Stent grafts and methods of use for treating aneurysms

Abstract

A stent graft includes a tubular aortic component that defines a lumen and a fenestration with a pocket at the fenestration. At least one proximal tunnel graft extends proximally within the lumen from the proximal opening of the pocket and is secured at a proximal end to the tubular component, and at least one distal tunnel graft extends distally within the lumen from the distal opening of the pocket and is secured at a distal end to the tubular aortic component. The stent graft can further include at least one branch stent graft, each of which extends through the fenestration and within at least one of the proximal tunnel graft or the distal tunnel graft. The stent graft can be implanted in a patient to thereby treat an aneurysm, such as a suprarenal or thoracoabdominal aortic aneurysm.

What is claimed is: 
     
         1 . A stent graft ( 10 ) comprising:
 a) a tubular aortic component ( 12 ) defining a lumen having a proximal end ( 14 ), a distal end ( 16 ), a major longitudinal axis ( 18 ), and defining a fenestration ( 20 ) between the proximal end ( 14 ) and the distal end ( 16 );   b) a pocket ( 38 ) at the fenestration, the pocket defining a pocket proximal opening ( 40 ) and a pocket distal opening ( 42 ) opposite the pocket proximal opening ( 40 ) within the lumen;   c) at least one proximal tunnel graft ( 44 ) having a proximal tunnel graft proximal end ( 46 ) and a proximal tunnel graft distal end ( 48 ), and defining at least one proximal tunnel graft lumen ( 50 ), the proximal tunnel graft extending proximally within the lumen from the proximal opening of the pocket, and being secured at its proximal end to the tubular aortic component ( 12 ); and   d) at least one distal tunnel graft ( 52 ) having a distal tunnel graft proximal end ( 54 ) and a distal tunnel graft distal end ( 56 ), and defining at least one distal tunnel graft lumen ( 58 ), the distal tunnel graft extending distally within the lumen from the distal opening of the pocket, and being secured at its distal end to the tubular aortic component ( 12 ).   
     
     
         2 . The stent graft of  claim 1 , wherein the distal end of the tubular aortic component ( 12 ) is bifurcated ( 82 ), thereby defining two legs of the stent graft. 
     
     
         3 . The stent graft of  claim 1 , wherein the fenestration ( 20 ) defines a fenestration proximal end ( 22 ) that lies in a plane orthogonal to the major longitudinal axis ( 18 ) of the tubular aortic component ( 12 ). 
     
     
         4 . The stent graft of  claim 1 , wherein the fenestration ( 20 ) defines a fenestration distal end ( 24 ) that lies in a plane orthogonal to the major longitudinal axis ( 18 ) of the tubular aortic component ( 12 ). 
     
     
         5 . The stent graft of  claim 1 , wherein the fenestration defines at least one of a fenestration proximal end ( 22 ) and a fenestration distal end ( 24 ) that lies in a plane orthogonal to the major longitudinal axis ( 18 ) of the tubular aortic component ( 12 ). 
     
     
         6 . The stent graft of  claim 5 , wherein at least one of the fenestration proximal end ( 22 ) and the fenestration distal end ( 24 ) of the fenestration ( 20 ) lying in the plane orthogonal to the major longitudinal axis has a length greater than that of at least one of: the total diameter of the distal end of the at least one proximal tunnel graft ( 44 ); and the total diameter of the proximal end of the at least one distal tunnel graft ( 52 ). 
     
     
         7 . The stent graft of  claim 1 , wherein the proximal end of the at least one proximal tunnel graft and the distal end of at least one of the at least one distal tunnel graft defines a flared opening. 
     
     
         8 . The stent graft of  claim 7 , further including at least one stent ( 67 ,  77 ) supporting the flared opening of at least one of the proximal tunnel graft proximal end ( 46 ) and at least one of the distal tunnel graft distal end ( 56 ). 
     
     
         9 . The stent graft of  claim 7 , wherein the proximal tunnel graft proximal end ( 66 ) defines a flared opening ( 67 ). 
     
     
         10 . The stent graft of  claim 7 , wherein the distal tunnel graft distal end ( 72 ) defines a flared opening. 
     
     
         11 . The stent graft of  claim 10 , further including at least one stent supporting the distal tunnel graft ( 70 ) and the proximal tunnel graft ( 64 ). 
     
     
         12 . The stent graft of  claim 8 , wherein both the distal tunnel graft distal end ( 72 ) and the proximal tunnel graft proximal end ( 66 ) define, respectively, a flared opening. 
     
