• FIG. 38 is a partial cross-sectional view of the delivery catheter and graft shown in FIG. 34, wherein the superior capsule assembly has been removed from the superior end of the graft.[0056]
• FIG. 39 is a partial cross-sectional view of the delivery catheter and graft shown in FIG. 35, wherein the inferior capsule has been removed from the inferior end of the graft.[0057]
• FIG. 40 is partial cross-sectional view of the delivery catheter and graft shown in FIG. 36, wherein the release system has been used to facilitate emplacement of the superior attachment system within the corporeal lumen.[0058]
• FIG. 41 is a partial cross-sectional view of the delivery catheter and graft shown in FIG. 37, wherein the release system has been utilized to facilitate emplacement of the inferior attachment system within the corporeal lumen.[0059]
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• As is shown in the drawings and for purposes of illustration, the invention is embodied in a thoracic graft and a delivery catheter therefor. One of the novel features of the present invention is the attachment system of the graft which operates to securely affix the graft within a lumen without the aid of a balloon catheter. Another novel feature of the present invention is the releasing system which functions to release the attachment systems of the graft once the graft has been advanced within the vasculature of the patient to the repair site.[0060]
• Generally, in the present invention, the graft is comprised of a monoluminal tubular member having superior and inferior extremities. Expandable attachment systems are secured to the superior and inferior ends of the tubular member. The attachment systems are provided with wall engaging members which are covered by the inferior and superior capsule assemblies. The delivery catheter includes a plurality of elongate components which are configured coaxially so that relative movement between them provides for deployment of the graft.[0061]
• In more detail, the[0062]delivery catheter50 is shown in FIGS.1-8. As shown in FIG. 1, thedelivery catheter50 includes aninner catheter assembly51, which is coaxially disposed within aninferior capsule catheter52, which is coaxially disposed within thecapsule jacket53. Also disposed about the inner catheter is asuperior capsule assembly90. Attached to theinferior capsule catheter52 is aninferior capsule assembly130. Theinferior capsule assembly130 and thesuperior capsule assembly90 are used to contain the attachment systems of thegraft55. A control wire assembly54 (see FIG. 6) is coaxially disposed within one of a plurality of lumens of aninner shaft61 included in theinner catheter assembly51 and is configured to move thesuperior capsule assembly90 in relation to the other components. In the preferred embodiment, the system is used as an over-the-wire device, such that thedelivery catheter50 is further configured with a lumen for a guidewire56 (see FIG. 4). It is contemplated, however, that the system can also be used with a well known fixed wire delivery configuration.
• Moreover, the[0063]delivery catheter50 includes a release wire57 (see FIG. 3). Therelease wire57 comprises a portion of a releasing system of thedelivery catheter50. Therelease wire57 is adapted to be disposed within one of the plurality ofinner shaft61 lumens and cooperates with structure attached to thegraft55 to maintain the attachment systems of thegraft55 in a collapsed configuration (see FIG. 12) as well as to facilitate the timely expansion of the attachment systems so that thegraft55 may be implanted in a lumen. Preferably, therelease wire57 has a diameter of approximately 0.010 inches and a length on the order of 100 cm, so that itsinferior end77 may be manipulated by the operator yet be long enough to extend beyond the repair site. In a presently preferred embodiment, theinferior end77 of therelease wire57 is attached to a rotating knob (not shown) so that when the knob is rotated, therelease wire57 wraps around the knob thereby causing it to move proximally relative to the other components of the delivercatheter50. It is also contemplated that, in the alternative, theinferior end77 of thecontrol wire57 is adapted to be gripped by the operator. Therelease wire57 may be made from FEP coated nitinol.
• Additionally, the delivery catheter includes an anti-elongation wire[0064]59 (see FIG. 2). Theanti-elongation wire59 cooperates with theinner shaft61 to prevent stretching of theinner shaft61 during deployment of thegraft55 within the lumen. Asuperior end79 of theanti-elongation wire59 is attached to theinner shaft61. Aninferior portion78 is similarly attached to theinner shaft61. Theanti-elongation wire59 may be disposed within a lumen of theinner shaft61 or may be positioned along side theinner shaft61. Preferably, the diameter of theanti-elongation wire59 is approximately 0.008 inches. In one presently preferred embodiment, theanti-elongation wire59 is made from kevlar yarn but it can also be made of stainless steel.
• As shown in FIG. 10, the[0065]inner shaft61 is preferably configured with multiple lumens; however, theinner shaft61 may be configured with a single or a plurality of lumens. Aguidewire lumen63 extends the length of theinner shaft61. Arelease wire lumen64 also extends the length of theinner shaft61. Acontrol wire lumen65 is provided for acontrol wire91 included in the control wire assembly54 and also extends the length of theinner shaft61. In an alternative embodiment, theinner shaft61 also includes ananti-elongation lumen66 extending its length (see FIG. 11). Additionally, as will be hereinafter discussed in more detail, theinner shaft61 may include a plurality of reinforcing bands, low profile projections or bumps and slits.
• The flexible elongate element of the[0066]inner shaft61 is preferably formed of a material suitable for intraluminal use, such as crosslinked polyethylene tubing. Themulti-lumen shaft61 is preferably extruded to an outer diameter of 0.08 inches (2.03 mm). Theguidewire lumen63 has an inner diameter of 0.040 inches (1.02 mm). Therelease wire lumen64 and thecontrol wire lumen65 each have a diameter of 0.022 inches (0.56 mm) but may range from 0.015 to 0.030 inches (0.381-0.762). The outside diameter may range from 0.035 to 0.1 inches (0.889-2.54 mm). In the embodiment of theinner shaft61 that includes theanti-elongation lumen66, theanti-elongation lumen66 may have a diameter of at least 0.008 inches. Theinner shaft61 may vary in length to suit the application, for example, from 50-150 cm.
• As shown in FIGS. 5 and 12, a conical-shaped[0067]knob100 is affixed toinner shaft61. As will be developed below, the conical-shapedknob100 cooperates with thegraft55 andsuperior capsule assembly90 to facilitate emplacement of thegraft55 within a lumen. Theinner shaft61 also includes tworelease wire notches102,104 which provide a space for therelease wire57 to exit and reenter therelease wire lumen64. By providing such a space, therelease wire57 can exit theinner shaft61 and be placed into engagement with the structure attached to thegraft55 which function to control whether the attachment systems of the graft are in their collapsed or expanded configuration. In one presently preferred embodiment, eachnotch102,104 is flanked by reinforcing bands (not shown) which add structural reinforcement to theinner shaft61 to prevent elongation of thenotches102,104 as well as low profile bumps (not shown) formed on theinner shaft61 which aid in keeping the reinforcing bands in place. Preferably, the material of the reinforcing bands is selected so that they perform as radiopaque markers. Further, additional bumps (not shown) may be formed on theinner shaft61 to cooperate with thesuperior capsule assembly90 to limit its proximal and distal movement.
