Modular stent graft assembly and use thereof

Abstract

A modular stent graft assembly ( 10 ) for repairing a ruptured abdominal aorta aneurysm ( 90 ) and having an aortic section tubular graft ( 12 ) and an iliac section tubular graft ( 14 ). The aortic section graft has a proximal attachment stent ( 32 ) thereon for suprarenal attachment of the assembly ( 10 ) to the aorta. A proximal end portion ( 50 ) of the iliac section graft ( 14 ) underlies the distal end portion ( 28 ) of the aortic graft ( 12 ) and presses outwardly thereagainst forming a friction fit, at a telescoping region ( 64 ). The assembly ( 10 ) can be selected from an inventory ( 300 ) containing a set of delivery systems ( 100 ) of four size aortic section grafts ( 12 ) and a set of delivery systems ( 200 ) of four size iliac section grafts ( 14 ), that together accommodate a large majority of aneurysm sizes, and delivery systems ( 250 ) containing four standard sizes of occluders ( 80 ).

1 . A modular stent graft assembly comprising; 
 an aortic section including a first tubular graft having a proximal end portion and a distal end portion, said distal end portion having a first constant diameter for a first predetermined length, said proximal end portion having a second diameter greater than said first constant diameter and sized for engagement against an aortic artery, said aortic section also including a first plurality of stents attached along said first tubular graft, wherein said aortic section is selected from a set of aortic sections each having a proximal end portion with a second diameter different from the second diameter of any other proximal end portion of the aortic sections in the set and greater than said first constant diameter of the distal end portion of said aortic section; and    an iliac section including a second tubular graft including a distal end portion having a third diameter sized for engagement against an iliac artery, said second tubular graft also including a proximal end portion having a fourth constant diameter for a second predetermined length and approximating said first constant diameter of said distal end portion of said aortic section, said iliac section also including a second plurality of stents attached along said second tubular graft, wherein said iliac section is selected from a set of iliac sections each having a distal end portion with a third diameter different from the third diameter of any other distal end portion of the iliac sections in the set and at least equal to said fourth constant diameter of the proximal end portion of said iliac section, whereby when said aortic and iliac sections are positioned in an aortic artery and an iliac artery, respectively, said proximal end portion of said iliac section and said distal end portion of said aortic section overlap at least a minimum length and engage each other when positioned one within another for said at least minimum length;    wherein said first tubular graft has a tapered transition portion between said proximal end portion and said distal end portion and wherein said tapered transition portion has one or two stents from said first plurality of stents attached therealong.    
     
     
         2 . The modular stent graft assembly of  claim 1 , wherein the second diameter of the proximal end portion of the first tubular graft is in a range of 22 to 34 mm.  
     
     
         3 . The modular stent graft assembly of  claim 2 , wherein said first and said fourth constant diameter are approximately 12 mm.  
     
     
         4 . The modular stent graft assembly of  claim 1 , wherein the third diameter of the distal end portion of the second tubular graft is in a range of 12 to 24 mm.  
     
     
         5 . The modular stent graft assembly of  claim 1 , wherein said first predetermined length of said distal end portion of said first tubular graft is in a range of 60 to 70 mm.  
     
     
         6 . The modular stent graft assembly of  claim 1 , wherein said first tubular graft has a total length in a range of 108 to 127 mm.  
     
     
         7 . The modular stent graft assembly of  claim 6 , wherein said second tubular graft has a total length in a range of 94 to 110 mm.  
     
     
         8 . The modular stent graft assembly of  claim 1 , wherein said second tubular graft has a tapered transition portion between said distal end portion and said proximal end portion and wherein said tapered transition portion has one or two stents from said second plurality of stents attached therealong.  
     
     
         9 . The modular stent graft assembly of  claim 8 , wherein said second predetermined length is in a range of 56 to 73 mm.  
     
     
         10 . The modular stent graft assembly of  claim 1 , wherein said assembly further comprises a bypass graft for interconnecting the contralateral and ipsilateral iliac arteries.  
     
     
         11 . The modular stent graft assembly of  claim 1 , wherein said assembly further comprises an occluder.  
     
     
         12 . The modular stent graft assembly of  claim 11 , said occluder including a tubular graft and said occluder including at least one stent, said graft having a constant diameter in a range of 14 to 24 mm.  
     
     
         13 . The modular stent graft assembly of  claim 8 , wherein said assembly further comprises an occluder.  
     
     
         14 . The modular stent graft assembly of  claim 13 , said occluder including a tubular graft and said occluder including at least one stent, said graft having a constant diameter in a range of 14 to 24 mm.  
     
     
         15 . The modular stent graft assembly of  claim 1 , wherein said aortic section includes an attachment stent attached to a proximal end of said first tubular graft and extending proximally therefrom.  
     