     
         13 . The stent graft of  claim 1 , further including a bare stent ( 28 ) having proximal apices and distal apices, the bare stent ( 28 ) affixed to the proximal end ( 14 ) of the tubular aortic component ( 12 ) at the distal apices and wherein the proximal apices extend proximally beyond the proximal end ( 14 ) of the tubular aortic component ( 12 ). 
     
     
         14 . The stent graft of  claim 1 , further including at least two branch stent grafts, each branch stent graft extending through the fenestration ( 20 ) and within at least one of the proximal tunnel graft lumen and the distal tunnel graft lumen. 
     
     
         15 . The stent graft of  claim 14 , further including at least two branch stent grafts, wherein the at least two branch stent grafts each extend through the fenestration, and wherein at least one of the branch stent grafts extends through one of the proximal tunnel graft lumen and the distal tunnel graft lumen. 
     
     
         16 . The stent graft of  claim 1 , wherein at least one of the proximal tunnel graft and the distal tunnel graft includes a septum ( 106 ,  108 ) that partitions at least one of the proximal tunnel graft lumen and the distal tunnel graft lumen into two sublumens, each sublumen having a proximal end and a distal end. 
     
     
         17 . The stent graft of  claim 16 , including a plurality of septums, wherein one septum partitions the proximal tunnel graft lumen into two lumens and one septum partitions the distal tunnel graft lumen into two sublumens. 
     
     
         18 . The stent graft of  claim 16 , further including at least two branch stent grafts, each branch stent graft extending through the fenestration and within one of the two sublumens of the proximal tunnel graft. 
     
     
         19 . The stent graft of  claim 16 , further including at least two branch stent grafts, each extending through the fenestration and each, independently, extending within one of the sublumens of the distal tunnel graft. 
     
     
         20 . The stent graft of  claim 16 , wherein both of the proximal tunnel graft and the distal tunnel graft is supported by a stent graft. 
     
     
         21 . The stent graft of  claim 20 , wherein each septum partitions the proximal and distal tunnel graft lumens into two sublumens to a point proximal to the flared distal opening of the distal tunnel graft or distal to the flared proximal opening of the proximal tunnel graft lumen. 
     
     
         22 . The stent graft of  claim 20 , further including four branch stent grafts, all of which extend through the fenestration, and each of which extends independently within one of the sublumens. 
     
     
         23 . A method for treating a suprarenal or thoracoabdominal aortic aneurysm, comprising the steps of:
 a) delivering a stent graft through an aorta ( 83 ) to an aneurysm site ( 84 ) of a patient, the stent graft being radially and releasably constrained by a delivery device, the stent graft including:
 i) a tubular aortic component ( 12 ) having a proximal end, a distal end, and a major longitudinal axis, and defining a lumen, and defining a fenestration between the proximal end and the distal end; 
 ii) a pocket at the fenestration and within the lumen, the pocket defining a proximal opening and a distal opening opposite the proximal opening; 
 iii) at least one proximal tunnel graft defining a proximal tunnel graft proximal end and a proximal tunnel graft distal end, the proximal tunnel graft extending proximally within the lumen from the proximal opening of the pocket, and being secured at its proximal end to the tubular aortic component ( 12 ); and 
 iv) at least one distal tunnel graft having a distal tunnel graft proximal end and defining a distal tunnel graft distal end, the distal tunnel graft extending distally within the lumen from the distal opening of the pocket, and being secured at its distal end to the tubular aortic component ( 12 ). 
   b) aligning the fenestration at the aneurysm site ( 84 ) of the patient with at least one branch of the aorta at the aneurysm site;   c) releasing the stent graft from the delivery device;   d) delivering at least one branch stent graft through the distal end of the stent graft through the distal tunnel graft lumen to the fenestration, and through the fenestration to a branch of the aorta at the aneurysm site, whereby the branch stent graft is radially and releasably constrained by a first branch delivery device;   e) releasing the branch stent graft from the first branch delivery device;   f) retracting the first branch delivery device;   g) delivering at least one branch stent graft through the proximal end of the stent graft through the proximal tunnel graft lumen to the fenestration, and through the fenestration to a branch of the aorta at the aneurysm site, whereby the branch stent graft is radially and releasably constrained by a second branch delivery device;   h) releasing the branch stent graft from the second branch delivery device; and   i) retracting the second branch delivery device, thereby treating the suprarenal or thoracoabdominal aortic aneurysm.