• The delivery catheter also includes the control wire assembly[0068]54, which is shown in FIGS. 1 and 6. The distal end of the control wire assembly54 consists of thesuperior capsule assembly90. As shown in more detail in FIGS.13-15, thesuperior capsule assembly90 may comprise acontrol wire91 secured within asuperior cap insert96 that is placed within asuperior cap92. Thesuperior cap92 includes a threaded male portion that is received in anose cone94 having a threaded female portion. Thenose cone94 is flexible and has an elongated conical or tapered shape adapted to facilitate advancement of thedelivery catheter50 through a patient's vasculature. A hollowsuperior capsule93 is secured to thesuperior cap92 and coaxially surrounds the control wire.
• As shown in FIG. 12, the conical-shaped[0069]knob100 is secured to theinner shaft61 and may be positioned withinsuperior capsule93 at a location adjacent and proximal to thesuperior cap92. As the control wire is moved in a longitudinal manner, the superior end of thecontrol wire95, thesuperior cap insert96, thesuperior cap92, thenose cone94 and thesuperior capsule93 each move as a single assembly (see also FIG. 14).
• The[0070]nose cone94 may be made from PEBAX and thesuperior cap92 may be formed from polycarbonate or other suitable material for insertion through the body lumen. Thenose cone94 is formed with abore104 of approximately the same diameter as the outer diameter of theinner shaft61. Similarly, thesuperior cap insert96 may be formed of the same material as thesuperior cap92, wherein thesuperior cap insert96 is provided with abore105 for receiving theinner shaft61. Thesuperior cap92 is further provided with arecess106 or other means for receiving the superior end of thesuperior capsule93. Thesuperior capsule93 is preferably formed of stainless steel, but may be formed of other suitable biocompatible material, such as a nickel titanium. Thesuperior cap recess106 is angled to allow crimping of thesuperior capsule93 to thesuperior cap92.
• The outside diameter of the[0071]superior capsule93 may range from 4-9 mm and is preferably 0.289 inches (7.3 mm) in outer diameter and 0.276 inches (7.01 mm) inner diameter. The length of thesuperior capsule93 is approximately 0.87 inches (22 mm).
• FIGS.[0072]13-15 show a presently preferred embodiment of thesuperior capsule assembly90. In this embodiment, thecontrol wire91 is threaded through anopening107 in thesuperior cap insert96. Alongitudinal slot109 is cut out in theinner shaft61 to expose thecontrol wire lumen65. The control wire is formed in a U-shaped bend over the opening in the superior cap insert and is configured to slide within the slot and in theinner shaft lumen65. The distal end of thecontrol wire95 resides in thesuperior cap insert96. This configuration allows the superior cap assembly to move axially along the inner catheter shaft. The U-shaped bend of the control wire through the superior cap insert, however, prevents the superior cap assembly from rotating in relation to the inner catheter shaft. As described above, the superior cap insert is firmly secured within the superior cap.
• It is to be understood that other embodiments of the superior capsule assembly are contemplated. For instance, the control wire may be configured to pass through the superior capsule assembly, by way of the[0073]inner shaft lumen65, and be attached at a superior end of the superior cap. Irrespective of the embodiment, however, it is contemplated that the control wire causes relative movement of the superior capsule assembly and the inner shaft.
• As shown in FIGS.[0074]16-20, ahandle assembly110 is secured to the proximal end of thecontrol wire91. The handle assembly comprises aproximal body111, adistal body112, acontrol knob113 withrotating shaft114 and ahypotube115. The two handle body parts have acentral bore119 for receiving theinner shaft61. A retainingpin129 may be used to secure the two pieces of the handle body together. It is also contemplated that thehandle assembly110 include one or more release wire knobs (not shown), each having a rotating shaft adapted to be attached to a release wire. Upon rotation of a release wire knob, it is contemplated that the release wire wraps around the rotating shaft to thereby cause the release wire to retract.
• The[0075]hypotube115 is coaxially disposed over theinner shaft61 and extends distally from thecentral bore119 in thedistal handle body112. The proximal end of the hypotube is secured to theinner shaft61 approximately one centimeter proximal from the distal end of the distal handle body by means of apolyethylene sealing tube116 which is heat shrunk over the proximal end of the hypotube. An adhesive may be used to fix the distal handle body to the hypotube.
• [0076]Hypotube115 consists of a rigid thin wall tube formed of a suitable material such as stainless steel. The hypotube has a length of about 55 centimeters and has an outside diameter of 0.095 inches (2.41 mm) and an inside diameter of 0.087 inches (2.21 mm). When acrimped graft55 is used, the hypotube may have marker bands (not shown) at predetermined positions distal of thecontrol handle body112. The marker bands facilitate the correct positioning of the inferior end of the graft.
• Referring to FIG. 16, the[0077]control wire91 resides in aninner shaft lumen65 and extends from thesuperior capsule assembly90 to anaperture117 located in the lumen just proximal of the proximal end of thehypotube115. The control wire preferably consists of an elongate solid flexible stainless steel wire having a lubricating coating, such as fluorinated ethylene-propylene (FEP). The coated control wire is about 0.02 inches (0.508 mm) in diameter, providing sufficient strength to move the inferior capsule assembly without buckling or kinking.
• The proximal end of the[0078]control wire91 is disposed within aretaining rack120, approximately six centimeters long and having a central bore to secure the control wire. The proximal end of theretaining rack120 is slidably disposed within alongitudinal guiding slot121 in theproximal handle111. Similarly, the distal end of theretaining rack120 is slidably disposed within anlongitudinal slot122 in thedistal handle body112.
• The[0079]retaining rack120 is configured withteeth123 along a longitudinal edge which engage a pinion orgear124. The pinion is attached to a lower end of therotating shaft114. The upper end of the rotating shaft is secured within thecontrol knob113 such that rotation of the control knob rotates the gear and in turn moves the retaining rack longitudinally within the guiding slots. Longitudinal movement of the retaining rack causes longitudinal movement of the proximal end of thecontrol wire91, causing like longitudinal movement of thedistal end95 of the control wire and of thesuperior capsule93. As shown in FIGS. 17 and 19, a lockingscrew118 is configured to fix the retaining rack in place. The locking screw ensures that the control wire and superior capsule will not move even if torque is applied to the control knob.
• At the base of the[0080]control knob113 is alocking gear125 which has curved teeth. The curved teeth engage alocking pin126 biased by alocking spring127 disposed within arecess128 in the upper surface of theproximal body111 of thecontrol handle110. The configuration of the curved teeth allows the control knob to turn in only one direction while the locking pin engages the locking gear. When the locking pin is moved to compress the locking spring, then the control knob may be turned in either direction. The locking gear is preferably molded as part of a plastic control knob, but may be a separate mechanism secured to the base of the control knob.
