AU2015205978A1 - Means for controlled sealing of endovascular devices - Google Patents

Abstract

Expandable sealing means for endoluminal devices have been developed for controlled activation. The devices have the benefits of a low profile mechanism (for both self-expanding and balloon-expanding prosthesis), contained, not open, release of the material, active conformation to the "leak sites" such that leakage areas are filled without disrupting the physical and functional integrity of the prosthesis, and on-demand, controlled activation, that may not be pressure activated.

Description

MEANS FOR CONTROLLED SEALING OF ENDOVASCULAR DEVICES CROSS-REFERENCE TO RELATED APPLICATIONS 5 The present application claims the benefit of priority to U.S.S.N. 61/532,814, filed September 9, 2011, U.S.S.N. 13/476,695, filed May 21, 2012, and U.S.S.N. 13/596,894, filed August 28, 2012, all of which are incorporated herein by reference in their entirety. FIELD OF THE INVENTION 10 The present disclosure is directed generally to endoluminal devices and associated systems and methods, and specifically to a method and devices for controlled actuation of means for sealing of an endoluminal prosthesis to a vessel wall. BACKGROUND OF THE INVENTION 15 An aneurysm is a localized, blood-filled dilation of a blood vessel caused by disease or weakening of the vessel wall. Aneurysms affect the ability of the vessel to conduct fluids, and can be life threatening if left untreated. Aneurysms most commonly occur in arteries at the base of the brain and in the aorta. As the size of an aneurysm increases, there is an increased risk of rupture, which can 20 result in severe hemorrhage or other complications including sudden death. Aneurysms are typically treated by surgically removing a part or all of the aneurysm and implanting a replacement prosthetic section into the body lumen. Such procedures, however, can require extensive surgery and recovery time. Patients often remain hospitalized for several days following the procedure, and 25 can require several months of recovery time. Moreover, the morbidity and. mortality rates associated with such major surgery can be significantly high. Another approach for treating aneurysms involves remote deployment of an endovascular graft assembly at the affected site. Such procedures typically require intravascular delivery of the endovascular graft assembly to the site of 30 the aneurysm. The graft is then expanded or deployed in situ and the ends of the 1 graft are anchored to the body lumen on each side of the aneurysm. In this way, the graft effectively excludes the aneurysm sac from circulation. One concern with many conventional endovascular graft assemblies, however, is the long term durability of such structures. Over time, the graft can 5 become separated from an inner surface of the body lumen, resulting in bypassing of the blood between the vessel wall and the graft. As used herein, endoleak is defined as a persistent blood or other fluid flow outside the lumen of the endoluminal graft, but within the aneurysm sac or adjacent vascular segment being treated by the device. When an endoleak occurs, it can cause continuous 10 pressurization of the aneurysm sac and may result in an increased risk of rupture. In addition to endoleaks, another concern with many conventional endovascular graft assemblies is subsequent device migration and/or dislodgement. For example, after a surgeon has found an optimal location for 15 the graft, the device must be fixed to the wall of the body lumen and fully sealed at each end of the graft to prevent endoleaks and achieve a degree of fixation that will prevent subsequent device migration and/or dislodgement. Aortic stenosis, also known as aortic valve stenosis, is characterized by an abnormal narrowing of the aortic valve. The narrowing prevents the valve 20 from opening fully, which obstructs blood flow from the heart into the aorta. As a result, the left ventricle has to work harder to maintain adequate blood flow through the body. If left untreated, aortic stenosis can lead to life-threatening problems including heart failure, irregular heart rhythms, cardiac arrest, and chest pain. Aortic stenosis is typically due to age-related progressive 25 calcification of the normal trileaflet valve, though other predisposing conditions include congenital heart defects, calcification of a congenital bicuspid aortic valve, and acute rheumatic fever. For the last fifty years, open heart surgery for aortic valve replacement using cardiopulmonary bypass, sternotomy (or mini-sternotomy), aortic cross 30 clamping and cardioplegic arrest represents the treatment of choice and the 2 standard of care for patients having severe aortic stenosis with symptoms (Bonow, et al., Circulation, 1 14:e84-231 (2006), Kvidal, et al., J. Am. Coll. Cardiol., 35:747-56 (2000), Otto, Heart, 84:211-8 (2000), Schwarz, et al., Circulation, 66:1105-10 (1982)). However, there is a large pool of patients 5 affected by severe aortic stenosis who are not candidates for open heart valve replacement surgery because they are considered too old (nonagenarians, centenaries) for such an invasive procedure, or because they are also affected by other co-existing conditions that compound their operative risk (lung, et al., Eur Heart J 26:2714-20 (2005). For these patients, who are at high surgical risk, a 10 less invasive treatment is necessary. Transcatheter aortic-valve implantation (TAV) is a procedure in which a bioprosthetic valve is inserted through a catheter and implanted within the diseased native aortic valve. The most common implantation routes include the transapical approach (TA) and transfermoral (TF), though trans-subclavian and 15 trans-aortic routes are also being explored (Ferrari, et al., Swiss Med Wkly, 140:wl3127 (2010). These percutaneous routes rely on a needle catheter getting access to a blood vessel, followed by the introduction of a guidewire through the lumen of the needle. It is over this wire that other catheters can be placed into the blood vessel, and implantation of the prosthesis is carried out. 20 Since 2002 when the procedure was first performed, there has been rapid growth in its use throughout the world for the treatment of severe aortic stenosis in patients who are at high surgical risk, and there is mounting support to adopt the therapy as the standard of care for patients that are not at a high risk for surgery. Clinical studies have shown that the rate of death from any cause at the 25 one-year mark among patients treated with TAV was approximately 25% (Grube, et al., Circ. Cardiovasc. Interv. 1:167-175 (2008), Himbert et al., J. Am. Coll. Cardiol., 54:303-311 (2009), Webb, et al., Circulation, 119:3009-3016 (2009), Rodes-Cabau, et al., J. Am. Coll. Cardiol., 55:1080-1090 (2010), and the results of two parallel prospective, multicenter, randomized, active-treatment 30 controlled clinical trials showed that TAV is superior to standard therapy, when 3 comparing the rate of death from any cause at the I-year mark (30.7% in the TAV group, as compared witi 50.7% in the standard-therapy group) (Leon, et al., N. Engl. J. Med., 363:1597-1607 (2010)). Paravalvular leaks are extremely rare in surgical aortic-valve 5 replacement-seen in just 1.5% to 2% of cases. But as experts observed at Euro PCR 2011, mild paravalvular leaks are relatively common in transcatheter aortic-valve implantation (TAV), and new data suggest that more severe paravalvular aortic regurgitation (AR) is a key reason for prosthetic valve dysfunction. According to Dr. Jan-Malte Sinning (Universitatsklinikum, Bonn, 10 Germany), moderate to severe periprosthetic aortic regurgitation occurs in approximately 15% of TAV-treated patients, a number drawn from 12 international registries. In 127 consecutive patients treated with TAV at his center, 21 developed moderate paravalvular AR postprocedure, and this was associated with a significantly higher rate of 30-day and one-year mortality, as 15 well as acute kidney injury, compared with patients with no or mild AR. Predictors of paravalvular AR included a low baseline left ventricular ejection fraction (LVEF) and inadequate sizing of the annulus or device. Dr. Kensuke Takagi (San Raffaele Hospital, Milan, Italy), reported that at his center, 32 patients developed AR grade 2+ to 4+, out of 79 consecutive patients treated 20 with the CoreValve (Medtronic). In multivariate analyses, valve-annulus mismatch, particularly in larger aortic annuli, was a significant predictor of developing more severe paravalvular AR; an even stronger predictor was low implantation of the valve, which increased the risk by more than threefold. And while postdilatation can help treat paravalvular AR, this is appropriate only in 25 patients in whom the valve was correctly positioned at the outset, Takagi said. See Leon MB, Piazza N, Nikolsky E, et al. Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials. JAm Coll Cardiol 2011; 57:253-269; Eur Heart J20l1; 32:205-217 The major potential offered by solving leaks with transcatheter heart 30 valves is in growing the market to the low risk patient segment. The market 4 opportunity in the low-risk market segment is double the size of that in the high risk segment and therefore it is imperative for a TAV device to have technology to provide superior long-term hemodynamic performance so that the physicians recommend TAV over SAVR. 5 More than 3 million people in the United States suffer from moderate or severe mitral regurgitation (MR), with more than 250,000 new patients diagnosed each year. Functional MR can be found in 84% of patients with congestive heart failure and in 65% of them the degree of regurgitation is moderate or severe. The long term prognostic implications of functional mitral 10 regurgitation have demonstrated a significant increase in risk for heart failure or death, which is directly related to the severity of the regurgitation. Compared to mild regurgitation, moderate to severe regurgitation was associated with a 2.7 fold risk of death and 3.2 fold risk of heart failure, and thus significantly higher health care cost. 15 Treatment of mitral valve regurgitation depends on the severity and progression of signs and symptoms. Left unchecked, mitral regurgitation can lead to heart enlargement, heart failure and further progression of the severity of mitral regurgitation. For mild cases, medical treatment may be sufficient. For more severe cases, heart surgery might be needed to repair or replace the valve. 20 These open-chest/open-heart procedures carry significant risk, especially for elderly patients and those with severe co-morbidities. While several companies are attempting to develop less invasive approaches to repair the mitral valve, they have found limited anatomical applicability due to the heterogeneous nature of the disease and, so far, have had a difficult time demonstrating efficacy that is 25 equivalent to surgical approaches. Innovative approaches to less invasive heart valve replacement are a promising alternative and Transcatheter Mitral Valve Implantation (TMVI) devices are under development. PVL is likely to be a major problem with these devices and more critical than it is in the case of TAV devices. This is in part due to the lesser degree of calcification observed at the 30 mitral valve replacement site, requiring the device have greater holding power. 5 TAV and TMVI devices may also be used to treat the disease states of aortic insufficiency (or aortic regurgitation) and mitral stenosis respectively, which are less prevalent compared to the aforementioned valvular disease states, yet have similar or worse clinical prognosis/severity. They can also be implanted 5 within failing bioprostheses that are already implanted surgically, referred to as a valve-in-valve procedure. An improved device for treatment of these conditions has been developed which includes a means for sealing the device at the site of placement, using a sealing ring that is activated by pressure as it is expanded in 10 situ. As the device expands, a swellable material is released into the sealing means that causes the sealing means to expand and conform to the vessel walls, securing it in place. See W02010/083558 by Endoluminal Sciences Pty Ltd. The mechanical constraints of these seals are extremely difficult to achieve require rapid activation in situ, sufficient pressure to secure but not to deform or 15 displace the implanted prosthesis, biocompatibility, and retention of strength and flexibility in situ over a prolonged period of time. It is therefore an object of the present invention to provide improved physician controllable means for sealing endovascular devices such as stents and aortic valves in situ. 20 It is a further object of the present invention to provide means for active conformation of the sealing means to the vascular anatomy if any remodeling occurs after implantation so that any resulting leaks are sealed. It is a further object of the present invention to provide sealing means to support fixation, anchoring or landing platform of/for the TAV device, 25 especially in individuals lacking sufficient calcification in the native valve and in individual with aortic insufficiency as a diseased state. It is a further object of the present invention to provide expandable materials, such as hydrogels, with the appropriate chemical and physical properties to permanently seal an endoluminal device to a vessel wall. 6 SUMMARY OF THE INVENTION Expandable sealing means for endoluminal devices have been developed for controlled activation. These include a means for controlled activation at the site where the device is to be secured, and thereby avoids premature activation 5 that could result in misplacement or leakage at the site. The sealing means for placement at least partially between an endoluminal prosthesis and a wall of a body lumen has a first relatively reduced radial configuration and a second relatively increased radial configuration which is activated by means of a wire or other similar means, by the pressure of expansion at the site of implantation, or 10 simply by virtue of the expansion of.the device, releasing a swellable material such as a hydrogel, foal or sponge into the sealing means, for example, by rupture of a capsule containing the swellable material, which then swells upon contact with fluid at the site to expand the sealing means into secure contact with the lumen walls. A semi-permeable membrane is used to prevent the 15 hydrogel gel material from escaping the seal, yet allows access of the fluid to the hydrogel. In preferred embodiments, the swellable material is spray dried onto the interior of the seal, optionally tethered to the material chemically by covalent crosslinking. This material typically has a permeability in the range of five to 70 microns, most preferably 35 to allow rapid access of the fluid to the hydrogel. 20 The sealing means is particularly advantageous since it expands into sites to eliminate all prosthetic-annular incongruities, as needed. A major advantage of these devices is that the sealing means creates little to no increase in profile, since it remains flat/inside or on the device until the sealing means is activated. Exemplary endoluminal devices including the sealing means for 25 controlled activation include stents, stent grafts for aneurysm treatment and transcutaneously implanted aortic valves (TAV) or mitral, tricuspid or pulmonary valves. In all embodiments, the sealing means is configured to maintain the same low profile as the device without the sealing means. In a preferred embodiment, the sealing means is positioned posterior to the prosthetic 30 implant, and is expanded or pulled up into a position adjacent to the implant at 7 the time of placement/deployment or sealing. This is achieved using sutures or elastic means to pull the seal up and around the implant at the time of placement, having a seal that expands up around implant, and/or crimping the seal so that it moves up around implant when the implant comes out of introducer sheath. 