Method for endovascular bypass stent graft delivery

Abstract

The invention provides a method of providing an endovascular bypass. The method includes the steps of inserting an elastic needle carrying a guidewire adjacent an ostium via a catheter and extending the needle through a branch vessel wall. The method continues by extending the needle through the extravascular space and inserting the needle through a main vessel wall to create an opening. The needle is retracted, leaving the guidewire in place. A bypass stent graft is inserted along the guidewire to provide a pathway between the branch vessel and the main vessel, and the inserted bypass stent graft is expanded. The branch vessel is occluded between the ostium of the bypass stent graft and the main vessel, and a main stent graft is inserted in the main vessel proximate the opening in the main vessel wall.

1 . A method of providing an endovascular bypass, the method comprising: 
 inserting an elastic needle adjacent an ostium via a catheter;    extending the needle through a branch vessel wall;    extending the needle through an extravascular space;    inserting the needle through a main vessel wall to create an opening;    delivering a guidewire via the needle;    retracting the needle, leaving the guidewire in place;    inserting a bypass stent graft along the guidewire through the extravascular space between the branch vessel and the main vessel;    expanding the inserted bypass stent graft;    occluding the branch vessel between the bypass stent graft and the main vessel; and    inserting a main vessel stent graft in the main vessel proximate the opening in the main vessel wall.    
   
   
       2 . The method of  claim 1  wherein the needle comprises a shape-memory material.  
   
   
       3 . The method of  claim 2  wherein the needle comprises nitinol.  
   
   
       4 . The method of  claim 1  wherein the main vessel is the aorta.  
   
   
       5 . The method of  claim 1  wherein the branch vessel is a renal artery.  
   
   
       6 . The method of  claim 1  wherein the graft comprises a material selected from the group consisting of polyester, ePTFE, silicone, polyurethane, and venous material.  
   
   
       7 . The method of  claim 1  wherein the needle comprises a radio-opaque material or coating.  
   
   
       8 . The method of  claim 1  wherein the step of expanding the inserted stent graft comprises: 
 expanding a balloon expansion device.    
   
   
       9 . The method of  claim 1  wherein the step of inserting a bypass stent graft comprises: 
 operating a cutting balloon to expand the extravascular space; and    removing the cutting balloon from the extravascular space prior to inserting the bypass stent graft into the extravascular space.    
   
   
       10 . The method of  claim 1  wherein the stent graft is configured with an oversized and flared end surface configured so that blood pressure pushes the flared end surface against an interior surface of the vessel.  
   
   
       11 . The method of  claim 1  wherein the stent graft is configured with at least one barbed surface configured so that the barbed surface maintains the stent graft in a position.  
   
   
       12 . The method of  claim 1  further comprising: 
 Attaching the bypass stent graft to the main and branch vessels with a magnetic anastomosis device.    
   
   
       13 . A system for treating an ostial aneurysm, the system comprising: 
 a catheter;    a retractable elastic needle carried within the catheter and covered with a sheath, wherein when the needle is positioned adjacent the ostium in a branch vessel, the needle deploys to a predetermined shape and punctures through a sidewall of the branch vessel and through a sidewall of the main vessel when the needle is extended, a guidewire is delivered via the needle, and the needle is retracted to allow placement of a bypass stent graft.    
   
   
       14 . The system of  claim 13  wherein the stent graft is configured with at least one barbed surface configured so that the barbed surface maintains the stent graft in a position.  
   
   
       15 . The system of  claim 13  wherein the stent graft is configured with an oversized and flared end surface configured so that blood pressure pushes the flared end surface against an interior surface of the vessel.  
   
   
       16 . The system of  claim 13  further comprising a balloon expansion device configured to expand in the extravascular space.  
   
   
       17 . The system of  claim 16  wherein the balloon expansion device comprises a cutting balloon.  
   
   
       18 . The system of  claim 13  wherein the needle comprises nitinol.  
   
   
       19 . The system of  claim 13  further comprising a magnetic anastomosis device configured to attach a bypass stent graft to a vessel.  
   
   
       20 . A system for treating a vascular condition, the system comprising: 
 a catheter;    a stent graft; and    an elastic needle releasably carrying a guidewire disposed within the needle.    
   
   
       21 . The system of  claim 20  wherein the needle comprises nitinol.  
   
   
       22 . The system of  claim 22  further comprising a balloon expansion device configured to expand in the extravascular space.  
   
   
       23 . The system of  claim 22  further comprising a magnetic anastomosis device.