     
         16 . The modular stent graft assembly of  claim 1 , wherein said first and said second pluralities of stents are attached to said first and said second tubular grafts, respectively, with first and second sets of predetermined spacings or gaps longitudinally therebetween, respectively.  
     
     
         17 . The modular stent graft assembly of  claim 1 , wherein said at least minimum length where said aortic and said iliac sections overlap includes at least two stents from each of said first and second pluralities of stents.  
     
     
         18 . A modular stent graft assembly comprising; 
 an aortic section including a first tubular graft having a proximal end portion and a distal end portion, said distal end portion having a first constant diameter for a first predetermined length, said proximal end portion having a second diameter greater than said first constant diameter and sized for engagement against an aortic artery, said aortic section also including a first plurality of stents attached along said first tubular graft, wherein said aortic section is selected from a set of aortic sections each having a proximal end portion with a second diameter different from the second diameter of any other proximal end portion of the aortic sections in the set and greater than said first constant diameter of the distal end portion of said aortic section; and    an iliac section including a second tubular graft including a distal end portion having a third diameter sized for engagement against an iliac artery, said second tubular graft also including a proximal end portion having a fourth constant diameter for a second predetermined length and approximating said first constant diameter of said distal end portion of said aortic section, said iliac section also including a second plurality of stents attached along said second tubular graft, wherein said iliac section is selected from a set of iliac sections each having a distal end portion with a third diameter different from the third diameter of any other distal end portion of the iliac sections in the set and at least equal to said fourth constant diameter of the proximal end portion of said iliac section, whereby when said aortic and iliac sections are positioned in an aortic artery and an iliac artery, respectively, said proximal end portion of said iliac section and said distal end portion of said aortic section overlap at least a minimum length and engage each other when positioned one within another for said at least minimum length;    said modular stent graft assembly being assembled from a kit of parts comprising:    a set of aortic sections each having a proximal end portion with a second diameter different from the second diameter of any other proximal end portion of the aortic sections in the set and greater than a first constant diameter of a distal end portion, each aortic section including a first tubular graft having a proximal end portion and a distal end portion, said distal end portion having a first constant diameter for a first predetermined length, said proximal end portion having a second diameter greater than said first constant diameter and sized for engagement within an aortic artery, said aortic section also having a first plurality of stents attached along said first tubular graft; and    a set of iliac sections each having a distal end portion with a third diameter different from the third diameter of any other distal end portion of the iliac sections in the set and at least equal to a fourth constant diameter of a proximal end portion, each iliac section including a second tubular graft including a distal end portion having a third diameter sized for engagement against an iliac artery, said second tubular graft also including a proximal end portion having a fourth constant diameter for a second predetermined length and approximating said first constant diameter of said distal end portion of said aortic section, said iliac section also having a second plurality of stents attached along said second tubular graft, whereby when said aortic and iliac sections are selected and positioned in an aortic artery and iliac artery, respectively, said proximal end portion of said iliac section and said distal end portion of said aortic section overlap at least a minimum length and engage each other when positioned one within another for said at least minimum length.    
     
     
         19 . A modular stent graft assembly according to  claim 18 , wherein the kit of parts also comprises an occluder for the other iliac artery whereby the flow of blood to both iliac arteries can be maintained by a bypass graft between the two iliac arteries.  
     
     
         20 . A kit of parts for a modular stent graft assembly for repairing a ruptured or symptomatic aneurysm in an aortic artery, said kit of parts comprising: 
 a set of aortic sections each having a proximal end portion with a second diameter different from the second diameter of any other proximal end portion of the aortic sections in the set and greater than a first constant diameter of a distal end portion, each aortic section including a first tubular graft having a proximal end portion and a distal end portion, said distal end portion having a first constant diameter for a first predetermined length, said proximal end portion having a second diameter greater than said first constant diameter and sized for engagement within an aortic artery, said aortic section also having a first plurality of stents attached along said first tubular graft; and    a set of iliac sections each having a distal end portion with a third diameter different from the third diameter of any other distal end portion of the iliac sections in the set and at least equal to a fourth constant diameter of a proximal end portion, each iliac section including a second tubular graft including a distal end portion having a third diameter sized for engagement against an iliac artery, said second tubular graft also including a proximal end portion having a fourth constant diameter for a second predetermined length and approximating said first constant diameter of said distal end portion of said aortic section, said iliac section also having a second plurality of stents attached along said second tubular graft, whereby when said aortic and iliac sections are selected and positioned in an aortic artery and iliac artery, respectively, said proximal end portion of said iliac section and said distal end portion of said aortic section overlap at least a minimum length and engage each other when positioned one within another for said at least minimum length.