5 This is extremely important with large diameter implants such as aortic valves, which are already at risk of damage to the blood vessel walls during transport. In another embodiment, the seal is placed around the skeleton of the TAV, so that it expands with the skeleton at the time of implantation of the TAV. In a variation of this embodiment, the seal is placed between the TAV and the 10 skeleton, and expands through the skeleton sections at the time of implantation to insure sealing. In all embodiments, it is absolutely critical that the hydrogel/expandable material operates under sufficient low pressure so that it does not push the stent away from the wall or alter the device configuration. These materials must 15 expand quickly (less than ten minutes, more preferably less than five minutes to full swelling), expand to a much greater volume (from two to 100 fold, more preferably from 50 to 90 fold, most preferably sixty fold) and retain the desired mechanical and physiochemical properties for an extended period of time, even under the stress of being implanted with the vasculature or heart. Gels having 20 the desired mechanical and swellable properties have been developed, as demonstrated by the examples. In yet another embodiment, a mechanism enables both deployment and retrieval of the system This is particularly important from the ease of use and placement accuracy perspective. This feature enables the physician to 25 change/alter the placement of the device in vivo if it was not properly positioned in the first attempt. Also, in the event of some complication during the operation, the physician can completely retrieve the device out of the patient (even after the "expandable material" has completely expanded). These devices have the advantages of providing excellent sealing in 30 combination with a low profile, controlled or contained release, and active 8 conforming to leak sites to eliminate prosthetic-annular incongruence. If vascular re-modeling occurs over time, which could lead to leakage, the seal will also remodel, preventing leaks from developing. For devices that are at high risk of leakage, a pleated or accordion-like design provides for even better 5 coverage and prevents uneven distribution of seal filler. BRIEF DESCRIPTION OF THE DRAWINGS Figures IA, lB and IC are perspective views of a transcatheter aortic valve (TAV) (Figure IA), a controlled activatable seal (Figure 1 B), and the seal placed around the TAV (Figure IC). 10 Figures 2A, 2B and 2C are perspective views of the TAV of Figure IC crimped toward the inflow side of the TAV in a telescopic manner (Figure 2A), with the TAV and seal in an expanded state with the stent aligned with the bottom section of the TAV. with the activation wire activated to expose the seal to fluids (Figure 2B), and post deployment, with the seal expanded by swelling 15 of the hydrogel within the seal when it contacts the blood. Figure 3 is a perspective cross-sectional view of the seal, showing the inner and outer membranes, hydrogel within the inner membrane and the rupture/activation site. Figures 4A, 4B and 4C are perspective views of the seal prior to rupture 20 and expansion of the seal (Figure 4A), during application of pressure from a wire to rupture the swelling material container and with partial expansion of the seal (Figure 4B), and after rupture of the swelling material container and with full expansion (Figure 4C). Figures 5A-5E are perspective views of a method depicting a "method" 25 to crimp and load the device with the "activation wire". The "activation wire" has to be shortened in length during the crimping/loading process so that the "activation or rupture" can be triggered during deployment/placement of the device. Before crimping/loading the "activation wire" is long enough so that the "activation mechanism" is far from activation and the hydrogel can remain 30 completely sealed/de-activated during storage. 9 Figures 6A-6B are perspective views of a seal that is placed inside of the TAV device. Figures 6C-6D are perspective views of a seal that is placed on the exterior of the TAV device. Figure 6E shows the seal placed on the inside of the device such that the outer impermeable membrane is moulded to the stent 5 scaffold and protrudes from within, in alignment with the stent pattern, while the inner permeable membrane remains in abutment with the inner circumference of the device. Hydrogels expand and cause the balloons to pop out. Figures 7A-7D are perspective views of an impermeable sealing system to protect the implantable device during storage in a preservative solution such 10 as glutaraldehyde, seals in place (Figure 7A); exterior seal being removed (Figure 7B); exterior seal removed and interior seals being removed (Figure 7C, 7D). Figure 8 is a cross-sectional view of the exterior and interior seals of Figures 7A-7D. 15 Figures 9A-9D are schematics of the placement of a Sapien valve with and without the disclosed sealing means. When the Sapien valve is placed too low into the LVOT leading to the graft skirt not completely apposing against the vasculature (Figure 9A), perivalvular leak may occur from the gaps/area above the skirt and around the device, through the open cells of the stent (Figure 9B). 20 The Sapien valve with sealing means, even when placed too low into the LVOT, seals the valve uniformly against the inner wall of the LVOT (Figure 9C). Figure 9D shows how no perivalvular leak occurs when the seal is in place, preventing the "leaking" blood from going back into the left ventricle. Figure IOA shows a correctly placed SJM/Medtronic TAV device. 25 Figure lOB depicts an incorrectly placed SJM/Medtronic TAV device, resulting in PV leaks. Figure lOC shows how perivascular leaks are prevented with an incorrectly placed SJM/Medtronic TAV device with sealing means. Figures 1 IA and 11B are prospective views of a self-aligning support member design for self-expanding TAV prosthesis, which enables system 30 deployment and retrieval without the use of "activation sutures". 10 Figures 12A-12F are prospective view of the self-aligning support as it is deployed, showing how the self-aligning support members are deployed from the catheter first to align the catheter and subsequently the frame of the prosthetic exits and extends outwardly and over the support members to position 5 the prosthetic. Figures 13A-13E are photographs of the deployment of the TAV using the sealing support members to position seal at time of placement. Figures 14A and 14B are graphs of percent swelling for the various formulations at 5 min (Figure 14A) and 60 min (Figure 14B). 10 Figures 15A-15B show an in vitro model of a paravalvular leak site due to device inapposition (Figure 15A) and the leak site sealed with the seal capsule without disturbing the base geometry of the device (Figure 1 5B). The conformation of the seal happens actively only in places where there are leak sites. The seal does not decrease the central orifice area of the device not having 15 any adverse effect on the blood flow as a result. View from heart into aorta; device of Figures 2A-2C. DETAILED DESCRIPTION OF THE INVENTION I. Definitions "Hydrogel" refers to a substance formed when an organic polymer 20 (natural or synthetic) is crosslinked via covalent, ionic, or hydrogen bonds to create a three-dimensional open-lattice structure which entraps water molecules to form a gel.. "Biocompatible" generally refers to a material and any metabolites or degradation products thereof that are generally non-toxic to the recipient and do 25 not cause any significant adverse effects to the subject. "Biodegradable" generally refers to a material that will degrade or erode by hydrolysis or enzymatic action under physiologic conditions to smaller units or chemical species that are capable of being metabolized, eliminated, or excreted by the subject. The degradation time is a function of material 30 composition and morphology. l1 As used herein, "rapidly" expanding refers to a material which reaches its desired dimensions in less than ten minutes after activation or exposure to fluid, more preferably in less than five minutes. II. Endoluminal Device Seal 5 A. Endoluminal Devices Endoluminal prosthesis and sealing devices are advanced through a body lumen in a first undeployed and reduced profile configuration. When positioned in situ, the sealing device expands from its reduced radial profile configuration to a second configuration with an increased radial profile. In situ, and in its 10 second configuration, the sealing device is configured to be positioned between the prosthesis and the wall of the body lumen. In one embodiment, when the endoluminal prosthesis is at the desired location in the body lumen, it is typically deployed from an introducer catheter whereupon it may move to an expanded radial configuration by a number of mechanisms. In some 15 embodiments, the prosthesis may be spring expandable. Alternatively, a balloon or expandable member can be inflated within the lumen of the prosthesis to cause it to move to an expanded radial configuration within the vessel. This radial expansion, in turn, presses the sealing device against a wall of the body lumen. One of the advantages of the seal is that it only fills the gaps, and does 20 not impact the placement and integrity - both physical and functional, of the prosthetic or the implant. In one embodiment, the sealing device is configured to fully seal a proximal, central and/or distal end of the endoluminal prosthesis for endovascular aneurysm repair (EVAR) to prevent endoleaks and prevent 25 subsequent migration and/or dislodgement of the prosthesis. In another embodiment, the sealing device is configured to fully seal a transcatheter aortic valve. Figures IA, lB and 1 C are perspective views of a transcatheter aortic valve (TAV) 10 (Figure IA), a controlled activatable seal (Figure IB) 12, and the seal placed around the TAV 14 (Figure IC). 12 Figures 2A, 2B and 2C are perspective views of the TAV 14 of Figure IC crimped toward the inflow side of the TAV10 in a telescopic manner (Figure 2A), with the TAV 10 and seal 12 in an expanded state with the stent aligned with the bottom section of the TAV, with the activation wire 16 activated to 5 expose the seal 12 to fluids (Figure 2B), and post deployment, with the seal 12 expanded by swelling of the hydrogel within the seal when it. contacts the blood. The endoluminal device may be-configured such that it moves independently of the endoluminal prosthesis. Alternatively, the endoluminal device may be connected to the prosthesis for delivery to a target site. The 10 endoluminal device may be connected to the prosthesis by any number of means including suturing, crimping, elastic members, magnetic or adhesive connection. In one embodiment, the sealing means is positioned posterior to the prosthetic implant, and is expanded and pulled up into a position adjacent to the implant at the time of sealing. This is achieved using sutures or elastic means to 15 pull the seal up and around the implant at the time of placement, having a seal that expands up around implant, and/or crimping the'seal so that it moves up around implant when implant comes out of introducer sheath. This is extremely important with large diameter implants such as aortic valves, which are already at risk of damage to the blood vessel walls during transport. 20 A key feature of the latter embodiment of the seal technology is that it enables preservation of the crimped profile of the endoluminal prosthesis. The seal technology is crimped distal or proximal to the prosthesis. In one aspect of this technology, the seal is aligned with the prosthesis by expansion of the seal. In another aspect, the seal zone of the prosthesis is aligned with the seal zone 25 prior to expansion of the prosthesis by use of activation members. In yet another embodiment, the seal is aligned with the seal zone of the prosthesis prior to prosthesis expansion by use of activation members, which can be made of an elastic or non-elastic material. In additional embodiments, the seal is positioned between the device 30 skeleton and the device, or on the exterior of the skeleton. 13 In a further embodiment, the endoluminal device may further include one or more engagement members. The one or more engagement members may include staples, hooks or other means to engage with a vessel wall, thus securing the device thereto. 5 B. The Seal The seal includes a flexible component that is configured to conform to irregularities between the endoluminal prosthesis and a vessel wall. The seal includes a generally ring-like structure having a first or inner surface and a second or outer surface. It contains a material that swells upon contact with a 10 fluid or upon activation of a foam, following placement, to inflate and conform the seal around the device. As shown in Figure 3, the seal 12 is a capsule-within-a capsule. The seal 12 can be provided in a variety of shapes, depending on the device it is to be used with. A "D" shape is the preferred embodiment, with the flat portion being 15 attached to the support structure and/or device to be implanted. The seal can be composed of a permeable, semi-permeable, or impermeable material. It may be biostable or biodegradable. For example, the seal may be composed of natural or synthetic polymers such as polyether or polyester polyurethanes, polyvinyl alcohol (PVA), silicone, cellulose of low to 20 high density, having small, large, or twin pore sizes, and having the following features: closed or open cell, flexible or semi-rigid, plain, melamine, or post treated impregnated foams. Additional materials for the seal can include polyvinyl acetal sponge, silicone sponge rubber, closed cell silicone sponges, silicone foam, and fluorosilicone sponge. Specially designed structures using 25 vascular graft materials including polytetrafluoroethylene (PTFE), polyethylterephthalate (PET), polyether ether ketone (PEEK), woven yams of nylon, polypropylene (PP), collagen or protein based matrix may also be used. PEEK is the preferred material at this time since the strength is high so that there will be no damage leading to failure when the TAV device is expanded against 14 sharp/calcified nodules and at the same time a relatively thin sheet of material can be used, helping maintain a lower profile. The seal material may be used independently or in combination with a mesh made from other types of polymers, titanium, surgical steel or shape 5 memory alloys. In other embodiments, the capsule may be segmented to include one or more compartments. The compartments may be relatively closely spaced. Further, the distance between adjacent compartments may vary. The segmented capsule of this embodiment may not extend completely around the endoluminal 10 prosthesis when the support member is in its second increased radial configuration. In one embodiment wherein the support member includes a capsule, the capsule maybe substantially surrounded by the support member. In other embodiments, however, the capsule may be only partially enveloped by the support member. 