Surgical bypass method

Abstract

An endovascular bypass graft includes a tubular member, a first expandable mesh stent attached to one end of the tubular member, and a second expandable mesh stent attached to an opposite end of the tubular member. The second stent is provided with a plurality of fenestrations. The graft is inserted into a principal blood vessel such as the aorta and positioned in the vessel so that the fenestrations are aligned with junctions with ancillary blood vessels. The graft is attached to the principal blood vessel so that the fenestrations remain aligned with the respective junctions, thereby allowing blood flow between the principal vessel and the auxiliary vessels through the respective junctions upon completion of the bypass operation.

1. A method for performing a bypass operation, comprising the steps of:
 providing a bypass graft comprising a tubular member having a sidewall provided with at least one fenestration including a plurality of fenestrations, the fenestrations each having a mid-longitudinal axis passing therethrough and a curved perimeter about the mid-longitudinal axis; 
 inserting said graft into a hollow organ an aorta of a patient; 
 positioning said graft in said organ so that the aorta to align at least a first and a second of said fenestration is aligned fenestrations with an internal organ junction junctions of the aorta with renal arteries of the patient, said first and second fenestrations each being aligned with one of the renal arteries, respectively; and 
 attaching said graft to said organ so that an upstream segment of the aorta to maintain the alignment of said fenestration remains aligned first and second fenestrations with said junction, thereby allowing communication the renal arteries and to allow blood flow between said hollow organ the aorta and an auxiliary organ the renal arteries through said junction said first and second fenestrations upon completion of said the bypass operation. 
 
     
     
       2. The method defined in  claim 1  wherein said graft further comprises a pair of expandable mesh stents attached to opposite ends of said tubular member, one of said stents being provided with said fenestration, said step of attaching including the step of securing said one of said stents to said hollow organ. 
     
     
       3. The method defined in  claim 2  wherein said hollow organ is an organ of the circulatory system and said auxiliary organ is a blood vessel. 
     
     
       4. The method defined in  claim 3  wherein said hollow organ is the aorta. 
     
     
       5. The method defined in  claim 4  wherein said step of inserting includes the steps of cutting the aorta longitudinally and laying open a wall of said aorta, said one of said stents being inserted into an upstream segment of said aorta. 
     
     
       6. The method defined in of claim  5  1, wherein said one of said stents is provided with a plurality of fenestrations, said step of positioning including further includes the step of aligning a third of said fenestrations with said renal arteries and said a junction of the aorta with a superior mesenteric artery of the patient, said attaching of said graft to the upstream segment of the aorta further including maintaining the alignment of said third fenestration with the junction of the aorta with the superior mesenteric artery to allow blood flow between the aorta and the superior mesenteric artery upon completion of the bypass operation. 
     
     
       7. The method defined in  claim 2  wherein said step of securing includes the steps of inserting a balloon into said one of said stents and inflating said balloon to expand said one of said stents. 
     
     
       8. The method of claim 6, wherein said graft has a mid-longitudinal axis, said third fenestration being on a line parallel to the mid-longitudinal axis of said graft and passing through said sidewall of said tubular member, said first and second fenestrations being spaced away from the line. 
     
     
       9. The method of claim 6, wherein said step of positioning said graft in the aorta further includes aligning a fourth of said fenestrations with a junction of the aorta with a celiac axis of the aorta of the patient. 
     
     
       10. The method of claim 9, wherein said graft has a mid-longitudinal axis, said third and fourth fenestrations being on a line parallel to the mid-longitudinal axis of said graft and passing through said sidewall of said tubular member. 
     
     
       11. The method of claim 9, wherein said graft has a mid-longitudinal axis and an axis transverse to the mid-longitudinal axis of said graft and passing through said first and second fenestrations, said third and fourth fenestrations being spaced away from the transverse axis. 
     
     
       12. The method of claim 9, wherein said graft has a mid-longitudinal axis, at least one of said fenestrations being elongated in a direction parallel to the mid-longitudinal axis of said graft. 
     
     
       13. The method of claim 1, wherein said graft has a first end including an opening and a bifurcated end opposite said first end, said bifurcated end including at least two openings, at least said first and second fenestrations being proximate said first end of said graft. 
     
     
       14. The method of claim 1, wherein said first and second fenestrations are positioned in said sidewall diametrically opposite to each other. 
     
     
       15. The method of claim 1, wherein at least one of said fenestrations is ring-shaped. 
     
     
       16. The method of claim 1, wherein each of said first and second fenestrations are configured to match the vascular junctions of the aorta with the renal arteries of the patient. 
     
     
       17. The method of claim 1, wherein said step of attaching includes attaching at least a portion of said graft to the upstream segment of the aorta upstream of the renal arteries. 
     