• As shown in FIGS. 1 and 7, the[0081]inferior capsule catheter52 consists of aninferior capsule assembly130 secured to the distal end of a flexible elongateouter shaft131 formed of a suitable plastic material such as polyether block amide available under the trademark “PEBAX”, available from Atochem Polymers, Glen Rock, N.J. Theouter shaft member131 is of a suitable length as, for example, 40 to 100 centimeters and preferably approximately 85 centimeters for the thoracic aortic artery. The outer shaft has a preferred outside diameter of 0.187 inches (4.75 mm) and an inside diameter of 0.125 inches (3.175 mm). The outer shaft can be produced in a certain color such as blue. To render the outer shaft radiopaque under x-rays, its material of construction may contain a radiopaque material, such as twenty percent by weight of bismuth subcarbonate or barium sulfate. The outer shaft may have markings or bands distal of thewye adapter145 at predetermined positions to indicate capsule jacket retraction and locking points.
• The[0082]inferior capsule assembly130 has aninferior capsule132 mounted on the distal extremity of theouter shaft member131. The inferior capsule has a preferred diameter ranging from 4 to 9 millimeters, which may be configured to accommodate different size grafts. The length of theinferior capsule132 is approximately 0.709 inches (18 mm). The inferior capsule is configured to match the size of thesuperior capsule assembly90. The inferior capsule is preferably made of stainless steel or similar impermeable and rigid, or semi-flexible material. The outer shaft member also serves as a shaft for advancing the inferior capsule, as hereinafter described. Thus, the outer shaft member should have a diameter which is less than that of the inferior capsule.
• Referring to FIG. 12, the[0083]inferior capsule132 is secured to the distal extremity of theouter shaft member131 by means of acapsule adapter assembly133. The capsule adapter assembly comprises ahousing134 and aninner sleeve135, which may be constructed from polycarbonate. The capsule adapter housingdistal extremity136 is secured in the proximal extremity of the capsule, for example, by crimping, by using a press fit swaging or an adhesive such as a cyanoacrylate ester. The capsule adapter housing distal extremity may be angled to facilitate securing the housing to the inferior capsule.
• The proximal extremity of the[0084]capsule adapter housing134 is secured to the distal extremity of theouter shaft member131 by means of an cyanoacrylate ester adhesive, or other suitable means. To facilitate a mechanical lock, the outer shaft distal extremity is molded to form aflange137, wherein the capsule adapter housing is configured so as to close around the flange. The capsule adapter housing is further provided with a recess for receiving the capsule adapterinner sleeve135. The inner sleeve is provided with a bore of a suitable diameter so as to allow theinner shaft61 to reside therein.
• A wye adapter[0085]145 (see FIG. 7) is secured to the proximal extremity of theouter shaft member131 of theinferior capsule catheter52. Thecentral arm146 of the wye adapter is connected to aTouhy Borst adapter147 which tightens around the guidingmember115 disposed in the central arm of the wye adapter. Theside arm148 of the wye adapter has astop cock149 mounted therein which is movable between open and closed positions. The stop cock is provided with a Luer fitting150 which is configured to accept a syringe for injecting a radiopaque contrast. Air may be purged from thecapsule jacket assembly53 by injecting fluid through the Luer fitting. The injection fluid will exit purgeports151 and152, thereby filling the capsule jacket assembly with injection fluid. The Luer fitting may be attached to a saline drip line during the operative procedure.
• Referring to FIGS. 1, 8 and[0086]12, thecapsule jacket assembly53 is slidably disposed coaxially over theinferior capsule catheter52 and theinner catheter assembly51. The capsule jacket assembly is comprised of amain jacket160, and a lockingconnector162. The main jacket diameter changes at a point approximately 15 centimeters from thedistal end163, depending on the length of thegraft55. The main jacket flares to an expanded diameter to cover thegraft55, theinferior capsule132 and thesuperior capsule93. The proximal ends of the jacket may be secured to thejacket adapter164 of the locking connector by mechanical means and by adhesive.
• When the[0087]capsule jacket assembly53 is in its most distal position, thedistal end163 of the capsule jacket extends to cover at least a portion of thesuperior capsule assembly90. Similarly, the capsulejacket locking connector162 is thereby positioned proximal to the inferior capsulecatheter purge port151. Prior to insertion into the lumen, locking ring165 (not shown) is turned to hold the capsule jacket assembly firmly in place, thereby maintaining a smooth transition surface along the length of thedelivery catheter50 which resides in the body vessels. When the locking ring is released, the capsule jacket assembly may be moved to a furthermost proximal position, wherein at least a portion of theinferior capsule assembly130 is exposed. Thus, the locking connector is positioned just distal to the capsulecatheter wye adapter145. The locking ring may be tightened at any intermediate position to firmly secure the capsule jacket assembly at the desired location. In addition, aradiopaque marker166 is provided at the distal end of the main jacket to facilitate proper linear positioning of the capsule jacket.
• As shown in FIGS. 1 and 9, the present invention includes an expandable intraluminal[0088]vascular graft55 for implanting in a body vessel. Referring to FIG. 21, the graft consists of a deformabletubular member170 which is provided withsuperior end171,inferior end172 and a cylindrical or continuous wall extending between the superior andinferior ends171,172 of thegraft55. A midsection of the tubular member of thegraft55 is crimped to resist kinking. Although a standard size crimp may be used, it is preferred to make the crimps radially deeper and less numerous than produced from standard crimping techniques. Having a sparsely crimped profile also reduces the elongation properties of thegraft55. Moreover, a sparsely crimpedgraft55 is easier to pack into the capsule jacket than a standard crimped graft. The low bulk and low elongation of the crimped graft further allows that thegraft55 may be packed into a smaller diameter capsule jacket. Additionally, the low crimp elongation factor allows for a higher degree of placement accuracy.
• The crimps of the[0089]thoracic graft55 may have a configuration approximating a square wave wherein the raised portion has an approximate width of 1.5 millimeters and the valley has an approximate width of 0.7 millimeters. The resulting crimp pitch is then preferably 2.2 millimeters. Further, the crimpedgraft55 of the present invention is configured with crimps having raised portions that are preferably approximately 1.2 millimeters deep. So configured, thegraft55 will maintain its high flexibility even under arterial pressures of over one hundred mm Hg within the corporeal lumen and the crimps will function to resist kinking. Also, by being so configured, radiopaque markers may be sewn within the selected valleys.
• The tubular member may have a length in the range of 7 to 15 centimeters. The tubular member may have a diameter of 30 to 40 mm. The continuous wall can be woven of any surgical implantable material such as polyethylene terephthalate (PET or polyester), but can be made of other materials such as PTFE. It is contemplated that the wall thickness be approximately 0.005 to 0.009 inches (0.127 to 0.229 mm), thinner than most conventional woven grafts. In order to prevent unraveling of the woven material at the ends, the ends can be melted with heat to provide a small melted bead of material on each end.[0090]