15 The capsule may include an outer wall to hold the agent therein. The outer wall may be made of a suitably flexible and biocompatible material. Alternatively, the capsule may include a more rigid structure having a pre designed failure mechanism to allow the release of agent therefrom. Examples of suitable materials include, but are not limited to, low density polyethylene, 20 high density polyethylene, polypropylene, polytetrafluoroethylene, silicone, or fluorosilicone. Other fluoropolymers that may be used for the construction of the capsule include: polytetrafluoroethylene, perfluoroalkoxy polymer resin, fluorinated ethylene-propylene, polyethylenetetrafluoroethylene, polyvinylfluoride, ethylenechlorotrifluoroethylene, polyvinylidene fluoride, 25 polylychlorotrifluoroethylene, perfluoropolyether, fluorinated ethylene propylene, terpolymer of tetrafluoroethylene, hexafluoropropylene and vinylidene fluoride), polysulphone and polyether ether ketone (PEEK). It may also include non-polymeric materials such as glass, bioglass, ceramic, platinum and titanium. It may further include biologically based materials such as 30 crosslinked collagen or alginates. It will be appreciated that the foregoing list is 15 provided merely as an example of suitable materials and is not an exhaustive list. The capsule may be composed of a material or combination of materials different from those provided above. The rate of release of the agent from the support member may vary, In 5 some embodiments, pressure exerted on the support member to rupture a capsule may release one or more agents. This rate of almost immediate release is particularly useful for delivering adhesive agents to a vessel to affix a prosthesis to a wall of the vessel. However, other agents may be released at a slower or at least a variable rate. Further, the agents may be released after the initial release 10 of a primary agent (e.g. the adhesive). For example, in an embodiment wherein the support member includes a segmented capsule, the first agent to be released may be held in one or more "immediate release" sub-compartments which include an outer wall configured to rupture under a pre-defined initial pressure. The support member may 15 include one or more slow release sub-compartments having outer walls configured to withstand the initial pressure but which either rupture when subjected to a greater pressure or which do not rupture but rather degrade over a certain period of time to release an agent held therein. Typically, the capsule is configured to rupture to release one or more 20 agents at a predetermined range of pressures. The range of rupture pressures includes between 5 and 250 psi, between 5 and 125 psi, between 10 and 75 psi, or at approximately 50 psi. A variety of different techniques or processes can be used to form pressure activated capsules or compartments. In one embodiment, for example, 25 a process for forming a pressure activated capsule includes pre-stressing the capsule during formation. The pre-stressed material will have a limited capacity to stretch when subjected to external pressure, and will fail when reaching critical stress on the stress-strain curve. The first stage of this method includes selecting a biocompatible capsule material that is also compatible with its 30 contents (e.g., the agent which can include adhesive material or a wide variety of 16 other types of materials). The capsule material should also have a tensile strength suitable for the particular application in which the capsule will be used. The next stage of this method includes forming an undersized capsule. The undersized capsule is essentially shaped as an extruded, elongated tube 5 (e.g., a "sausage") with one end of the tube sealed (e.g., by dipping, dip molding, vacuum forming blow molding, etc.). The process continues by expanding the capsule to its final shape. 'The capsule can be expanded, for example, by stretching (e.g., either hot or cold) using appropriate tooling so that the capsule material is pre-stressed to within a stress level, and whereby the clinically 10 relevant balloon inflation pressure will exceed the failure stress of the capsule material. The method can further include filling the capsule with the desired contents while the capsule is tinder pressure so as to achieve pre-stressing in a single step. After filling the capsule, the capsule can be sealed (e.g., using a heat welding process, laser welding process, solvent welding process, etc.). 15 In another embodiment, a capsule can be formed by forming an air pillow or bubble wrap-type capsule assembly using a vacuum form process or other suitable technique. The next stage of this process includes perforating a film at the base of the capsule assembly and filling the individual capsules with the desired contents under an inert atmosphere. After filling the capsules, the 20 puncture hole can be resealed by application of another film over the puncture hole and localized application of heat and/or solvent. Other methods can be used to seal the puncture hole. In several embodiments, the capsule can be configured such that the puncture hole re-ruptures at the same pressure as the capsule itself so that there is some agent (e.g., adhesive material within the 25 capsule) flowing onto the corresponding portion of the endoluminal prosthesis. One or more failure points can be created within a capsule. This process can include creating a capsule shaped as an extruded, elongated tube with one end of the tube sealed (e.g., by dipping, dip molding, vacuum forming blow molding, etc.). The capsule can be composed of a polymer material (e.g., 30 polyethylene, polypropylene, polyolefin, polytetrafluoroethylenes, and silicone 17 rubber) or another suitable material. At one or more predetermined locations along the elongated tube, the process can include creating areas of substantially reduced thickness. These areas can be formed, for example, using a tool (e.g., a core pin with a razor blade finish along the length of the capsule), laser ablation, 5 creating partially penetrating holes, creating an axial adhesive joint (e.g., tube from a sheet) that is weaker than the substrate, or other suitable techniques. The method next includes filing the capsule with the desired contents at a pressure below that required to rupture the thinned or weakened areas. After filling the capsule, the open end of the capsule can be sealed using one of the welding 10 processes described above or other suitable processes. In yet another particular embodiment, one or more stress points can be created within a capsule. This method can include forming a capsule and filling the capsule with the desired contents using any of the techniques described above. After forming the capsule and with the capsule in an undeployed 15 configuration, the process can further include wrapping a suture (e.g., a nitinol wire) about the capsule at a predetermined pitch and tension. When the capsule is moved from the undeployed state to a deployed configuration and takes on a curved or circumferential shape, the suture compresses the capsule at the predetermined points. Stress points are created in the capsule walls at these 20 points because of the increased pressure at such points. In another embodiment the device may include one or more pressure points on the supporting member such as spikes or other raised areas which cause the penetration of the capsule once a predetermined pressure is applied thereto. 25 Still yet another particular embodiment for forming a pressure activated capsule or compartment includes creating a double walled capsule in which an inner compartment of the capsule is sealed and separated from an outer compartment of the capsule that contains the adhesive or other desired agent. The inner compartment can be composed of a compliant or flexible material, 30 and the outer compartment can be composed of a substantially less compliant 18 material. The outer compartment may or may not have failure points. The inner compartment is in fluid communication via a one way valve with a low compliance reservoir. The reservoir is configured to be pressurized by inflation of an expandable member or balloon to a high pressure, thereby allowing the 5 valve to open and pressurize and expand the inner compartment. This process in turn pressurizes the outer compartment (that contains the adhesive) until the outer compartment ruptures. One advantage of this particular embodiment is that it can increase the pressure within the capsule to a value higher than otherwise possible with an external expandable member or balloon alone. 10 In a still further embodiment, the capsule has an inner compartment made from a relatively rigid material or mesh and an outer compartment made from a relatively flexible material. In this embodiment, the inner compartment acts as a reservoir, containing the agent and is designed to break or rupture at a predetermined pressure. The outer compartment may also have a failure 15 pressure point to allow release of the agent. The rigidity of the inner compartment may provide a longer-term stability and shelf life of the encapsulated agent. The application of rupture pressure may be carried out either locally or remotely, e.g. via a tube directly connected to the capsule that is connected to an external source at the delivery device entry site (e.g. femoral 20 artery). Expandable Capsule In one embodiment, a seal entirely surrounds the capsule sueh that the capsule is "suspended" within the seal. In one specific embodiment, for example, the seal 12 can include a porous material configured to prevent any .25 embolization (distal or proximal) of released agent(s) 108 from the capsule 106. The seal may have a graded degree of relative porosity from relatively porous to relatively non-porous. Preferred porosity size is from five to seventy microns, more preferably about 35 microns so that the fluid can rapidly access the swellable material. * 19 In the preferred embodiment, the capsule is a single annular compartment within the seal, and extends completely around the periphery of the endoluminal prosthesis. In other embodiments, however, the capsule may include one or more additional compartments or sections, and may not extend 5 completely around the endoluminal prosthesis. Moreover, the capsule may or may not be contained within the seal, and can be positioned at a different location on the apparatus relative to the seal. In addition, the capsule can have a variety of different shapes and/or sizes depending upon the particular application, the agent(s), the configuration of the endoluminal prosthesis, and a 10 number of other factors. Permeable and Impermeable Membranes In a preferred embodiment, shown in Figure 3, the seal 12 includes two membranes, an inner membrane 18 and an outer membrane 20. An expandable material such as a foam or hydrogel 22 is placed within the inner membrane 18. 15 The inner membrane 18 is semi-permeable (allowing fluid ingress but not egress of entrapped hydrogen or foam) while the outer membrane 20 is impermeable except at an optional pre-determined rupture point 24. The outer membrane 20 is designed to be impermeable to fluid during storage and transport and during any pre-procedural preparations e.g. rinsing or washing of the device, to protect 20 the polymer 22 from premature swelling. The outer membrane 20 is also designed to be strong and puncture resistant so that it does not tear or is punctured or pierced by the sharp edges of the native calcification even when subject to pressures up to l4atm. This prevents the rupture of the inner membrane 18, mitigating any risk of embolization of the expandable material or 25 hydrogel 22. The rupture point 24 allows fluid such as blood to penetrate into the expandable seal only when the seal is expanded in place, thereby preventing leaks. Permeable membranes may be made from a variety of polymer or organic materials, including polyimides, phospholipid bilayer, thin film 30 composite membranes (TFC or TFM), cellulose ester membranes (CEM), 20 charge mosaic membranes (CMM), bipolar membranes (BPM), and anion exchange membranes (AEM). A preferred pore size range for allowing fluid in but not hydrogel to escape is from five to seventy microns, more preferably about 35 to seventy 5 microns, most preferably about 35 microns, so that the fluid can rapidly access the swellable material. The permeable membrane may be formed only of permeable material, or may have one or more areas that are impermeable. This may be used to insure that swelling does not disrupt the shape of the seal in an undesirable area, such 10 as on the interior of the device where it abuts the implant or prosthesis, or where it contacts the device support members. In some embodiments, the second impermeable membrane is applied with plasma vapour deposition, vacuum deposition, co-extrusion, or press lamination. 15 Expandable Materials Expandable materials which swell in contact with an aqueous fluid are preferred. Most preferably, these materials expand from two to 100 times; more preferably from 50 to 90 fold, most preferably about 60 fold. Blood and/or other fluids at the site of implantation can penetrate into the seal after it is breached, 20 causing dried or expandable materials to absorb the fluid and swell or react to expand due to formation or release of gas reaction products. The semi permeable inner membrane 18 prevents the expandable material 22 from escaping the seal 12, but allows fluid to enter. By expanding in volume, the material seals the endoluminal space. 25 Any expandable material having suitable physical and chemical properties may be used. In certain embodiments, the expandable material is a hydrogel. Other suitable materials include foams and sponges formed at the time of activation. Expandable materials are chosen to be stable at both room temperature 30 and 37-40 *C and to be sterilizable by one or more means such as radiation or 21 steam. Sponges or foams can be made from biocompatible materials that allow tissue ingrowth or endothelialisation of the matrix. Such endothelialisation or tissue ingrowth can be facilitated either through selection of appropriate polymeric materials or by coating of the polymeric scaffold with suitable growth 5 promoting factors or proteins. 1. Hydrogels Hydrogels are selected to provide rapid swelling as well as to be biocompatible in the event of a breach of capsule integrity. Two or more hydrogels or other materials that swell may be used. 10 Expandable gels have been developed that are stronger and more resilient than current expandable gels. These gels are able to expand rapidly to at least I Ox, 20x, 25x, 30, or 40x of the dry state and more preferably up to 50 x their dry state when exposed to physiological liquids in less than 25, 24, 23, 22, 21, 20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, 5, or 4 minutes. These 15 stronger gels are synthesized using long chain cross-linkers, typically molecules with more than 20 carbon atoms and/or a molecular weight greater than 400Da, more preferably more than 40 carbon atoms and/or a molecular weight greater than 800 Da, that will act as molecular reinforcement molecules, creating a more resilient and longer lasting gel while maintaining excellent swelling properties. 20 The swelling force of these gels can also be adjusted to not exert more radial force than necessary, typically around 0.0005N/mm 2 to 0.025N/mm 2 , preferably 0.002N/mm 2 to 0.012N/mm 2 . In some embodiments, these gels can be spray dried onto, or covalently attached to, a base membrane or mesh used to encapsulate the gel before being 25 fitted to the surgical device. The gels can be covalently attached by introducing one or more functional groups that can form covalent bonds to one or more functional groups on the base membrane or mesh. Suitable functional groups include, but are not limited to, allylic, vinyl or acrylic groups. The functional groups can be introduced directly onto the get and/or membrane or mesh or as 30 part of a longer/larger chemical moiety. "Allyl", as used herein, refers to a group 22 having the structural formula H2C=CH-CH2R, where R is the point of connection to the rest of the molecule, i.e., hydrogel and/or base membrane or mesh. "Acrylic", as used herein, refers to a group having the structure