     
       18. A method for performing a bypass operation, comprising the steps of:
 providing a bypass graft comprising a tubular member having sidewall including a plurality of fenestrations, the fenestrations each having a mid-longitudinal axis passing therethrough and a curved perimeter about the mid-longitudinal axis;   inserting said graft into an aorta of a patient;   positioning said graft in the aorta to align a first of said fenestrations with a junction of the aorta with a renal artery, said first fenestration being aligned with the renal artery, and to align a second of said fenestrations with a junction of the aorta with a superior mesenteric artery of the patient, said second fenestration being aligned with the superior mesenteric artery; and   attaching said graft to an upstream segment of the aorta to maintain the alignment of said first and second fenestrations with the renal and the superior mesenteric arteries, respectively, and to allow blood flow between the aorta and the renal artery and between the aorta and the superior mesenteric artery through said first and second fenestrations upon completion of the bypass operation.   
     
     
       19. The method of claim 18, wherein said step of attaching further includes the steps of inserting a balloon into said graft and inflating said balloon to expand said graft. 
     
     
       20. The method of claim 18, wherein said graft has a first end and a bifurcated end opposite said first end, said bifurcated end including at least two openings, at least said first and second fenestrations being proximate said first end of said graft. 
     
     
       21. The method of claim 18, wherein said graft has a mid-longitudinal axis, said second fenestration being on a line parallel to the mid-longitudinal axis of said graft and passing through said sidewall of said tubular member, said first fenestration being spaced away from the line. 
     
     
       22. The method of claim 18, wherein said step of positioning said graft in the aorta further includes aligning a third of said fenestrations with a junction of the aorta with a celiac axis of the aorta of the patient. 
     
     
       23. The method of claim 18, wherein at least one of said fenestrations is ring-shaped. 
     
     
       24. The method of claim 18, wherein each of said first and second fenestrations are configured to match the vascular junctions of the aorta with the renal artery and superior mesenteric artery, respectively, of the patient. 
     
     
       25. The method of claim 18, wherein said step of attaching includes attaching at least a portion of said graft to the upstream segment of the aorta upstream of the renal arteries. 
     
     
       26. The method of claim 22, wherein a fourth of said fenestrations is positioned in said sidewall diametrically opposite to said first fenestration. 
     
     
       27. The method of claim 26, wherein said graft has a mid-longitudinal axis, said second and third fenestrations being on a line parallel to the mid-longitudinal axis of said graft and passing through said sidewall of said tubular member. 
     
     
       28. The method of claim 26, wherein said graft has a mid-longitudinal axis and an axis transverse to the mid-longitudinal axis of said craft and passing through said first fenestration, said second and third fenestrations being spaced away from the transverse axis. 
     
     
       29. The method of claim 26, wherein said graft has a mid-longitudinal axis, at least one of said fenestrations being elongated in a direction parallel to the mid-longitudinal axis of said graft. 
     
     
       30. A method for performing a bypass operation, comprising the steps of:
 providing a bypass graft comprising a tubular member having a sidewall including a plurality of fenestrations, at least a first and a second of said fenestrations being separated from one another by a portion of the sidewall of said tubular member;   inserting said graft into an aorta of a patient;   positioning said graft in the aorta to align said first and second fenestrations with junctions of the aorta with renal arteries of the patient and to align a third of said fenestrations with a junction of the aorta with a superior mesenteric artery of the patient, said first and second fenestrations each being aligned with one of the renal arteries, respectively, said third fenestration being aligned with the superior mesenteric artery of the patient; and   attaching said graft to an upstream segment of the aorta to maintain the alignment of said first and second fenestrations with the renal arteries and to allow blood flow between the aorta and the renal arteries through said first and second fenestrations upon completion of the bypass operation, and to maintain the alignment of said third fenestration with the junction of the aorta with the superior mesenteric artery to allow blood flow between the aorta and the superior mesenteric artery upon completion of the bypass operation.   
     
     
       31. The method of claim 30, wherein said step of positioning said graft in the aorta further includes aligning a fourth of said fenestrations with a junction of the aorta with a celiac axis of the aorta of the patient. 
     
     
       32. The method of claim 30, wherein said graft has a first end including an opening and a bifurcated end opposite said first end, said bifurcated end including at least two openings, at least said first and second fenestrations being proximate said first end of said graft. 
     
     
       33. The method of claim 30, wherein said graft has a mid-longitudinal axis, at least one of said fenestrations being elongated in a direction parallel to the mid-longitudinal axis of said graft. 
     
     
       34. The method of claim 30, wherein said first and second fenestrations are positioned in said sidewall diametrically opposite to each other. 
     
     
       35. The method of claim 30, wherein at least one of said fenestrations is ring-shaped. 
     
     
       36. The method of claim 30, wherein each of said first and second fenestrations are configured to match the vascular junctions of the aorta with the renal arteries of the patient. 
     
     
       37. The method of claim 30, wherein said step of attaching includes attaching at least a portion of said graft to the upstream segment of the aorta upstream of the renal arteries.