• As shown in FIG. 21, a segment of[0091]polyester yarn199 or similar material is used to produce a thrombogenic surface to improve blood clotting along the inferior and superior ends of the maintubular member170. The filaments of the yarn segment are teased apart to increase the embolization area. The yarn segment is sutured to thewall173 of the graft between one or more of thevees177 of the superior andinferior attachment systems175,176. Other modifications may be made as to the location of the fuzzy yarns to produce a similar result. Likewise, the graft may be made of velour or terry to similarly occlude blood flow around the outside of the ends of the graft adjacent the attachment system and to enhance adhesion of the graft to the aorta.
• Referring to FIG. 21, an[0092]expandable attachment system175 is secured adjacent thesuperior end171 of thetubular member170. Similarly, anexpandable attachment system176 is secured adjacent the tubular member'sinferior end172. Each attachment system serves to yieldably urge the tubular member from a first compressed or collapsed position to a second expanded position and provides a fluid tight seal between thegraft55 and the corporeal lumen wall. Each attachment system is formed of a plurality ofvees177 with theouter apices178 andinner apices179 of the vees being formed with helical torsion springs180 to yieldably urge the long legs and short legs of each of the vees outwardly at a direction approximately at right angles to the plane in which each of the vees lie.
• As shown in more detail in FIGS. 23 and 24, the superior and[0093]inferior attachment systems175,176 are comprised of a single piece of wire which is formed to provide thevees177 and also to define the helical torsion springs180 between thelegs181 and182. The two ends of the single piece of wire can be welded together in one of the legs to provide a continuous spring-like attachment system and is approximately 30 mm long. In the construction shown in FIGS. 23 and 24, it can be seen that the attachment systems have apices lying in four longitudinally spaced-apart parallel planes which are spaced with respect to the longitudinal axis of thetubular member170. The apices lying in each plane are staggered to provide for the minimum profile when the attachment systems are placed in its collapsed condition.
• The superior and[0094]inferior attachment systems175 and176 are secured to the superior andinferior ends171 and172, respectively, of thetubular member170 by suitable means such as apolyester suture material190. In an alternate embodiment, however, it is further contemplated that the center section of the graft be supported by one or more self-expanding attachment systems stacked end to end. (See FIG. 25). As shown in FIG. 21, the suture material is used for sewing the attachment systems onto thewall173 of the tubular member. The suture material runs along each of the legs or struts181 and182 and throughapices178 and179 to firmly secure each leg to the graft and to keep outer edge of thegraft55 from sliding medially along the attachment system. Theinferior attachment system176 may be attached to theinferior end172 of thegraft55 in a similar manner. The furthest extending apices protrude approximately 9 mm beyond the ends of the graft and it is contemplated that the portion of the attachment system affixed to the graft extend approximately 25 mm from the ends of the graft toward its center. In a presently preferred embodiment, theattachment systems175,176 may be attached to thegraft55 so that the bottom of theinner apices179 are positioned adjacent theends171,172 of thegraft55. By so positioning theattachment systems175,176, the fluid tight seal between thegraft55 and vessel wall may be enhanced.
• As shown in FIGS.[0095]22-24,wall engaging members195 are preferably secured to near the center of thelegs181,182 by suitable means such as welding. The wall engaging members are secured near the center of thelegs181,182 because the least amount of stress exists at the center of thelegs181,182. Consequently, the fatigue life of the weld or other securing means is optimized. The wall engaging members are configured to extend beyond theapices178,179 approximately 2 mm and have a diameter ranging from 0.015 to 0.025 inches and a length from 2 to 5 millimeters. The wall engaging members are preferably sharpened to provide conical tips, and should have a length which is sufficient for the tip to penetrate into and perhaps through the corporeal lumen wall. There may be eightwall engaging members195 per attachment system, one extending beyond each inner andouter apex178,179, or there may be fourwall engaging members195 per attachment system, wherein a wall engaging member extends beyond eachouter apex178. It is also contemplated that the hook portion of the wall engaging members, instead of being straight, be curved radially outward to facilitate insertion into the wall of the lumen being repaired (See FIG. 26). Further, the wall engaging members may be affixed to a strut so that the hook portion is substantially perpendicular to the plane in which the apex resides (FIGS. 23 & 24) or the hook may be routed over the apex, having its end curved radially outward so as to keep a low radial profile (FIGS. 27 & 28).
• The superior and[0096]inferior attachment systems175,176 and thewall engaging members195 secured thereto are formed of a corrosion resistant material which has good spring and fatigue characteristics. One such material found to be particularly satisfactory is “ELGILOY” which is a cobalt-chromium-nickel alloy manufactured and sold by Elgiloy of Elgin, Ill. The wire can have a diameter ranging from 0.016 to 0.020 inches. For example, 0.020 inch diameter wire for the frame and wall engaging members may be used in the larger grafts of 36 to 40 millimeters diameter.
• It has been found that the spring force created by the helical torsion springs[0097]180 at theapices178 and179 is largely determined by the diameter of the wire. The greater the diameter of the wire, the greater the spring force applied to thelegs181 and182 of the vees. Also, the longer the distances are between the apices, the smaller the spring force that is applied to the legs. It therefore has been desirable to provide a spacing between the outer extremities of the legs of approximately thirty millimeters, although smaller or larger distances may be utilized.
• To facilitate securing the[0098]graft55 in the corporeal lumen, thewall engaging members195 of thesuperior attachment system175 andinferior attachment system176 may be angled with respect to the longitudinal axis of thetubular member170. The wall engaging members face outwardly from the tubular member to facilitate holding the graft in place (See FIGS.21-24). Preferably, the wall engaging members on the superior attachment means are inclined from the longitudinal axis and toward the inferior end of thegraft172 by 60° to 80° from radial. Likewise, the wall engaging members of the inferior attachment system may be inclined towards the superior end of thegraft175 by 60° to 80° from radial. By angling the wall engaging members so that they resist the force of the blood flow, the implanted wall engaging members oppose migration of the graft.