H

2 C=CH-C(=O)-. The preferred IUPAC name for the group is prop-2-enoyl, 5 and it is also (less correctly) known as acrylyl or simply acryl. Compounds containing an acryloyl group can be referred to as "acrylic compounds". "Vinyl", as used herein, refers to a group containing the moiety -CH=CH 2 , which is a derivatives of ethene, CH 2

=CH

2 , with one hydrogen atom replaced with some other group or bond, such as a bond to the base substrate or 10 membrane. Vinyl groups can be introduced directly onto the hydrogel and/or base membrane or mesh or can be part of a longer/larger chain. The long chain hydrophilic crosslinking agents described above have at least two and preferably more than two reactive functional groups (e.g., allyl, acrylic, vinyl, etc.) capable of participating in a free radical polymerization 15 reaction or additional reaction, such as Michael addition, and where at least part of the molecule is attached to a substrate, anchoring the gel to the substrate to prevent release of smaller gel particles in case of gel fracture. Long-chain cross-linkers and/or the chemical attachment of the gels to a porous substrate result in gels that are more capable of withstanding cyclic 20 loads. These seals containing gels can be made in any shape, including annular or strip shape. The principle behind these cross-linkers is that rather than having a short cross-linker with only two polymerizable groups, the crosslinking agents described herein includes long chain hydrophilic polymer (such as PVA, PEG, PVAc, natural polysaccharides such as dextran, HA, agarose, and starch) with 25 multiple polymerizable/reactive groups. The long chain crosslinking agents result in a hydrogel which is less susceptible to "fragmenting" which is important as it minimizes any risk of small gel particles breaking off and embolizing to the brain. The long chain crosslinking agents also result in increased integrity of the hydrogel, making it more pliable and thereby 30 increasingly resilient under cyclic loads, an important factor for long-term 23 durability of the hydrogel. The benefits are a much stronger hydrogel, approximately 0.0005N/mm2 to 0.025N/mm 2 more preferably between 2 2 0.002N/mm 2 to 0.012N/mm , as compared to hydrogels crosslinked with short chain divalent linkers, as noted above, less than 20 carbon atoms and/or a 5 molecular weight of less than 400 Da with two active groups that can be used for cross-linking (e.g. vinyl, acrylic, allylic). Interestingly, while these gels are very firm, they at the same time possess very good swelling characteristics. Very strong gels do not swell as much and/or as rapidly. As used herein, very strong refers generally to hydrogels having a strength greater than about 0.0005N/mm 2 10 to 0.025N/mm 2 . Desired rates of swelling are 30x or greater, with an ideal range of 50x - 80x. The greater the swelling rate, the smaller the introduction profile of the device, allowing treatment of a greater number of patients who have smaller access vessels (femoral arteries, radial arteries, etc.). Suitable components of such gels include, but are not limited to, acrylic 15 acid, acrylamide or other polymerizable monomers; cross-linkers such as polyvinyl alcohols as well as partially hydrolyzed poly. vinyl acetates, 2 hydroxyethyl methacrylates (HEMA) or various other polymers with reactive side groups such as acrylic, allylic, and vinyl groups, can be used. In addition, a wide range of natural hydrocolloids such as dextran, cellulose, agarose, starch, 20 galactomannans, pectins, hyaluronic acid etc. can be used. Reagents such as allyl glycidyl ether, allyl bromide, allyl chloride etc. can be used to incorporate the necessary double bonds to participate in a free radical polymerization reaction or addition reaction, such as those containing acrylic, allylic and vinyl groups, into the backbones of these polymers. Depending on the chemistry 25 employed, a number of other reagents can be used to incorporate reactive double bonds. Studies to identify hydrogels having substantial swelling in a short time were performed, as described in examples I and 2. The main factors that influence swelling of a hydrogel based on polymerisation and cross-linking of 30 synthetic monomers are: 24 (1) type of monomer; (2) type of cross-linker; (3) concentration of monomer and cross-linker in the gel; and (4) the ratio of monomer to cross-linker. 5 Examples of rapidly swelling hydrogels include, but are not limited to, acrylic acid polymers and copolymers, particularly crosslinked acrylic acid polymer and copolymers. Suitable crosslinking agents include acrylamide, di(ethylene glycol) diacrylate, poly(ethylene glycol) diacrylate, and long-chain hydrophilic polymers with multiple polymerizable groups, such as poly vinyl 10 alcohol (PVA) derivatized with allyl glycidyl ether. Additional examples of materials which can be used to form a suitable hydrogen include polysaccharides such as alginate, polyphosphazines, poly(acrylic acids), poly(methacrylic acids), poly(alkylene oxides), poly(vinyl acetate), polyvinylpyrrolidone (PVP), and copolymers and blends of each. See, for example, U.S. Patent No. 5,709,854, 15 6,129,761 and 6,858,229. In general, these polymers are at least partially soluble in aqueous solutions, such as water, buffered salt solutions, or aqueous alcohol solutions. In some embodiments, the polymers have charged side groups or are monovalent ionic salts thereof. Examples of polymers with acidic side groups that can be 20 reacted with cations are poly(phosphazenes), poly(acrylic acids), poly(methacrylic acids), poly(vinyl acetate), and sulfonated polymers, such as sulfonated polystyrene. Copolymers having acidic side groups formed by reaction of acrylic or methacrylic acid and vinyl ether monomers or polymers can also be used. Examples of acidic groups are carboxylic acid groups and 25 sulfonic acid groups. Examples of polymers with basic side groups that can be reacted with anions are poly(vinyl amines), poly(vinyl pyridine), poly(vinyl imidazole), and some imino substituted polyphosphazenes. The ammonium or quaternary salt of the polymers can also be formed from the backbone nitrogens or pendant imino 30 groups. Examples of basic side groups are amino and imino groups. 25 A water-soluble gelling agent such as a polysaccharide gum, more preferably a polyanionic polymer like alginate can be cross-linked with a polycationic polymer (e.g., an amino acid polymer such as polylysine) to form a shell. See e.g., U.S. Patent Nos. 4,806,355, 4,689,293 and 4,673,566 to Goosen 5 et al.; U.S. Patent Nos. 4,409,331, 4,407,957; 4,391,909 and 4,352,883 to Lim et al.; U.S. Patent Nos. 4,749,620 and 4,744,933 to Rha et al.; and U.S. Patent No. 5,427,935 to Wang et al. Amino acid polymers that may be used to crosslink hydrogel forming polymers such as alginate include the cationic poly(amino acids) such as polylysine, polyarginine, polyornithine, and copolymers and 10 blends thereof. Other exemplary polysaccharides include chitosan, hyaluronan (HA), and chondroitin sulfate. Alginate and chitosan form crosslinked hydrogels under certain solution conditions, while HA and chondroitin sulfate are preferably modified to contain crosslinkable groups to form a hydrogel. Alginate forms a 15 gel in the presence of divalent cations via ionic crosslinking. Although the properties of the hydrogel can be controlled to some degree through changes in the alginate precursor (molecular weight, composition, and macromer concentration), alginate does not degrade, but rather dissolves when the divalent cations are replaced by monovalent ions. In addition, alginate does not promote 20 cell interactions. See U.S. Patent No. 4,391,909 to Lim et al. for description of alginate hydrogel crosslinked with polylysine. Other cationic polymers suitable for use as a cross-linker in place of polylysine include poly( p-amino alcohols) (PBAAs) (Ma M, et al. Adv. Mater. 23:H189-94 (2011). Chitosan is made by partially deacetylating chitin, a natural 25 nonmammalian polysaccharide, which exhibits a close resemblance to mammalian polysaccharides, making it attractive for cell encapsulation. Chitosan degrades predominantly by lysozyme through hydrolysis of the acetylated residues. Higher degrees of deacetylation lead to slower degradation times, but better cell adhesion due to increased hydrophobicity. Under dilute 30 acid conditions (pH < 6), chitosan is positively charged and water soluble, while 26 at physiological pH, chitosan is neutral and hydrophobic, leading to the formation of a solid physically crosslinked hydrogen. The addition of polyol salts enables encapsulation of cells at neutral pH,. where gelation becomes temperature dependent. 5 Chitosan has many amine and hydroxyl groups that can be modified. For example, chitosan has been modified by grafting methacrylic acid to create a crosslinkable macromer while also grafting lactic acid to enhance its water solubility at physiological pH. This crosslinked chitosan hydrogel degrades in the presence of lysozyme and chondrocytes. Photopolymerizable chitosan 10 macromer can be synthesized by modifying chitosan with photoreactive azidobenzoic acid groups. Upon exposure to UV in the absence of any initiator, reactive nitrene groups are formed that react with each other or other amine groups on the chitosan to form an azo crosslink Hyaluronan (HA) is a glycosaminoglycan present in many tissues 15 throughout the body that plays an important role in embryonic development, wound healing, and angiogenesis. In addition, HA interacts with cells through cell-surface receptors to influence intracellular signaling pathways. Together, these qualities make HA attractive for tissue engineering scaffolds. HA can be modified with crosslinkable moieties, such as methacrylates and thiols, for cell 20 encapsulation. Crosslinked HA gels remain susceptible to degradation by hyaluronidase, which breaks HA into oligosaccharide fragments of varying molecular weights. Auricular chondrocytes can be encapsulated in photopolymerized HA hydrogels where the gel structure is controlled by the macromer concentration and macromer molecular weight. In addition, 25 photopolymerized HA and dextran hydrogels maintain long-term culture of undifferentiated human embryonic stem cells. HA hydrogels have also been fabricated through Michael-type addition reaction mechanisms where either acrylated HA is reacted with PEG-tetrathiol, or thiol-modified HA is reacted with PEG diacrylate. 27 Chondroitin sulfate makes up a large percentage of structural proteoglycans found in many tissues, including skin, cartilage, tendons, and heart valves, making it an attractive biopolymer for a range of tissue engineering applications. Photocrosslinked chondroitin sulfate hydrogels can be been 5 prepared by modifying chondroitin sulfate with methacrylate groups. The hydrogel properties were readily controlled by the degree of methacrylate substitution and macromer concentration in solution prior to polymerization. Further, the negatively charged polymer creates increased swelling pressures allowing the get to imbibe more water without sacrificing its mechanical 10 properties. Copolymer hydrogels of chondroitin sulfate and an inert polymer, such as PEG or PVA, may also be used. Biodegradable PEG hydrogels can be been prepared from triblock copolymers of poly(ct-hydroxy esters)-b-poly (ethylene glycol)-b-poly(a hydroxy esters) endcapped with (meth)acrylate functional groups to enable 15 crosslinking. PLA and poly(8-caprolactone) (PCL) have been the most commonly used poly(a-hydroxy esters) in creating biodegradable PEG macromers for cell encapsulation. The degradation profile and rate are controlled through the length of the degradable block and the chemistry. The ester bonds may also degrade by esterases present in serum, which accelerates 20 degradation. Biodegradable PEG hydrogels can also be fabricated from precursors of PEG-bis-[2-acryloyloxy propanoate]. As an alternative to linear PEG macromers, PEG-based dendrimers of poly(glycerol-succinic acid)-PEG, which contain multiple reactive vinyl groups per PEG molecule, can be used. An attractive feature of these materials is the ability to control the degree of 25 branching, which consequently affects the overall structural properties of the hydrogel and its degradation. Degradation will occur through the ester linkages present in the dendrimer backbone. The biocompatible, hydrogel-forming polymer can contain polyphosphoesters or polyphosphates where the phosphoester linkage is 30 susceptible to hydrolytic degradation resulting in the release of phosphate. For 28 example, a phosphoester can be incorporated into the backbone of a crosslinkable PEG macromer, poly(ethylene glycol)-di-[ethylphosphatidyl (ethylene glycol) methacrylate] (PhosPEG-dMA), to form a biodegradable hydrogel. The addition of alkaline phosphatase, an ECM component synthesized 5 by bone cells, enhances degradation. The degradation product, phosphoric acid, reacts with calcium ions in the medium to produce insoluble calcium phosphate inducing autocalcification within the hydrogel. Poly(6-aminoethyl propylene phosphate), a polyphosphoester, can be modified with methacrylates to create multivinyl macromers where the degradation rate was controlled by the degree 10 of derivitization of the polyphosphoester polymer. Polyphosphazenes are polymers with backbones consisting of nitrogen and phosphorous separated by alternating single and double bonds. Each phosphorous atom is covalently bonded to two side chains. The polyphosphazenes suitable for cross-linking have a majority of side chain groups 15 which are acidic and capable of forming salt bridges with di- or trivalent cations. Examples of preferred acidic side groups are carboxylic acid groups and sulfonic acid groups. Hydrolytically stable polyphosphazenes are formed of monomers having carboxylic acid side groups that are crosslinked by divalent or trivalent cations such as Ca 2 # or Al 3 . Polymers can be synthesized that degrade 20 by hydrolysis by incorporating monomers having imidazole, amino acid ester, or glycerol side groups. Bioerodible polyphosphazines have at least two differing types of side chains, acidic side groups capable of forming salt bridges with multivalent cations, and side groups that hydrolyze under in vivo conditions, e.g., imidazole groups, amino acid esters, glycerol and glucosyl. Hydrolysis of 25 the side chain results in erosion of the polymer. Examples of hydrolyzing side chains are unsubstituted and substituted imidizoles and amino acid esters in which the group is bonded to the phosphorous atom through an amino linkage (polyphosphazene polymers in which both R groups are attached in this manner are known as polyaminophosphazenes). For polyimidazolephosphazenes, some 29 of the "R" groups on the polyphosphazene backbone are imidazole rings, attached to phosphorous in the backbone through a ring nitrogen atom. In all embodiments, it is absolutely critical that the hydrogel/expandable material operates under sufficient low pressure so that it does not push the stent 5 away from the wall or alter the device configuration. In summary, the expandable material is contained within a material, such as a semi-permeable or impermeable material so that it is retained at the site here it isneeded to seal a leak. The material is selected based on the means for activation. If the material is expanded by mechanical shear or exposure to a foaming agent, these materials 10 are provided internally within the seal, allowing an external activating agent such as an activation wire to disrupt themeans for isolating the activation agent from the expandable material. If the material is activated by contact with fluid, no additional means for isolation are required if the device is stored dry prior to use, since it will activate in situ when exposed to body fluids. If the material is 15 stored wet prior to use, a second impermeable membrane is required to keep the expandable material dry prior to activation. This will typically include a rupture site which is opened at the time of implantation to allow biological fluid to reach the expandable material through the semi-permeable material (i.e., where semi permeable refers to a material retaining the expandable material but allowing 20 fluid to pass). Alternatively the impermeable material may not include a rupture site but simply be removed after the device is removed from storage and washed with saline, prior to loading into the catheter, so that once the device is deployed, in situ liquid will cause the hydrogel to swell. The properties of the different materials complement each other. For 25 example, in the time immediately after valve deployment it is important that the material swells quickly to seal perivalvular leaks as soon as possible. Mechanical strength may be compromised in the short term to enable fast swelling. In the long term, however, it is paramount that the seal has high mechanical strength. In some embodiments, the mechanical strength of the 22 30 hydrogel(s) is from about 0.0005 N/mm to about 0.025 N/mm 2 , preferably from 30 about 0.002 N/mm2 to about 0.0 12 N/mm 2 . The mechanical strength should be high enough to allow swelling and thereby "actively" conform to the gaps leading to leakage but not high enough to disturb the physical or functional integrity of the prosthesis or implant or to push the prosthesis or implant away 5 from the wall. Another important consideration is that the mechanical strength' should not be so high as to exert excess pressure on the anatomy, particularly around the Left Bundle Branch (LBB), which is responsible for the cardiac conduction. If excess pressure is exerted a cardiac conduction abnormality known as the Left Bundle Branch Block (LBBB) may occur. Typically, it is 10 taken into consideration that the outward pressure exerted on the anatomy by the swelling of the hydrogel is less than that exerted by the prosthesis or implant. A degradable material, which may be a hydrogel, that swells quickly, may be used in conjunction with a nondegradable material, which may be a hydrogel, that swells slower but has higher mechanical strength. In the short 15 term, the degradable material capable of rapid swelling will quickly seal the perivalvular leak. Over time, this material degrades and will be replaced by the material exhibiting slower swelling and higher mechanical strength. Eventually, the seal will be composed of the slower swelling nondegradable material. It is also possible to use only one material in the seal, but in two or more different 20 forms. For example, two different crystal sizes of hydrogels may be used in the seal, because different particle sizes of hydrogel may exhibit different properties. 2. Foams and Sponges Alternatively, a foam generated prior to implantation can also be used as 25 a swellable material to form a seal. For example, a suitable matrix, such as a biocompatible polymer or crosslinkable prepolymer, may be blended with one or more foaming agents. Foaming agents include compounds or mixtures of compounds which generate a gas in response to a stimulus. When dispersed within a matrix and exposed to a stimulus, the foaming agents evolve a gas, 30 causing the matrix to expand as fine gas bubbles become dispersed within the 31 matrix. Examples of suitable foaming agents include compounds which evolve a gas when hydrated with biological fluids, such as mixture of a physiologically~ acceptable acid (e.g., citric acid or acetic acid) and a physiologically acceptable base (e.g., sodium bicarbonate or calcium carbonate). Other suitable foaming 5 agents are known in the art, and include dry particles containing pressurized gas, such as sugar particles containing carbon dioxide (see, U.S. Patent No. 3,012,893) or other physiologically acceptable gases (e.g., nitrogen or argon), and pharmacologically acceptable peroxides. Other examples include changing the morphology of known hydrogel 10 materials in order to decrease swelling times. Means for changing the morphology include increasing the porosity of the material, for example, by freeze-drying or porogen techniques. For example, particles can be produced by spray drying by dissolving a biocompatible material such as a polymer and surfactant or lipid in an appropriate solvent, dispersing a pore forming agent as a 15 solid or as a solution into the solution, and then spray drying the solution and the pore forming agent, to form particles. The polymer solution and pore forming agent are atomized to form a fine mist and dried by direct contact with hot carrier gases. Using spray dryers available in the art, the polymer solution and pore forming agent may be atomized at the inlet port of the spray dryer, passed 20 through at least one drying chamber, and then collected as a powder. The temperature may be varied depending on the gas or polymer used. The temperature of the inlet and outlet ports can be controlled to produce the desired products. The size and morphology of the particles formed during spray drying is a function of the nozzle used to spray the solution and the pore forming agent, 25 the nozzle pressure, the flow rate of the solution with the pore forming agent, the polymer used, the concentration of the polymer in solution, the type of polymer solvent, the type and the amount of pore forming agent, the temperature of spraying (both inlet and outlet temperature) and the polymer molecular weight. Generally, the higher the polymer molecular weight, the larger the particle size, 30 assuming the polymer solution concentration is the same. 32 Typical process parameters for spray drying are as follows: inlet temperature=30-200*C, outlet temperature=5- I 00*C, and polymer flow rate= 10 5,000 mI/min. Pore forming agents are included in the polymer solution in an amount of between 0.01% and 90% weight to volume of polymer solution, to 5 increase pore formation. For example, in spray drying, a pore forming agent such as a volatile salt, for example, ammonium bicarbonate, ammonium acetate. ammonium carbonate, ammonium chloride or ammonium benzoate or other volatile salt as either a solid or as a solution in a solvent such as water can be used. The solid pore forming agent or the solution containing the pore forming 10 agent is then emulsified with the polymer solution to create a dispersion or droplets of the pore forming agent in the polymer. This dispersion or emulsion is then spray dried to remove both the polymer solvent and the pore forming agent. After the polymer is precipitated, the hardened particles can be frozen and lyophilized to remove any pore forming agent not removed during the polymer 15 precipitation step. Fast swelling can be achieved by preparing small particles of dried hydrogels. The extremely short diffusion path length of microparticles makes it possible to complete swelling in a matter of minutes. Large dried hydrogels can be made to swell rapidly regardless of their size and shape by creating pores that 20 are interconnected to each other throughout the hydrogel matrix. The interconnected pores allow for fast absorption of water by capillary force. A simple method of making porous hydrogel is to produce gas bubbles during polymerization. Completion of polymerization while the foam is still stable results in formation of superporous hydrogels. Superporous hydrogels can be 25 synthesized in any molds, and thus, three-dimensional structure of any shape can be easily made. The size of pores produced by the gas blowing (or foaming) method is in the order of 100 mm and larger. If any portion of a superporous hydrogel is in contact with water or an aqueous medium, water is absorbed immediately through the open channels to 33 fill the whole space. This process makes the dried superporous hydrogels-swell very quickly. Expandable sponges or foams can also be used for sealing of surgical implantations. These sponges or foams and be cut into a strips or annular shapes 5 and either dried down or dehydrated by other means and then be allowed to rapidly re-hydrate once the device is in place. Alternatively, such materials can be hydrated and then squeezed to reduce their volume to allow these to be attached to the surgical implement and then allowed to expand to form a seal once the surgical implement is in place. Such swelling would be nearly instant. 10 One further benefit of sealing material in the form of sponges or foams is that their expansion can be reversible so that they can easier be retracted from their implanted position back into the delivery catheter and thereby enable complete re-positioning of the device multiple times and/or complete retrievability of the device. Such sponges and foams can be made from a range of materials 15 including, but not limited to, synthetic polymers, natural polymers or mixtures thereof. Such materials can be formed by including pore forming substances such as gas or immiscible solvents in the monomer/polymer mix prior to polymerization and/or cross-linking. By using the appropriate monomers and/or polymeric cross-linkers such sponges/foams can be made to withstand cyclic 20 stress; such materials could also further be reinforced with compatible fibres or whiskers to increase strength and reduce the probability for breakage. In some embodiments, these sponges or foams can be chemically attached to a base membrane or mesh used to encapsulate the sponge/foam before being fitted to the surgical device. This could be done by attaching either 25 allylic or acrylic groups to the base substrate, either as small molecules or as long chain tentacles anchoring the expandable to the substrate preventing release of smaller particles in case of fracture. Foams may be designed to expand without the need for the semi permeable membrane. 34 C. The support member or skeleton The seal may be sufficiently flexible to conform to irregularities between the endoluminal prosthesis and a vessel wall. The band of material may include a mesh-like or a generally ring-like structure configured to receive at least a 5 portion of an endoluminal prosthesis such that it is positioned between the portion of the prosthesis and a vessel wall. This is usually referred to as a skeleton or support member. As shown in Figures 4A-4C, the seal 12 has a stent/metal backing or skeleton 26. The skeleton 26 provides structure and enables crimping, loading 10 and deployment. The skeleton 26 can be either a balloon expanding or a self expanding stent. The skeleton 26 is attached to the surface of the outer membrane 20. When the support member is in the second reduced radial configuration, it may form a substantially helical configuration. The helical structure of the 15 support member provides an internal passage therein to receive at least a portion of an endoluminal prosthesis. The support member may include steel such as MP35N, SS316LVM, or L605, a shape memory material or a plastically expandable material. The shape memory material may include one or more shape memory alloys. In this embodiment, movement of the shape memory 20 material in a pre-determined manner causes the support member to move from the first reduced radial configuration to the second increased radial configuration. The shape memory material may include Nickel-Titanium alloy (Nitinol). Alternatively, the shape memory material-may include alloys of any one of the following combinations of metals: copper-zinc-aluminium, copper 25 aluminium-nickel, copper-aluminium-nickel, iron-manganese-silicon chromium-manganese and copper-zirconium. Additionally, titanium-palladium nickel, nickel-titanium-copper, gold-cadmium, iron-zinc-copper-aluminium, titanium-niobium-aluminium, uranium-niobium, hafnium-titanium-nickel, iron manganese-silicon, nickel-iron-zinc-aluminium, copper-aluminium-iron, 30 titanium-niobium, zirconium-copper-zinc, nickel-zirconium-titanium. 35 At least part of the support member may also include any one of the following combinations of metals: Ag-Cd 44/49 at.% Cd; Au-Cd 46.5/50 at.% Cd; Cu-Al-Ni 14/14.5 wt.% Al and 3/4.5 wt.% Ni, Cu-Sn approx. 15 at.% Sn, Cu-Zn 38.5/41.5 wt.% Zn, Cu-Zn-X (X= Si, Al, Sn), Fe-Pt approximately 25 at 5 % Pt, Mn-Cu 5/35 at.% Cu, Pt alloys, Co-Ni-Al, Co-Ni-Ga, Ni-Fe-Ga, Ti-Pd in various concentrations, Ni-Ti (approximately 55% Ni). The shape memory material of the support member may act as a spine along the length of the support member. The plastically-expandable or balloon-expandable materials may include 10 stainless steel (316L, 316LVM, etc.), Elgiloy, titanium alloys, platinum-iridium alloys, cobalt chromium alloys (MP35N, L605, etc.), tantalum alloys, niobium alloys and other stent materials. The support member may be composed of a biocompatible polymer such as polyether or polyester, polyurethanes or polyvinyl alcohol. The material may 15 further include a natural polymer such as cellulose ranging from low to high density, having small, large, or twin pore sizes, and having the following features: closed or open cell, flexible or semi-rigid, plain, melamine, or post treated impregnated foams. Additional materials for the support member include polyvinyl acetal sponge, silicone sponge rubber, closed cell silicone 20 sponges, silicone foam, and fluorosilicone sponge.. Specially designed structures using vascular graft materials such as PTFE, PET and woven yarns of nylon, may also be used. At least part of the support member may be composed of a permeable mateHal. Alternatively, at least part of the support member may be semi 25 permeable. In a further embodiment, at least part of the support member may be composed of an impermeable material. The support member may further include semi-permeable membranes made from a number of materials. Example include polyimide, phospholipid bilayer, thin film composite membranes (TFC or.TFM), cellulose ester 36 membrane (CEM), charge mosaic membrane (CMM), bipolar membrane (BPM) or anion exchange membrane (AEM). The support member may include at least a porous region to provide a matrix for tissue in-growth. The region may further be impregnated with an 5 agent to promote tissue in-growth. The support member itself may be impregnated with the agent or drug. The support member may further include individual depots of agent connected to or impregnated in an outer surface thereof. In one embodiment wherein the support member includes one or more capsules, the agent may be released by rupturing of the capsule. Whether the 10 agent is held in capsules, depots, in a coating or impregnated in the material of the support member, a number of different agents may be released from the support member. For example,'in an embodiment wherein the support member includes a capsule, the capsule may include an annular compartment divided by a frangible wall to separate the compartment into two or more sub 15 compartments. A different agent may be held in each sub-compartment. In one embodiment, the annular compartment may be divided longitudinally with at least one inner sub-compartment and at least one outer sub-compartment. Alternatively, the capsule may be divided radially into two or more sub compartments. The sub-compartments may be concentric relative to one 20 another. In the embodiment wherein the capsule is segmented, the different compartments may hold different agents therein. The support member may have hooks, barbs or similar/other fixation means to allow for improved/enhanced anchoring of the sealing device to the vasculature. In addition, the support member may serve as the "landing zone" 25 for the device when there may be the need to position the device in a more reinforced base structure, for example, in the case of valves where there is insufficient calcification for adquate anchoring, short and angulated necks of abdominal and thoracic aortic aneurysms, etc. In all embodiments, the support member may be connected to a graft or 30 stent by a tethering member. The tethering member may be made of an 37 elastomeric material. Alternatively, the tethering member may be non elastomeric and have a relatively fixed length or an appropriately calculated one for desired activation mechanism. In embodiments where a device support member includes a capsule, the 5 capsule may include a single annular compartment within the support member. In this embodiment, when the support member is in its second increased radial configuration, the capsule extends completely around the periphery of the endoluminal prosthesis. Alternatively, the capsule may only partially extend around the periphery of the prosthesis. Two or more capsules may extend 10 around the prosthesis. In other embodiments, shown in Figures 6A-6D, the capsule 80 may have an accordion-like structure to allow for wider, deeper expansion into the potential leak sites and also keep more room for expansion with any vascular re modeling and thereby ensure constant and durable sealing. This can be 15 positioned within the support structure 82 as shown in Figures 6A-6B or on the exterior of the support structure 82 as shown in Figures 6C-6D. D. Therapeutic, Prophylactic or Diagnostic Agents It can be advantageous to incorporate one or more therapeutic, prophylactic or diagnostic agents ("agent") into the device, either by loading the 20 agent(s) into or onto the structural or sealing material. The rate of release of agent may be controlled by a number of methods including varying the following the ratio of the absorbable material to the agent, the molecular weight of the absorbable material, the composition of the agent, the composition of the absorbable polymer, the coating thickness, the number of coating layers and 25 their relative thicknesses, the agent concentration, and/or physical or chemical binding or linking of the agents to the device or sealing material. Top coats of polymers and other materials, including absorbable polymers, may also be applied to control the rate of release. Exemplary therapeutic agents include, but are not limited to., agents that 30 are anti-inflammatory or immunomodulators, antiproliferative agents, agents 38 which affect migration and extracellular matrix production, agents which affect platelet deposition or formation of thrombis, and agents that promote vascular healing and re-endothelialization, described in Tanguay et a!. Current Status of Biodegradable Stents, Cardiology Clinics, 12:699-713 (1994), J. E. Sousa, P. W. 5 Serruys and M. A. Costa, Circulation 107 (2003) 2274 (Part 1), 2283 (Part II), K. J. Salu, J. M. Bosmans, H. Bult and C. J. Vrints, Acta Cardiol 59 (2004) 5 1. Examples of antithrombin agents include, but are not limited to, Heparin (including low molecular heparin), R-Hirudin, Hirulog, Argatroban, Efegatran, Tick anticoagulant peptide, and Ppack. 10 Examples of antiproliferative agents include, but are not limited to, Paclitaxel (Taxol), QP-2 Vincristin, Methotrexat, Angiopeptin, Mitomycin, BCP 678, Antisense c-myc, ABT 578, Actinomycin-D, RestenASE, 1 -Chlor deoxyadenosin, PCNA Ribozym, and Celecoxib. Agents modulating cell replication/proliferation include targets of 15 rapamycin (TOR) inhibitors (including sirolimus, everolimus and ABT-578), paclitaxel and antineoplastic agents, including alkylating agents (e.g., cyclophosphamide, mechlorethamine, chlorambucil, melphalan, carmustine, lomustine, ifosfamide, procarbazine, dacarbazine, temozolomide, altretamine, cisplatin, carboplatin and oxaliplatin), antitumor antibiotics (e.g., bleomycin, 20 actinomycin D, mithramycin, mitomycin C, etoposide, teniposide, amsacrine, topotecan, irinotecan, doxorubicin, daunorubicin, idarubicin, epirubicin, mitoxantrone and mitoxantrone), antimetabolites (e.g., deoxycoformycin, 6 mercaptopurine, 6-thioguanine, azathioprine, 2-chlorodeoxyadenosine, hydroxyurea, methotrexate, 5-fluorouracil, capecitabine, cytosine arabinoside, 25 azacytidine, gemcitabine, fludarabine phosphate and aspariginase), antimitotic agents (e.g., vincristine, vinblastine, vinorelbine, docetaxel, estramustine) and molecularly targeted agents (e.g., imatinib, tretinoin, bexarotene, bevacizumab, gemtuzumab ogomicin and denileukin diftitox). Examples of anti-restenosis agents include, but are not limited to, 30 immunomodulators such as Sirolimus (Rapamycin), Tacrolimus, Biorest, 39 Mizoribin, Cyclosporin, Interferon .gamma. I b, Leflunomid, Trani last, Corticosteroide, Mycophenolic acid and Biphosphonate. Examples of anti-migratory agents and extracellular matrix modulators include, but are not limited to Halofuginone, Propyl-hydroxylase-Inhibitors, C 5 Proteinase-Inhibitors, MMP-Inhibitors, Batimastat, Probucol. Examples of antiplatelet agents include, but are not limited to, heparin. Examples of wound healing agents and endothelialization promoters include vascular epithelial growth factor ("VEGF"), 17-Estradiol. Tkase Inhibitors, BCP 671, Statins, nitric oxide ("NO")-Donors, and endothelial 10 progenitor cell ("EPC")-antibodies. Other active agents may be incorporated. For example, in urological applications, antibiotic agents may be incorporated into the device or device coating for the prevention of infection. In gastroenterological and urological applications, active agents may be incorporated into the device or device coating 15 for the local treatment of carcinoma. The agent(s) released from the seal or support member may also include tissue growth promoting materials, drugs, and biologic agents, gene-delivery agents and/or gene-targeting molecules, more specifically, vascular endothelial growth factor, fibroblast growth factor, hepatocyte growth factor, connective 20 tissue growth factor, placenta-derived growth factor, angiopoietin- I or granulocyte-macrophage colony-stimulating factor. Agents for modulating cellular behaviour include microfibrillar collagen, fibronectin, fibrin gels, synthetic Arg-Gly-Asp (RGD) adhesion peptides, tenascin-C, Del-1, CCN family (e.g., Cyr6l) hypoxia-inducible factor-1,acetyl choline receptor agonists 25 and monocyte chemoattractant proteins. Gene delivery agents include viral vectors for gene delivery (e.g., adenoviruses, retroviruses, lentiviruses, adeno associated viruses) and non-viral gene delivery agents/methods (e.g., polycation polyethylene imine, functional polycations, consisting of cationic polymers with cyclodextrin rings or DNA within crosslinked hydrogel microparticles, etc.). 40 In one embodiment the one or more agents may include monoclonal antibodies. For example the monoclonal antibody may be an angiogenesis inhibitor such as Bevacizumab or have anti-inflammatory properties. Further examples of specific monoclonal antibodies include, but are not limited to, 5 Adalimumab, Basiliximab, Certolizumab pegol, Cetuximab Daclizumab, Eculizumab, Efalizumab, Gemtuzumab, Ibritumomab tiuxetan, Infliximab Muromonab-CD3, Natalizumab, Omalizumab, Palivizumab, Panitumumab, Ranibizumab, Rituximab, Tositumomab or Trastuzumab. The agent(s) may be steroids such as corticosteroids, estrogens, 10 androgens, progestogens and adrenal androgens. The agent(s) may include antiplatelet, antithrombotic and fibrinolytic agents such as glycoprotein Ilb/Illa inhibitors, direct thrombin inhibitors, heparins, low molecular weight heparins, platelet adenosine diphosphate (ADP) receptor inhibitors, fibrinolytic agents (e.g., streptokinase, urokinase, recombinant tissue plasminogen activator, 15 reteplase and tenecteplase, etc). Additionally, gene targeting molecules such as small interference RNA, micro RNAs, DNAzymes and antisense oliogonucleotides, or cells such as progenitor cells (e.g., endothelial progenitor cells, CD34+ or CD133+monocytes, hemopoietic stem cells, mesenchymal stem cells, 20 embryonic stem cells, multipotent adult progenitor cells and inducible pluripotent stem cells) and differentiated cells (e.g., endothelial cells, fibroblasts, monocytes and smooth muscle cells) may be agent(s). Furthermore, drug delivery agents like mucoadhesive polymers (e.g., thiolated polymers), or pharmacologic agents of local treatment of atherosclerosis such as high density 25 lipoprotein cholesterol (HDL), HDL mimetics, heme oxygenase-l inducers (e.g. probucol and its analogues, resveratol and its analogues), hydroxymethylglutaryl CoA (HMG-CoA) reductase inhibitors and fibrates (including fenofibrate, gemfibrozil, clofibrate etc) may be included agents. The agent(s) may also modulate cellular behavior in relation to 30 bioprosthesis, such as microfibrillar collagen, fibronectin, fibrin gels, synthetic 41 Arg-Gly-Asp (RGD) adhesion peptides, tenascin-C, Del-I, CCN family (e.g., Cyr61) hypoxia-inducible factor-I, acetyl choline receptor agonists and monocyte chemoattractant proteins. It may also be advantageous to incorporate in or on the device a contrast 5 agent, radiopaque markers, or other additives to allow the device to be imaged in vivo for tracking, positioning, and other purposes. Such additives could be added to the absorbable composition used to make the device or device coating, or absorbed into, melted onto, or sprayed onto the surface of part or all of the device. Preferred additives for this purpose include silver, iodine and iodine 10 labeled compounds, barium sulfate, gadolinium oxide, bismuth derivatives, zirconium dioxide, cadmium, tungsten, gold tantalum, bismuth, platinum, iridium, and rhodium. These additives may be, but are not limited to, mircro- or nano-sized particles or nano particles. Radio-opacity may be determined by fluoroscopy or by x-ray analysis. 15 In some embodiments, one or more low molecular weight drug such as an anti-inflammatory drug are covalently attached to the hydrogel forming polymer. In these cases, the low molecular weight drug such as an anti inflammatory drug is attached to the hydrogel forming polymer via a linking 20 moiety that is designed to be cleaved in vivo. The linking moiety can be designed to be cleaved hydrolytically, enzymatically, or combinations thereof, so as to provide for the sustained release of the low molecular weight drug in vivo. Both the composition of the linking moiety and its point of attachment to the drug are selected so that cleavage of the linking moiety releases either a drug 25 such as an anti-inflammatory agent, or a suitable prodrug thereof. The composition of the linking moiety can also be selected in view of the desired release rate of the drug. Linking moieties generally include one or more organic functional groups. Examples of suitable organic functional groups include secondary 30 amides (-CONH-), tertiary aides (-CONR-), secondary carbamates (-OCONH 42 -NHCOO-), tertiary carbamates (-OCONR-; -NRCOO-), ureas (-NHCONH-; NRCONH-; -NHCONR-, -NRCONR-), carbinols (-CHOH-, -CROH-), disulfide groups, hydrazones, hydrazides, ethers (-0-), and esters (-COO-, -CH 2 0 2 C-,