• The helical torsion springs[0099]180 placed at theapices178 and179 serve to facilitate compression of thegraft55 to place the superior andinferior attachment systems175 and176 within thecapsule assemblies90 and130, as hereinafter described. The compression of the graft may be accomplished by deformation of the helical torsion springs to just beyond their elastic limit, thereby having a small component within the plastic range. Placing the apices in different planes and staggering or offsetting thewall engaging members195 and196 significantly reduces the minimum compressed size of the attachment systems. Having the apices in different planes also helps to prevent the wall engaging members from becoming entangled with each other or with the apices. The natural spring forces of the helical torsion springs serves to expand the graft to its expanded position as soon as the attachment system is released. Significantly, the spring forces of the attachment system of thegraft55 are such that the graft is securely attached within the lumen without the aid of a balloon catheter.
• The[0100]graft55 includesreleasable ties205,207 attached to its exterior near the superior andinferior ends171,172 of thegraft55 respectively. Thereleasable ties205,207 cooperate with therelease wire57 of thedelivery catheter50 to load theattachment systems175,176 of thegraft55 within the inferior andsuperior capsules assemblies90,130 and to subsequently emplace thegraft55 within a corporeal lumen. As shown in FIG. 22, eachreleasable tie205,207 consists of a single thread that is attached at its midsection to thegraft55 so that a majority of theties205,207 reside exterior to thegraft55 and configured into two loops. The loops are wrapped around thegraft55 and are placed into engagement with therelease wire57 by threading the release wire through each of the loops respectively. In the alternative, theties205,207 can be looped around therelease wire57. Thereafter, the ends of theties205,207 are pulled tight to collapse theattachment systems175,176 and are then stitched to thegraft55 and knotted.
• It is to be noted that the[0101]ties205,207 can be threaded through the portions of the sutures which reside on the exterior of the graft and which secure the attachment systems to thegraft55. By doing so, when therelease wire57 is removed from engagement with theties205,207, they are conveniently restrained from interfering with the expansion of the attachment systems. Further, due to the relative small size of the loops formed in theties205,207, upon expansion of the attachment systems, they are removed from contacting the attachment systems. Moreover, by so configuring theties205,207, they are kept out of the way of blood flow and are, therefore, made unavailable for occluding the vessel or causing the formation of unwanted blood clots. Theties205,207 may be made from braided polyester or nylon suture or any other material having similar properties.
• In order to engage the[0102]releasable ties205,207, therelease wire57 is configured to pass through the walls of thegraft55. Since thegraft55 is contemplated to be woven, it comprises warp and weft yarns which are separated to allow passage of therelease wire57 through the walls of thegraft55. Asuperior passageway209 is provided by separating warp and weft yarns located near thesuperior end171 of thegraft55. Similarly, aninferior passageway211 is provided by separating warp and weft yarns located near theinferior end172 of thegraft55. In a presently preferred embodiment, each of thepassageways209,211 consist of two sets of closely spaced-apart warp and weft yarns which are individually separated to allow passage of therelease wire57 through the walls of thegraft55, wherein one of the two sets of warp and weft yarns serves as an exit and the other as an entrance. In an alternate embodiment, each of thepassageways209,211 consist of one set of warp and weft yarns that is separated to thereby provide both an exit and entrance for therelease wire57 through the graft walls.
• In other embodiments, the[0103]releasable ties205,207 maybe passed through thegraft55 in order to be placed into engagement with therelease wire57. Further, thereleasable ties205,207 may be configured so that eyes which are adapted to receive the release wire are knotted into each end of the ties. Additionally, it is also contemplated that, rather than passing therelease wire57 through each loop of eachreleasable tie205,207, therelease wire57 may be passed through only one loop of each releasable tie and the other loop of each releasable tie is placed around the first loop of the releasable tie receiving the release wire in order to provide a cooperating system for compressing theattachment systems175,176.
• The[0104]graft55 preferably contains radiopaque markers means for locating thegraft55 and for detecting any twisting of thegraft55 during deployment. The radiopaque marker means takes the formradiopaque markers197 affixed along the crimped midsection of the graft and within the valleys comprising the crimped portion. The radiopaque markers are made of a suitable material such as a platinum tungsten alloy wire of a suitable diameter such as 0.004 inches (0.102 mm) which is wound into a spring coil having a diameter of 0.4 inches (1.0 mm). The radiopaque markers are secured to thetubular member170 bysutures199, using the same material to secure the attachment systems to the graft.
• Referring also to FIG. 21, the[0105]radiopaque markers197 have a length of approximately 3 millimeters. By placing markers along the tubular member, it is possible to ascertain the position of thegraft55 and to determine whether thegraft55 has twisted between its superior andinferior ends171,172. Under fluoroscopy, the markers will be exhibited as a relatively straight lines for an untwisted graft, wherein a twisted graft will be revealed by a non-parallel pattern of markers. By placing the markers at equal increments apart, it is possible to use fluoroscopy to ascertain longitudinal compression or tension on the graft.
• The sizing of the[0106]graft55 may be performed on a patient-by-patient basis, or a series of sizes may be manufactured to adapt to most patient needs. For the repair of a thoracic aneurysm, the length of thegraft55 is selected so to span approximately one centimeter superior and one centimeter inferior of the aneurysm, wherein thewall engaging members195 and196 of the graft can seat within normal tissue of the vessel on both sides of the aneurysm. Thus, the graft should be about two centimeters longer than the aneurysm being repaired. During the pre-implant fluoroscopy procedure, a conventional pigtail angiography catheter is used to determine the locations of proximal arteries to ensure they will not be covered by the implanted graft. Similarly, the diameter of thetubular member170 is selected by measuring the corporeal lumen which will receive the graft by conventional radiographic techniques and then selecting a tubular member having a diameter one millimeter larger than that measured. For specific applications, one ormore pleats198 may be sewn into the walls of the grafts so as to provide a more suitable emplacement within a lumen having a narrow portion (See FIGS.29-32). Thesuture material190 used for affixing the attachment systems to the graft may be used for providing the graft with pleats.
• FIG. 12 depicts the distal end of the[0107]delivery catheter50 assembled for deployment. Thegraft55 is disposed within thecapsule jacket assembly53. Thesuperior attachment system175 is removably retained within thesuperior capsule93. Likewise,inferior attachment system176 is removably retained within theproximal capsule132. Thesuperior cap92,nose cone94 andsuperior capsule93 are in the retracted or proximal position adjacent to the conical-shapedknob100. Similarly,control wire91 is locked (not shown) viacontrol knob113 in its retracted or proximal position. During initial deployment, theouter shaft member131 is in its most distal position in relation toinner catheter assembly51 and is locked in place by the locking ring on the Touhy Borst adapter147 (not shown).