CHRO

2 C-), wherein R is an alkyl group, an aryl group, or a heterocyclic group. 5 In general, the identity of the one or more organic functional groups within the linking moiety can be chosen in view of the desired release rate of the anti inflammatory agents. In addition, the one or more organic functional groups can be chosen to facilitate the covalent attachment of the anti-inflammatory agents to the hydrogel forming polymer. In preferred embodiments, the linking moiety 10 contains one or more ester linkages which can be cleaved by simple hydrolysis in vivo to release the anti-inflammatory agents. In certain embodiments, the linking moiety includes one or more of the organic functional groups described above in combination with a spacer group. The spacer group can be composed of any assembly of atoms, including 15 oligomeric and polymeric chains; however, the total number of atoms in the spacer group is preferably between 3 and 200 atoms, more preferably between 3 and 150 atoms, more preferably between 3 and 100 atoms, most preferably between 3 and 50 atoms. Examples of suitable spacer groups include alkyl groups, heteroalkyl groups, alkylaryl groups, oligo- and polyethylene glycol 20 chains, and oligo- and poly(amino acid) chains. Variation of the spacer group provides additional control over the release of the drug in vivo. In embodiments where the linking moiety includes a spacer group, one or more organic functional groups will generally be used to connect the spacer group to both the drug and the hydrogel forming polymer. 25 In certain embodiments, the one or more drugs are covalently attached to the hydrogel forming polymer via a linking moiety which contains an alkyl group, an ester group, and a hydrazide group. By way of exemplification, Figure I illustrates conjugation of the anti-inflammatory agent dexamethasone to alginate via a linking moiety containing an alkyl group, an ester group 30 connecting the alkyl group to the anti-inflammatory agent, and a hydrazide 43 group connecting the alkyl group to carboxylic acid groups located on the alginate. In this embodiment, hydrolysis of the ester group in vivo releases dexamethasone at a low dose over an extended period of time. Reactions and strategies useful for the covalent attachment of drugs to 5 hydrogel forming polymers are known in the art. See, for-example, March, "Advanced Organic Chemistry." 5 th Edition, 2001, Wiley-nterscience Publication, New York) and Hermanson, "Bioconjugate Techniques," 1996, Elsevier Academic Press, U.S.A. Appropriate methods for the covalent attachment of a given drug can be selected in view of the linking moiety desired, 10 as well as the structure of the anti-inflammatory agents and hydrogel forming polymers as a whole as it relates to compatibility of functional groups, protecting group strategies, and the presence of labile bonds. The seal can further serve as a porous matrix for tissue in-growth and can aid in promoting tissue in-growth, for example, by adding growth factors, 15 etc. This should improve the long-term fixation of the endoluminal prosthesis. For example, the seal can be impregnated with activators (e.g., adhesive activator) that induce rapid activation of the agent (e.g., a tissue adhesive) after the agent has been released from the capsule. In other embodiments, however, the seal can be composed of different materials and/or include different features. 20 The agent(s) in the capsule can include adhesive materials, tissue growth promoting materials, sealing materials, drugs, biologic agents, gene-delivery agents, and/or gene-targeting molecules. In another embodiment, the one or more agent may be sheathed for delivery to a target site. Once positioned at the target site, the one or more agent may be unsheathed to enable release to the 25 surrounding environment. This embodiment may have particular application for solid or.semi-solid state agents. Adhesives that may be used to aid in securing the seal to the lumen, or to the device to be implanted include one or more of the following cyanoacrylates (including 2-octyl cyanoacrylate, n-butyl cyanoacrylate, iso-butyl-cyanoacrylate 30 and methyl-2- and ethyl-2-cyanoacrylate), albumin based sealants, fibrin glues, 44 resorcinol-formaldehyde glues (e.g., gelatin-resorci no I-formaldehyde), ultraviolet-(UV) light-curable glues (e.g., styrene-derivatized (styrenated) gelatin, poly(ethylene glycol) diacrylate (PEGDA), carboxylated camphorquinone in phosphate-buffered saline (PBS), hydrogel sealants-eosin 5 based primer consisting of a copolymer of polyethylene glycol with acrylate end caps and a sealant consisting of polyethylene glycol and polylactic acid, collagen-based glues and polymethylmethacrylate. E. Additional encapsulation of sealing means for increased shelf life 10 The seal may be sterile packaged for distribution and use. In the alternative, it may be packaged as part of, or in a kit with, the device it is designed to seal, such as a TAV or stent. This additional encapsulation prevents the activation of the expandable material during storage within solutions (e.g. glutaraldehyde, alcohol) by acting as a 100% moisture barrier. I5 Heart valves, both transcatheter and surgical, are stored in glutaraldehyde or similar solutions primarily to preserve the tissue component of the device. Before the device is implanted, it is prepared for implantation by removing it from the solution and rinsing it thoroughly so that all the glutaraldehyde is washed off. 20 Although the outer impermeable layer of the sealing device/capsule is meant to prevent any penetration of water from the glutaraldehyde into the capsule, there is a likelihood that the thickness may be insufficient given the profile constraints and as a result there may only be a limited shelf-life that may be obtained. In order to obtain an increased shelf-life where the encapsulated 25 expandable material remains in its desirable unexpanded state until introduced within the body, an additional impermeable layer may be needed. This additional impermeable layer is not required once the device is removed out of the storage solution, and is rinsed to wash all the glutaraldehyde away. This will typically be removed after removing the device from the storage fluid and just before 30 implantation. 45 To make the sealing means low profile, the thickness of the outer and inner membranes has to be kept to the minimum. If the sealing device is stored submerged in a solution, as in the case with transcatheter valves, for its shelf life, the low profile, thin membranes may allow moisture to permeate through 5 them and thereby risk the premature activation of the sealing means. Therefore, an additional means is necessary to ensure the appropriate shelf-life of the sealing device can be obtained. As shown in Figures 7A-7D and 8, this additional means can be an additional layer 92 of encapsulation over the "impermeable" outer membrane 10 94. This additional layer 92 may be much thicker and may be laminated by metallic layers several microns in thickness to make it 100% moisture impermeable. This additional encapsulation layer is removable and is designed to have a mechanism which enables easy peeling of the hermetic sealing capsule/layer 15 so that this layer can be removed just before loading and crimping of the prosthesis into the delivery catheter, before it is delivered into the vasculature. The layer can be removed using different means, including peeling off, cracking off, melting off, vapouring off after the rinsing process is complete and the device is ready to load. 20 The additional encapsulation layer may be designed with a mechanism so that it can be attached to the device assembly with the sealing means during the assembly process by suturing or other appropriate means such that the removal process insures that integrity of the sealing means and its assembly with the base device remains completely intact. 25 A moisture impermeable film composite comprises a combination of polymer films, metalized polymer films and metal films. The polymer layers can be comprised of, but not limited to; Polyether ether ketone (PEEK), Polyethylene terephthalate (PET), Polypropylene (PP), Polyamide (PI), Polyetherimide (PEI) or Polytetrafluroethylene (PTFE). Polymer films may or 30 may not be mineral filled with either glass or carbon. Polymer films will have a 46 thickness of 6um or above. Metal films and coatings include aluminum, stainless steel, gold, mineral filled (glass & carbon) and titanium with a thickness of 9um or above. Coatings can be applied with processes such as plasma vapor deposition, press lamination, vacuum deposition, and co-extrusion. Metal films 5 can be laminated to polymer films via press lamination. E. Devices for Placement of Devices with Sealing Means Embodiments which position seal at time of implant In a preferred embodiment, the sealing means is positioned posterior to the prosthetic implant, and is expanded or pulled up into a position adjacent to 10 the implant at the time of sealing. This is achieved using sutures or elastic means to pull the seal up and around the implant at the time of placement, having a seal that expands up around implant, and/or crimping the seal so that it moves up around implant when implant comes out of introducer sheath. This is extremely important with large diameter implants such as aortic valves, which 15 are already at risk of damage to the blood vessel walls during transport. A key feature of the latter embodiment of the seal technology is that it enables preservation of the crimped profile of the endoluminal prosthesis. The seal technology is crimped distal or proximal to the prosthesis. In one aspect of this technology, the seal is aligned with the prosthesis by expansion of the seal. 20 In another aspect, the seal zone of the prosthesis is aligned with the seal zone prior to expansion of the prosthesis by use of activation members. In yet another embodiment, the seal is aligned with the seal zone of the prosthesis prior to prosthesis expansion by use of activation members, which can be made of an elastic or non-elastic material. 25 In a further embodiment, the endoluminal device may further include one or more engagement members. The one or more engagement members may include staples, hooks or other means to engage with a vessel wall, thus securing the device thereto. As shown in Figures I IA and 11B, self-aligning support members 82 30 made ofNitinol eliminate the use of attachment sutures within the catheter 80. 47 The dual-membrane capsule containing the hydrogel can be attached to these members and is activated with the expansion of the prosthesis. The self-aligning members 82 can be directly laser-cut as part of the prosthesis frame 84 or can be connected using sutures. The primary advantage of this mechanism is that it 5 eliminates any failure mode with the "activation member" (sutures, etc.) that enables the alignment of the capsule with the distal/proximal/middle section of the prosthesis. Mechanisms for Deployment and Retrieval In yet another embodiment, a mechanism enables both deployment and 10 retrieval of the system. This is particularly important from the ease of use and placement accuracy perspective. This feature enables the physician to change/alter the placement of the device in vivo if it was not properly positioned in the first attempt. Also, in the event of some complication during the operation, the physician can completely retrieve the device out of the patient 15 (even after the "expandable material" has completely expanded). The key features when used with a self-expanding prosthesis: 1. system re-positionability (if the prosthesis is partially retrieved back in the catheter) - that enables accurate/precise placement if the device in the anatomy 2. system retrievability (both the prosthesis and the els SEAL capsule can be 20 completely captured back into the catheter and retrieved out of the body). III. Methods of Use The device and seal can be utilized for sealing in a variety of tissue lumens, including cardiac chambers, cardiac appendages, cardiac walls, cardiac valves, arteries, veins, nasal passages, sinuses, trachea, bronchi, oral cavity, 25 esophagus, small intestine, large intestine, anus, ureters, bladder, urethra, vagina, uterus, fallopian tubes, biliary tract or auditory canals. In operation, the endoluminal prosthesis is positioned intravascularly within a patient so that the prosthesis is at a desired location along a vessel wall. A balloon or other expandable member is then expanded radially from within the endoluminal 30 prosthesis to press or force the apparatus against the vessel wall. As the balloon 48 expands, the activation wire is triggered, rupturing the capsule and causing the seal to swell, and in some embodiment, releasing agents. In one embodiment, the agent includes an adhesive material and when the capsule ruptures, the adhesive material flows through the pores of the seal. As discussed above, the 5 seal can control the flow of the adhesive to prevent embolization of the adhesive material. In specific embodiments, the device may be used to seal a graft or stent within an aorta of a patient. In a further embodiment, the device may be used to seal an atrial appendage. In this embodiment, the device may deliver an agent to 10 effect the seal of a prosthetic component across the opening to the atrial appendage. In a further embodiment, the device may be used to seal a dissection in a vessel. In this embodiment, the support member is positioned adjacent the opening of the false lumen and an intraluminal stent subsequently delivered 15 thereto. Upon radial expansion of the stent, the support member is caused to release adhesive therefrom to seal the tissue creating the false lumen against the true vessel wall. In a further embodiment, the device is used to seal one or more emphysematous vessels. 20 In a still further embodiment, the device may be used to seal an artificial valve within a vessel or tissue structure such as the heart. An example includes the sealing of an artificial heart valve such as a TAV. It is envisaged that the seal provided by the present device will prevent paravalvular leaks. As shown in Figures 4A-4C, the activation of the polymer 22 within the 25 seal 12 takes place when a section of the outer membrane 20 is ruptured at the designated rupture point 24 using the activation wire 16. This is shown in Figure 4A. prior to rupture where the seal 12 is relatively flat; the designated rupture site 24 is opened as shown in Figure 4B, then the seal 12 is-expanded, as shown in Figure 4C. The rupture site 24 is formed by weakening the surface of 30 the membrane 20 at the site 24 using means such as a laser to partially cut into 49 or perforate the membrane 20. An activation wire 16 is secured to the rupture site 24 by means of an adhesive, suture, or restraining means such as a brad, rivet, staple or clamp. The rupture site 24 is opened at a pre-determined pressure or location by pulling of the active wire, typically connected to the 5 prosthesis or a part of the placement catheter Figures 5A-5E depict a. method to crimp and load the device with the "activation wire" 16. The activation wire 16 has to be shortened in length during the crimping/loading process so that the "activation or rupture" can be triggered during deployment/placement of the device. Before crimping/loading the 10 activation wire 16 is long enough so that the "activation mechanism" is far from activation and the hydrogel in the seal 14 can remain completely sealed/de activated during storage and shelf-life. The metal crimp is used to shorten the length of the activation wire 16 during the crimping/loading procedure. During storage the metal crimp in the 15 "uncrimped" state and after the completion of the insertion of the device into the catheter it is "crimped" and the excess activation wire 16 is cut off. After this step the final steps of completely loading the TAV device in the catheter are completed and the device is ready to be inserted into the patient. The device with seal is inserted in a manner typical for the particular 20 device. After reaching the implantation site, the seal is ruptured and the seal expands to seal the site. The guidewire and insertion catheter are then withdrawn and the insertion site closed. Figures 9A-9D are diagrams of the placement of a Sapien valve 50 with and without the disclosed sealing means 52. When the Sapien valve 50 is placed 25 too low into the LVOT leading to the graft skirt not completely apposing against the vasculature (Figure 9A), perivalvular leaking will occur from the gaps/area above the skirt and around the device, through the open cells of the stent (Figure 9B). As shown in Figure 9C, the Sapien valve 50 with sealing means 52, even when placed too low into the LVOT, seals the valve 50 uniformly against the 30 inner wall of the LVOT. Figure 9D shows how no perivalvular leak occurs 50 when the seal 52 is in place, preventing the "leaking" blood from going back into the left ventricle. Analogous results are obtained with the SJM/Medtronic TAV device. Figure 1 OA shows a correctly placed SJM/Medtronic TAV device 60. Figure 5 10B depicts an incorrectly placed SJM/Medtronic TAV device 60, resulting in PV leaks. Figure 1 OC shows how perivascular leaks are prevently with an incorrectly placed SJM/Medtronic TAV device 60 with sealing means 62. Figures 6A-6B are perspective views of a seal that is placed inside of the TAV device. Figures 6C-6D are perspective views of a seal that is 10 placed on the exterior of the TAV device. Figure 6E shows the seal placed on the inside of the device such that the outer impermeable membrane is moulded to the stent scaffold and protrudes from within, in alignment with the stent pattern, while the inner permeable membrane remains in abutment with the inner circumference of the device. Hydrogels expand and cause the balloons to pop 15 out. Figures 7A-7D are perspective views of an impermeable sealing system to protect the implantable device during storage in a preservative solution such as glutaraldehyde, seals in place (Figure 7A); exterior seal being removed (Figure 7B); exterior seal removed and interior seals being removed (Figure 7C, 20 7D). Figure 8 is a cross-sectional view of the exterior and interior seals of Figures 7A-7D. As discussed above with reference to Figures 1 IA and I IB, self-aligning support members 82 made of Nitinol eliminate the use of attachment sutures within the catheter 80. The dual-membrane capsule containing the hydrogel can 25 be attached to these members and is activated with the expansion of the prosthesis. The self-aligning members 82 can be directly laser-cut as part of the prosthesis frame 84 or can be connected using sutures. The primary advantage of this mechanism is that it eliminates any failure mode with the "activation member" (sutures, etc.) that enables the alignment of the capsule with the 30 distal/proximal/middle section of the prosthesis. This embodiment allows 51 placement of the device and sealing at the same time, and insures proper alignment of the device at the time of implantation. As shown in Figures 12A-12F, the self-expanding TAV prosthesis frame 90 is released from the catheter 94 during deployment. Self-aligning support 5 members 92 after release from the catheter "flip" and align themselves (and anything attached to it) to the base of the TAV prosthesis. The steps are followed in the reverse order during retrieval. Figures 13A-13E show the deployment of a TAV device I 10 using attachment sutures 112 that pull the seal 114 into place adjacent the device 10 frame 116 at the time of implantation. The seal may be sterile packaged for distribution and use. In the alternative, it may be packaged as part of, or in a kit with, the device it is designed to seal, such as a TAV or stent. . The present invention will be further understood by reference to the 15 following non-limiting examples. Example 1: Preparation of Hydrogel with Rapid Swelling Studies to identify hydrogels having substantial swelling in a short time were performed. The main factors that influence swelling of a hydrogel based on polymerisation and cross-linking of synthetic monomers are: 20 Type of monomer Type of cross-linker Concentration of monomer and cross-linker in the gel The ratio of monomer to cross-linker Acrylic acid polymers are capable of rapid swelling and are regarded as 25 having good biocompatibility. A number of commercially available cross linkers can be used to crosslink the polymers to form a hydrogel. These include Bis acrylamide, di(ethylene glycol) diacrylate, and poly(ethylene glycol) diacrylate (MW 500 Da). 52 Materials and Methods Studies were conducted to identify appropriate combinations of acrylic acid concentration, type of cross-I inker, concentration. of cross-I inker and ratio of monomer to cross-linker. The basic composition of the formulations used to 5 make the gels is shown in Table 1. These were prepared as follows: Mix acrylic acid with cross-linker and 50% of the necessary water, adjust pH to neutral with 15M sodium hydroxide and adjust the total volume with water. Degas the solution under vacuum in a desiccator or other suitable 10 container. Add initiators (APS and TEMED), mix well and leave to gel overnight. Test for mechanical properties and swelling. After forming the gels in small beakers or Falcon tubes, the gels were cut into small pieces and dried until complete dryness. Small pieces of gel were then 15 collected and re-swollen in phosphate buffered saline (PBS). The weight of the gel pieces were then recorded at regular intervals. Results Compositions and swelling data are shown in Tables 1 and 2. 53 Table 1. Swellable Formulations Gel 2 3 5 6 21 29 25 AA 40 40 40 20 20 15 10 Bis 0.4 0.4 0.4 0.2 0.1 0.05 0.02 APS 0.33 0.08 0.08 0.08 0.08 0.08 0.08 TEMED 0.33 0.8 0.08 0.08 0.1 0.1 0.1 STATUS Swelled I Swelled Swelled Swelled Swelled Swelled Swelling ,Gel 17 23 19 26 28 iAA 20 15 1 105 PEG 0.1 0.05 0.05 0.02 0.025 APS 0.08 0.08 0.08 0.08 0.08 TEMED 0.1 0.1 0.1 0.1 0.1 STATUS Swelled Swelled Swelled Swelling Swelling Gel 18 24 27 AA 20 15 10 DEG 0.1 0.05 0.02 APS 0.08 0.08 0.08 TMED 0.1 0.1 0.1 STATUS Swelled Swelled Swelling 54 0000i n Cl 0 \ l 0 tz0 t oo 0 - 0). ~ 0) ' - tn DO o bb ~ - 0 N Cl Cl a'tn Z ?~ C-e 0 .0 C CL. cn, o ~ - l _o en 2 * cnN E oto a3 C.) (iI cf~N c cc A ~ ~ : El C 0 >> * cn 0 o o-os 2 o0- 0 u- Cl 0 Cl o o r~Y ~e -. ~ Cl ~ 2 r'- 0-0 Cl A 02 on O 00 T N. ~u 9 0 ' 00-' 0 0'c .J e 2 o S e *0 a E~ r