• During initial deployment, the conical-shaped[0108]knob100 is positioned just proximal to thesuperior cap92 and is disposed within thesuperior capsule93. Moreover, as depicted in FIG. 12, thereleasable ties205,207 are wrapped around thegraft55 and are placed into engagement with therelease wire57 to thereby place the inferior andsuperior attachment systems176,175 in a collapsed configuration.
• Further, the[0109]release wire57 is configured so that it is disposed within therelease wire lumen64 of theinner shaft61. Therelease wire57 first exits theinner shaft61 through the inferiorrelease wire notch102 and then passes through theinferior passageway211 of thegraft55 and through the loops of the inferior releasable tie207 (see FIGS. 33 and 34). From there, therelease wire57 passes back through theinferior passageway211 and inferiorrelease wire notch102 of theinner shaft61 and back into therelease wire lumen64. Therelease wire57 then passes through therelease wire lumen64 until it reaches the secondrelease wire notch104 formed in theinner shaft61. Therelease wire57 passes through thesecond notch104 and through thesuperior passageway209 of thegraft55 and through the loops formed in the superiorreleasable tie205. Finally, therelease wire57 reenters theinner shaft61 by again passing through thesuperior passageway209 and the secondrelease wire notch104 and advances distally within therelease wire lumen64. By so configuring therelease wire57, theattachment systems175,176 are locked to theinner shaft61 both radially and axially.
• In another embodiment of the[0110]delivery catheter50, it is contemplated to include a second release wire217 (see FIG. 35). In this embodiment, each release wire is configured to cooperate with one of thereleasable ties205,207. For instance, thefirst release wire57 may be configured to cooperate with thereleasable tie207 attached to theinferior end172 of the graft and thesecond release wire217 may be configured to cooperate with thereleasable tie205 attached to thesuperior end171 of thegraft55. Also, in the two release wire system, thefirst release wire57 is configured to pass through theinferior notch102 and thesecond release wire217 is configured to pass through the superior orsecond notch104. Further, the two release wires may share therelease wire lumen64 or a second release wire lumen may be formed in the inner shaft69.
• Referring again to FIG. 12, it shows the attachment of the[0111]anti-elongation wire59 to theinner shaft61. In one presently preferred embodiment, theanti-elongation wire59 is advanced through theanti-elongation wire lumen66 until it reaches a longitudinal position along theinner shaft61 near where thegraft55 is loaded in adelivery catheter50 assembled for deployment. At this longitudinal position, theanti-elongation wire59 exits theinner shaft61 through ananti-elongation wire notch213 and is affixed to theinner shaft61 by way of ananti-elongation band215. Formed into the exterior of theinner shaft61 and positioned on either side of theband215 may be low profile bumps (not shown) which facilitate retaining theband215 in place on theinner shaft61. Theanti-elongation wire59 is inserted through a gap or hole formed in theband215 and tied into a knot to thereby prevent proximal movement of the anti-elongation wire relative to theinner shaft61. Theanti-elongation wire59 is similarly affixed to theinner shaft61 at its proximal end in that it exits theinner shaft61, passes through another band flanked by low profile bumps (not shown) and is tied in a knot to prevent distal movement of the anti-elongation wire relative to theinner shaft61. In another presently preferred embodiment, theanti-elongation wire59 lies outside theinner shaft61 but is similarly attached to theinner shaft61 to prevent elongation thereof.
• Further, as shown in FIG. 12, the[0112]capsule jacket assembly53 is positioned such that the distal end of the capsule jacketmain jacket160 overlaps at least a portion of thedistal capsule93. During deployment, capsule jacket locking connector162 (not shown) secures the main jacket in place. Thus, when any movement or force is applied to thehandle assembly110, theentire apparatus50 moves as a single unit.
• By way of example, the following describes a method of repair of an aortic aneurysm using the method comprising the present invention for intraluminal placement of a graft in an aorta. First, a patient is prepared in a conventional manner by use of a[0113]guide wire56, a dilator and sheath (not shown) to open the iliac artery or abdominal aorta or vessel of the patient. The distal end of thedelivery catheter50 is then inserted into the sheath, which has previously been placed in the vessel. In the preferred embodiment of the present invention,inner shaft lumen63 is provided for receiving theguide wire56. However, the following procedure may also be used when the guiding member is constructed as part of theinner catheter assembly51.
• As shown in FIG. 36, the[0114]guide wire56 is introduced by the physician into the femoral artery and advanced to the desired location in theaorta200 and adjacent to the diseased or damaged portion of thevessel201. Theinner catheter assembly51, theinferior capsule catheter52, thecapsule jacket assembly53, the control wire assembly54 and the releasing system are all configured for deployment of the graft as shown in FIGS. 1 and 12. Thus, the assemblies are advanced by the physician as a single unit over the guide wire. The physician uses thehandle assembly110 and the proximal end of theinner shaft member70 to guide the distal end of the assemblies over the guide wire.
• Next, the locking[0115]connector162 of thecapsule jacket assembly53 is loosened to allow movement of the capsule jacket main jacket160 (See FIG. 1). It is to be noted that the capsule jacketmain jacket160 may be withdrawn prior or subsequent to advancing thegraft55 anddelivery catheter50 to the repair site. While using one hand to firmly grasp theinferior capsule catheter52 and hold it stationary, the physician grasps thejacket adapter164 with the other hand and gently pulls the jacket adapter proximally towards the capsulecatheter wye adapter145, as shown in FIG. 37. Thecapsule jacket assembly53 is moved to fully exposegraft55 and the inferior andsuperior capsule assemblies90,130. At this time, the releasing system retains thegraft55 within the inferior andsuperior capsules assemblies90,130. Therelease wire57 functions to limit relative movement of the ends of thegraft55 and the capsules by engaging thereleasable ties205,207 wrapped around the graft55 (see FIG. 12). The lockingconnector162 is then tightened to hold thecapsule jacket assembly53 in place.
• The[0116]control knob113 is then rotated to cause relative movement between thesuperior capsule assembly90 and theinner catheter assembly51 to expose the superior attachment system175 (see FIGS. 1, 12 &38). Rotating thecontrol knob113 causes theretaining rack120 to move thecontrol wire91 in a distal direction. Since thesuperior cap92 andsuperior capsule93 are secured to thecontrol wire91, they move in corresponding relationship with the rotation of thecontrol knob113. As thesuperior capsule assembly90 is moved from engagement with thesuperior attachment system175, the conical-shaped knob is exposed, creating a smooth profile at the proximal end of the superior capsule to thereby facilitate removal of the superior end of the delivery catheter from within the implanted graft. At this point, theanti-elongation wire59 functions to prevent theinner shaft61 from stretching. As thecontrol knob113 is turned, thecontrol wire91 andsuperior capsule assembly90 advance within the vasculature of the patient. However, if theinner shaft61 is easily stretched and if the distal end of the catheter is bent relative to thesuperior capsule assembly90, the force advancing thecapsule assembly90 may stretch theinner shaft61 rather than slide thecapsule assembly90 distally on theinner shaft61. The anti-elongation wire prevents this.