-

cc u0 E QC) r~ 0 '0 1 ' 0 '0 '0 En' ' C)0 0 n 0 N A en ~' 0 E 0 i c-II o C) C) - -~ C 0.n ~CL C)cc)E <~222 E CL~0 ' ' 0 CD - r- 00 9 0 , 0 0 oo m r- q Swelling data for the various formulations is graphed in Fig. 14A (swelling within 5 min) and Fig 14B (swelling within 60 min). As can be seen from the primary data, the quickest swelling gel was gel No. 23, which swelled 2000% in 5 min, which compares quite well to the 300% 5 swelling rate for polyacrylamide gels. When allowed to swell for 60 min, gel No 19 swelled nearly 7000%, while gel No. 23 swelled 4000%. As the ideal gel has rapid swelling and reaches its maximum swelling state quickly, gel No. 23 is the best gel based on swelling data alone. Gel No. 23 consists of 15% Acrylic acid and 0.05% poly(ethylene glycol) diacrylate. Gel 10 No. 19 consists of 10% Acrylic acid and 0.05% poly(ethylene glycol) diacrylate. Example 2: Assessment of Alternative crosslinkers for Hydrogels The principle behind the selected crosslinkers is that rather than having a short cross-linker with only two polymerizable groups, a polyvalent crosslinker (i.e., a long-chain hydrophilic polymer with multiple polymerizable groups) is 15 being used. A much stronger hydrogel is obtained compared to short chain, divalent crosslinkers. While these gels are very firm, they possess very good swelling characteristics. Very strong gels do not normally swell very much. Poly vinyl alcohol (PVA) was derivatized with allyl glycidyl ether under alkaline conditions. Gels were made by combing acrylic acid with the PVA 20 based crosslinker and then polymerizing the mixture by free radical polymerization using ammonium persulfate and TEMED as initiators. In principle, the crosslinker can be made with a number of different starting materials: A range of PVAs as well as partially hydrolyzed poly vinyl acetates, 2-hydroxyethyl methacrylates (HEMA) or various other polymers with 25 reactive side groups can be used as the basic polymeric backbone. In addition, a wide range of natural hydrocolloids such as dextran, cellulose, agarose, starch, galactomannans, pectins, hyaluronic acid etc. can be used. A range of reagents such as allyl glycidyl ether, allyl bromide, allyl chloride etc. can be used to incorporate the necessary double bonds into this backbone. Depending on the 30 chemistry employed, a number of other reagents can be used to incorporate 59 reactive double bonds. Preparation of Polyvalent Crosslinker Polyvinyl alcohol (PVA, 30-70 kDa) was derivatized with allyl glycidyl ether under alkaline conditions. 2g PVA was dissolved in 190 mL water. Once 5 fully dissolved, 10 mL 50% NaOH was added, followed by I mL allyl, glycidyl ether and 0.2g sodium borohydride. The reaction was allowed to proceed for 16 hours. Subsequently, the crosslinker was precipitated from the reaction mixture by addition of isopropanol. The precipitate was collected by filtration, washed with isopropanol, and re-dissolved in 50 mL of water. The crosslinker was 10 utilized for gel formation, as described below without further purification or characterization. Gel Formation and Characterization Gels were formed by combining acrylic acid with the PVA-based crosslinker prepared above, and then polymerizing the mixture by free radical 15 polymerization using ammonium persulfate and TEMED as initiators. Three gets were prepared containing 15% acrylic acid in combination with various ratios/concentrations of the PVA-based crosslinker. The components listed in Table 3 (excluding initiators) were mixed and degassed by placing the tubes in a desiccator with a vacuum applied. After 10 minutes, the 20 vacuum was turned off, and the tubes remained in the desiccator for a further 10 minutes under vacuum. The desiccator was opened, and the initiator was added. The contents of the tubes were then mixed thoroughly. The tubes were capped and left overnight to polymerize, forming hydrogels. 60 Table 3. Composition of gels 23a-c formed using polyvalent PVA-based crosslinkers. Gel Components (mL) 23a 23b 23c acrylic acid 1.5 1.5 1.5 PVA cross-linker 0.0526 0.526 5.26 50% NaOH 1.251 2.15 2.35 H20 7.122 5.779 0.795 APS 0.04 0.04 0.04 TEMED 0.05 0.05 0.05 total 10.02 10.05 10.00 pH (pre-initiator addition) 7.416 7.557 7.451 5 The gel had a faint pink color, and exhibited a pH of approximately 7.7 when gelled. An increase in opacity in the gels was observed, with gel 23a having the lowest opacity, and gel 23c having the highest opacity. The gels had gel strength that was significantly higher than the gels made with the poly(ethylene glycol) diacrylate as crosslinker. The gels had very good 10 mechanical properties as well as very good swelling. The swelling rates for gels 23a-c were measured, and are shown in Table 4. Percent swelling was measured after 5 minutes and 60 minutes. Table 4. Swelling behavior of gels 32a-c formed using polyvalent PVA-based 15 crosslinkers. Gel 23a 23b 23c 5 min swelling* 1000-2000% 250-1100% 900-1000% 60 min swelling* 4000-6000% 1100-2500% 3600-4300% *3 repeats were made for each gel swelling experiment 61 Example 3: Demonstration of Sealing in in vitro model. Materials and Methods An in vitro model of a TAV implantation shown in Figures 15A-15B was constructed using a tube having placed therein a TAV formed of a 5 collapsible mesh 102 securing heart leaflets 104. In the model the mesh 102 did not seat uniformly into the tube, creating a paravalvular leak site 106 between a region of the mesh 102 and the tube 100. The TAV includes an expandable seal as described above with reference to Figures 2A-2C. The seal 12 was expanded using wire 16 to expose seal 12 to 10 the surrounding fluid (blood), causing the hydrogel to expand and press the seal 12 against the interior of the tube 100, causing the seal 12 membrane to seal the perivalvular leak site 108. Results Figure 15A shows a paravalvular leak site 106 due to device 15 inapposition. Figure 15B shows the leak site is sealed with the seal capsule 108 without disturbing the base geometry of the device. The conformation of the seal happens actively only in places where there are leak sites. The seal does not decrease the central orifice area of the device not having any adverse effect on the blood flow as a result. 20 From the foregoing, it will be appreciated that specific embodiments of the disclosure have been described herein for purposes of illustration, but that various modifications may be made from these embodiments. Certain aspects of the disclosure described in the context of particular embodiments may be combined or eliminated in other embodiments. For example, a sealing device in 25 accordance with particular embodiments may include only some of the foregoing components and features, and other devices may include other components and features in addition to those disclosed above. Further, while advantages associated with certain embodiments have been described in the context of those embodiments, other embodiments may also exhibit such 30 advantages, and not all embodiments need necessarily exhibit such advantages. 62 Accordingly, the disclosure can include other embodiffients not shown- or' described above.