• As shown in FIG. 39, with the[0117]handle assembly110 held firmly in place, theinferior capsule catheter52 is next moved proximally, which results in theinferior attachment system176 to be removed from the inferior capsule assembly130 (see also FIGS. 1 & 12). Once theinferior attachment system176 is free of theinferior capsule assembly130, therelease wire57 can be withdrawn from engagement with the superior andinferior ties205,207 to thereby allow theattachment systems175,176 to spring open and engage the walls of the lumen (see FIGS. 40, 41). Theties205,207 remain attached to the exterior of the graft and out of blood flow. The force with which theattachment systems175,176 spring open, in conjunction with the forces applied by the blood present in the aorta against the interior of thegraft55, operates to seat the attachment systems of thegraft55 within the aorta.
• Although the method of deployment described involved removing each attachment system from the capsules prior to withdrawing the[0118]release wire57, it is to be understood that, for example, thesuperior attachment system175 can be removed from thesuperior capsule assembly90 and therelease wire57 withdrawn to allow thesuperior attachment system175 to engage the walls of the lumen prior to doing the same with theinferior attachment system176 so that theinferior attachment system176 engages the lumen. Further, it is important to avoid placing thegraft55 in excessive longitudial tension, as such a condition may cause thegraft55 to close should it be deployed in a curved position of a lumen. To avoid placing thegraft55 in such a condition, the end of thegraft55 which is yet to be deployed can be moved toward the end of thegraft55 that has been deployed.
• When the[0119]graft55 is seated within the aorta, thewall engaging members195 of thesuperior attachment system175 point proximally and with the direction of blood flow, whereas thewall engaging members195 of theinferior attachment system176 point distally and against the direction of blood flow. By so orienting thewall engaging members195, thegraft55 is prevented from migrating downstream or upstream within the aorta. Thewall engaging members195 of thesuperior attachment system175 prevent thegraft55 from migrating downstream in response to forces applied to thegraft55 by the direction of blood flow. Similarly, thewall engaging members195 of theinferior attachment system176 prevent the graft from migrating upstream in response to forces applied by the blood within the aorta.
• A number of the steps of the previously described method for placing the[0120]graft55 within a vessel lumen may be reordered so that theinferior end172 of thegraft55 may be attached within the lumen prior to attaching thesuperior end171 of thegraft55 within the lumen. This alternate procedure may be preferred when repairing a thoracic aortic aneurysm because of the high blood flow and flow rate in the thoracic region of the aorta. By attaching the inferior end of the graft first, the drag on the partially implanted graft may be minimized, thereby avoiding the potential problem of thegraft55 being forced from engagement with the vessel lumen.
• In order to attach the[0121]inferior end172 of thegraft55 within the lumen prior to attaching thesuperior end171 within the lumen, the two release wire system (see FIG. 35) may be employed. By withdrawing thefirst release wire57 prior to withdrawing thesecond release wire217, theinferior attachment system176 can be permitted to engage the walls of the lumen before thesuperior attachment system175 does so, to thereby attach theinferior end172 of thegraft55 within the lumen before thesuperior end171 is attached within the lumen. Thesecond release wire217 can then be withdrawn to attach thesuperior end171 of thegraft55 within the lumen. This dual release wire system can also be used to attach thesuperior end172 of thegraft55 within the lumen first.
• As a final step in any of the methods employed, the delivery catheter is removed from the patient (not shown). The[0122]superior capsule assembly90 and distal end of theinner shaft61 are moved proximal relative to thegraft55 by first loosening the locking ring147 (See FIG. 1). Then, while holding theinferior capsule catheter52 in place by grasping thewye adapter145 with one hand, theinner catheter assembly51 is moved proximally by gently pulling thehandle assembly110 with the other hand. The proximal end of thesuperior capsule93 may be mated with the inferior capsule for smooth transition.
• Finally, the capsule[0123]jacket locking connector162 is loosened. While holding thecapsule jacket adapter164 in place, the inner catheter assembly andinferior capsule catheter51 and52 are moved proximally and in unison by gently pulling thewye145 of the inferior capsule catheter. The catheters are moved until the distal end of themain jacket163 covers thesuperior capsule93 or until the inferiorcapsule adapter housing134 mates with the flared transition of the capsule jacket, thereby creating a smooth transition along the entire length of thedelivery catheter50. Thereafter, theinner catheter assembly57,inferior capsule catheter52,capsule jacket assembly53 and control wire assembly54 are removed from the aorta through the incision. Thegraft55 andattachment systems175 and176 remain secured to the vessel wall202, thereby sealing theaneurysm201 from blood flow.
• The entire procedure described herein can be observed under fluoroscopy. The relative positioning of the[0124]graft55 and thedelivery catheter50 can be readily ascertained by theradiopaque attachment systems175 and176,radiopaque markers197 provided on the graft, and theradiopaque marker87 on the inner shaft61 (See FIG. 5). If any twisting of the graft has occurred between placement of the superior attachment system and the inferior attachment system, then the twisting can be readily ascertained by observing the series ofmarkers197. Adjustments to eliminate any twisting which may have occurred can be made before exposing the graft'ssecond extremity172 by rotation of thecatheter52. Any excessive graft tension or compression can be ascertained by observing theradiopaque markers197 under fluoroscopy. Adjustments to graft tension can be made before exposing the second extremity of the graft by applying tension on thecapsule catheter assembly52.
• Post implant fluoroscopy procedures can be utilized to confirm the proper implantation of the device by the use of a conventional angiographic pigtail catheter or by injecting radiopaque contrast into the guide wire lumen of the balloon catheter shaft. Thereafter the jacket can be removed from the patient and the incisions closed with conventional suturing techniques. Tissues should begin to grow into the graft within two to four weeks. This establishes a complete repair of the aneurysm which had occurred.[0125]
• While several particular forms of the invention have been illustrated and described, it will be apparent that various modifications can be made without departing from the spirit and scope of the invention. For example, references to materials of construction and specific dimensions are also not intended to be limiting in any manner and other materials and dimensions could be substituted and remain within the spirit and scope of the invention. Accordingly, it is not intended that the invention be limited, except as by the appended claims.[0126]

Claims (21)

What is claimed is:

1. A system for repairing a lumen, said system comprising:

a graft having a tubular body, a superior end and an inferior end;

a superior attachment system secured to said superior end of said graft and an inferior attachment system secured to said inferior end of said graft, said superior and inferior attachment systems having a first configuration and a second configuration, said first configuration compressed from said second configuration; and

a delivery catheter for placing said graft within the lumen, said delivery catheter having a releasing system, said releasing system including a superior tie to retain said superior attachment system in said first configuration and an inferior tie to retain said inferior attachment system in said first configuration.

2. The system ofclaim 1, wherein said releasing system further includes at least one release wire cooperating with said superior and inferior ties to retain said superior and inferior attachment systems in said first configuration and to place said superior and inferior attachment systems in said second configuration.

3. The system ofclaim 2, wherein said delivery catheter includes an anti-elongation wire.

4. The system ofclaim 3, wherein said delivery catheter includes an inner catheter, an inferior capsule catheter, an inferior capsule assembly attached to said inferior capsule catheter, and a superior capsule assembly, said inner catheter disposed within said inferior capsule assembly, said superior capsule assembly and said inferior capsule catheter;

said inferior capsule catheter, said superior capsule assembly and said inner catheter assembly each adapted to move relative to each other; and

said superior capsule assembly adapted to contain said superior attachment system and said inferior capsule assembly adapted to contain said inferior attachment system.

5. The system ofclaim 4, wherein said delivery catheter further includes a capsule jacket assembly, said capsule jacket assembly adapted to overlay and move relative to said inferior capsule catheter, said superior capsule assembly and said inner catheter.

6. The system ofclaim 4, wherein said inner catheter includes a control wire lumen adapted to slidably receive a control wire, said control wire having a distal end secured to said superior capsule assembly.

7. The system ofclaim 4, wherein said superior capsule assembly includes a flexible and tapered nose cone.

8. The system ofclaim 4, wherein said inner catheter includes an anti-elongation lumen adapted to receive said anti-elongation wire and at least one notch in communication with said anti-elongation lumen, said anti-elongation wire adapted to exit said anti-elongation lumen through said notch and to be affixed to an exterior of said inner catheter.

9. The system ofclaim 4, wherein said inner catheter includes a release wire lumen adapted to receive said release wire and at least one notch in communication with said release wire lumen, said release wire exiting said release wire lumen through said at least one notch to engage said tie and to reenter said release wire lumen through said notch.

10. The system ofclaim 9, wherein said inner catheter includes a conical-shaped knob cooperating with said superior capsule assembly for retracting said superior capsule assembly through said graft.

11. The system ofclaim 4, wherein said inner catheter includes a release wire lumen, said release wire slidably disposed in said release wire lumen, an inferior notch and a superior notch each in communication with said release wire lumen, said release wire exiting said inferior notch, engaging said inferior tie and reentering said inferior notch, said release wire further exiting said superior notch, engaging said superior tie and reentering said superior notch.

12. The system ofclaim 11, wherein said superior and inferior ties each include a single suture, each said suture secured at a midpoint to said graft, formed into two loops through which said release wire is threaded and affixed at their ends to said graft.

13. The system ofclaim 12, wherein each said suture is secured to said graft so that each said suture resides exterior said graft.

14. The system ofclaim 13, wherein said release wire passes through a wall of said graft near said inferior end of said graft to engage said inferior tie and passes through said wall of said graft near said superior end of said graft to engage said superior tie.

15. The system ofclaim 13, wherein each said suture is passed through a wall of said graft to engage said release wire.

16. A graft for intraluminal repair of a thoracic aortic aneurysm, comprising:

a hollow tubular body, a superior end and an inferior end, said hollow tubular body having a predetermined diameter, length and wall thickness adapted for intraluminal repair of a thoracic aortic aneurysm.

17. The graft ofclaim 16, wherein said predetermined diameter ranges from 30-40 mm.

18. The graft ofclaim 16, wherein said predetermined length ranges from 7-15 cm.

19. The graft ofclaim 16, wherein said predetermined wall thickness ranges from 0.127 to 0.229 mm.

20. A method for placing a graft within a lumen, which comprises the steps of:

providing a graft having an attachment system secured thereto, said attachment system having a first configuration and a second configuration, said first configuration compressed from said second configuration;

providing a delivery catheter for receiving said graft and for placing said graft within the lumen, said delivery catheter having a releasing system cooperating with said attachment system, said releasing system including a tie and a release wire;

placing said release wire into engagement with said tie;

causing said tie to place said attachment system in said first configuration;

loading said graft within said delivery catheter;

placing said delivery catheter within the lumen;

unloading said graft from said delivery catheter; and

removing said release wire from engagement with said tie to permit said attachment system to assume said second configuration and to engage the lumen.

21. A method for repairing a thoracic aortic aneurysm, which comprises the steps of:

providing a graft having an attachment system secured thereto, said attachment system having a first configuration and a second configuration, said first configuration compressed from said second configuration;

providing a delivery catheter for receiving said graft and for placing said graft within the thoracic aorta, said delivery catheter having a releasing system;

causing said releasing system to retain said attachment system in said first configuration;

loading said graft within said delivery catheter;

placing said delivery catheter within a patient's vasculature;

advancing said delivery catheter to the thoracic aorta;

unloading said graft from said delivery catheters; and

causing said releasing system to permit said attachment system to assume said second configuration and to engage said thoracic aorta.

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