Claims (74)

1. An endoluminal seal for sealing an endoluminal implant or prosthesis to a wall of a lumen of a subject, the endoluminal seal comprising: an expandable material selected from the group consisting of hydrogels, sponges and foams optionally spray dried or chemically coupled to the interior of the endoluminal seal, a first semi-permeable membrane adjacent to and containing the expandable material; wherein the expandable material is activated by exposure to a fluid or a foaming 2 2 agent and has a mechanical strength of between about 0.0005 N/mm2 and 0.025 N/mm2

2. The endoluminal seal of claim 1 further comprising a second impermeable membrane, metal foil or laminate preventing fluid or foaming agent from penetrating the semi-permeable membrane to contact the expandable material prior to activation.

3. The endoluminal seal of claim 2 wherein the second impermeable membrane comprises a rupture site and activation means for rupturing the impermeable membrane to allow fluid or foaming agent to penetrate the semi-permeable membrane and contact the expandable material to expand the seal.

4. The endoluminal seal of any one of the preceding claims that is positioned within or is in close abutment to the exterior of the implant or prosthesis, not changing the profile from that of the implant or prosthesis during implantation.

5. The endoluminal seal of any one of the preceding claims that expands under sufficient low pressure so that it seals the space between the implant or prosthesis and luminal wall, but does not push the implant or prosthesis away from the lumen wall.

6. The endoluminal seal of any one of the preceding claims wherein the seal actively conforms to a leak site between the lumen wall and the implant or prosthesis, without altering the rest of the device configuration. 64

7. The endoluminal seal of any one of the preceding claims wherein the first membrane has a pore size in the range of between five and 70 microns, preferably 35 microns.

8. The endoluminal seal of any one of the preceding claims wherein the expandable material is a hydrogel which expands two to one hundred fold, preferably 50 to 90 fold, in less than about 15 minutes.

9. The endoluminal seal of claim 8 comprising a swellable hydrogel material selected from the group consisting of polyacrylic acids and polyalkylene oxides.

10. The endoluminal seal of any one of the preceding claims comprising a support member which interfaces between the seal and the endoluminal implant or prosthesis and can go from an unexpanded or crimped state to an expanded state.

11. The endoluminal seal of claim 10 wherein the support member is an expandable mesh or struts, optionally including means for securing the implant or prosthesis at the site of implantation.

12. The endoluminal seal of claim 10 wherein the seal is crimped distal or proximal to the prosthesis, and aligned with the prosthesis prior to or at the time of placement.

13. The endoluminal seal of claim 3 wherein the activation means is a wire connected to the rupture site that can be attached to the implant or prosthesis or aligned with a catheter element for placement of the implant or prosthesis.

14. The endoluminal seal of claim 3 wherein the activation means is an expansion means that increases pressure within the seal to rupture the impermeable membrane.

15. The endoluminal seal of any one of the preceding claims further comprising a pharmaceutical, therapeutic or diagnostic agent to be released.

16. The endoluminal seal of claim 3 further comprising an adhesive which is released when the rupture site is ruptured. 65

17. The endoluminal seal of any one of the preceding claims having a circumference complementary to a portion of the endoluminal implant or prosthesis, wherein the seal is in abutment to and substantially the same or less than the diameter of the endoluminal implant or prosthesis, prior to expansion of the seal.

18. The endoluminal seal of any one of the preceding claims, wherein the hydrogel swells up to 80 times its weight in the dry state in less than about 15 minutes.

19. The endoluminal seal of any one of the preceding claims, wherein the hydrogel is reinforced with fibres or whiskers.

20. The endoluminal seal of claim 19, wherein the fibres or whiskers have been chemically activated to allow reaction with the hydrogel.

21. The endoluminal seal of any one of the preceding claims, wherein the hydrogel is anchored to a substrate.

22. The endoluminal seal of any one of the preceding claims, wherein the hydrogel comprises one or more polymers selected from the group consisting of acrylic acid polymer and copolymers, polysaccharides, polyphosphazines, poly(methacrylic acids), poly(alkylene oxides), poly(vinyl acetate), polyvinylpyrrolidone (PVP), polyvinyl alcohol (PVA) and copolymers and blends of each.

23. An endoluminal seal for sealing of an endoluminal implant or prosthesis delivered in an introducer catheter or sheath, comprising an endoluminal implant or prosthesis and the seal of any one of the preceding claims, wherein the seal is aligned with the endoluminal implant or prosthesis by expansion of the seal or the endoluminal implant or prosthesis.

24. An endoluminal seal for sealing of an endoluminal implant or prosthesis delivered in an introducer catheter or sheath, comprising an endoluminal implant or prosthesis and the seal of any one of claims 1 to 22, wherein the seal is aligned with the region of the 66 endoluminal implant or prosthesis to be sealed prior to expansion of the endoluminal implant or prosthesis by use of an activation member.

25. An endoluminal seal for sealing of an endoluminal implant or prosthesis delivered in an introducer catheter, comprising an endoluminal implant or prosthesis and the seal of any one of claims 1 to 22, wherein the seal is crimped distal or proximal to the endoluminal implant or prosthesis, and aligns with a portion of the endoluminal implant or prosthesis when it is removed from the introducer catheter or sheath.

26. An endoluminal seal for sealing of endoluminal implant or prosthesis, comprising fixation members attaching the seal to a distal or proximal portion of the endoluminal implant or prosthesis, for delivery in an introducer catheter or sheath, wherein the fixation members pull the seal into abutment with a portion of the endoluminal implant or prosthesis when it is removed from the introducer catheter or sheath.

27. An endoluminal seal for sealing of endoluminal implant or prosthesis, comprising release members attaching the seal to a distal or proximal portion of the endoluminal implant or prosthesis, for recapture of the implant or prosthesis in an introducer catheter or sheath after complete or partial expansion, wherein the release members engage or disengage to enable the seal to be pulled into an introducer catheter or sheath.

28. A method of sealing a lumen comprising implanting an endoluminal implant or prosthetic comprising one or more of the endoluminal seal of any one of claims 1 to 22 affixed thereto, optionally comprising an impermeable membrane with a rupture site, into a wall of a lumen of a subject.

29. The method of claim 28 comprising activating the rupture site of the endoluminal seal.

30. The method of claim 28 wherein the rupture site is activated by withdrawal of a wire attached thereto. 67

31. The method of claim 28 comprising attaching the endoluminal seal to a stent or valve prosthesis to form a salable endoluminal device and inserting the- endoluminal device into an insertional catheter with a guidewire.

32. The method of claim 28 further comprising releasing a therapeutic, prophylactic or diagnostic agent or adhesive at the site of sealing.

33. A method for implanting an endoluminal seal for sealing an endoluminal implant or prosthesis to a wall of a lumen of a subject of claim 28, the endoluminal seal comprising: an expandable material, a first semi-permeable membrane adjacent to and containing the expandable material, a second removable impermeable membrane preventing- fluid- from reaching the impermeable membrane when the seal is stored in an aqueous environment, wherein the second impermeable membrane is removable by peeling, cracking, melting, or vaporization.

34. The method of claim 33 wherein the second impermeable membrane is applied with plasma vapour deposition, vacuum deposition, coextrusion, or press lamination.

35. The method of claim 33 wherein the semi-permeable membrane has a porosity of between five and seventy microns.

36. A biocompatible hydrogel or foam that swells to at least 10 times its weight in the dry state in less than about 15 minutes and has a mechanical strength from about 0.0005 N/mm2 to 0.025 N/mm2.

37. The hydrogel or foam of claim 36 , wherein the hydrogel swells up to 80x its weight in the dry state in less than about 15 minutes.

38. The hydrogel or foam of claim 36 , wherein the hydrogel comprises a long chain crosslinking agent. 68

39. The hydrogel or foam of claim 38, wherein the long chain crosslinking agent comprises a hydrophilic polymer having a molecular weight of at least 400 Daltons, preferably at least 800 Daltons.

40. The hydrogel or foam of claim 38, wherein the long chain crosslinking agent comprises more than two reactive groups.

41. The hydrogel of claim 36, wherein the hydrogel is reinforced with fibres or whiskers.

42. The hydrogel or foam of claim 41, wherein the fibres or whiskers have been chemically activated to allow reaction with the hydrogel.

43. The hydrogel or foam of claim 36 , wherein the hydrogel is anchored to the substrate.

44. The hydrogel or foam of claim 36 , wherein the hydrogel comprises one or more polymers selected from the group consisting of acrylic acid polymer and copolymers, polysaccharides, polyphosphazines, poly(methacrylic acids), poly(alkylene oxides), polyvinyl acetate), polyvinylpyrrolidone (PVP), polyvinyl alcohol (PVA) and copolymers and blends of each.

45. An endoluminal seal for sealing an endoluminal implant or prosthesis to a wall of a lumen of a subject, the endoluminal seal comprising: an expandable material selected from the group consisting of hydrogels, sponges and foams optionally spray dried or chemically couple to the interior of the endoluminal seal, a first membrane adjacent to and containing the expandable material; wherein the expandable material is activated by exposure to a fluid or a foaming agent.

46. The endoluminal seal of claim 45 further comprising a second impermeable membrane, metal foil or laminate preventing fluid or foaming agent from penetrating the semi-permeable membrane to contact the expandable material prior to activation. 69

47. The endoluminal seal of claim 46 wherein the second impermeable membrane comprises a rupture site and activation means for rupturing the impermeable membrane to allow fluid or foaming agent to penetrate the semi-permeable membrane and contact the expandable material to expand the seal.

48. The endoluminal seal of claim 45 that is positioned within or is close abutment to the exterior of the implant or prosthesis, not changing the profile from that of the implant or prosthesis during implantation.

49. The endoluminal seal of claim 45 that expands under sufficient low pressure so that it seals the space between the implant or prosthesis and luminal wall, but does not push the implant or prosthesis away from the lumen wall.

50. The endoluminal seal of claim 45 wherein the seal actively conforms to a leak site between the lumen wall and the implant or prosthesis, without altering the rest of the device configuration.

51. The endoluminal seal of claim 45 wherein the first membrane has a pore size in the range of 5-70 microns, preferably 35 microns.

52. The endoluminal seal of claim 45 wherein the expandable material is a hydrogel which expands two to one hundred fold, preferably 50 to 90 fold, upon contact with a fluid and the first membrane is permeable to fluid.

53. The endoluminal seal of claim 52 comprising a swellable hydrogel material selected from the group consisting of polyacrylic acids and polyalkylene oxides. '

54. The endoluminal seal of claim 45 comprising a support member which interfaces between the seal and the endoluminal implant or prosthesis and can go from an unexpanded or crimped state to an expanded state.

55. The endoluminal seal of claim 54 wherein the support member is an expandable mesh or struts, optionally including means for securing the implant or prosthesis at the site of implantation. 70

56. The endoluminal seal of claim 54 wherein the seal is crimped distal or proximal to the prosthesis, and aligned with the prosthesis prior to or at the time of placement.

57. The endoluminal seal of claim 47 wherein the activation means is a wire connected to the rupture site that can be attached to the implant or prosthesis or aligned with a catheter element for placement of the implant or prosthetic.

58. The endoluminal seal of claim 47 wherein the activation means is an expansion means that increases pressure within the seal to rupture the impermeable membrane.

59. The endoluminal seal of claim 45 further comprising a pharmaceutical, therapeutic or diagnostic agent to be released.

60. The endoluminal seal of claim 38 further comprising an adhesive which is released when the rupture site is ruptured.

61. The endoluminal seal of claim 45 having a circumference complementary to a portion of the endoluminal implant or prosthesis, wherein the seal is in abutment to and substantially the same or less than the diameter of the endoluminal implant or prosthesis, prior to expansion of the seal.

62. An endoluminal seal for sealing of an endoluminal implant or prosthesis delivered in an introducer catheter or sheath, comprising an endoluminal implant or prosthesis and seal, wherein the seal is aligned with the endoluminal implant or prosthesis by expansion of the seal or the endoluminal implant or prosthesis.

63. An endoluminal seal for sealing of an endoluminal implant or prosthesis delivered in an introducer catheter or sheath, comprising an endoluminal implant or prosthesis and seal, wherein the seal is aligned with the region of the endoluminal implant or prosthesis to be sealed prior to expansion of the endoluminal implant or prosthesis by use of an activation member. 71

64. An endoluminal seal for sealing of an endoluminal implant or prosthesis delivered in an introducer catheter, comprising an endoluminal implant or prosthesis and seal, wherein the seal is crimped distal or proximal to the endoluminal implant or prosthesis, and aligns with a portion of the endoluminal implant or prosthesis wheri it is removed from the introducer catheter or sheath.

65. An endoluminal seal for sealing of endoluminal implant or prosthesis, comprising fixation members attaching the seal to a distal or proximal portion of the endoluminal implant or prosthesis, for delivery in an introducer catheter or sheath, wherein the fixation members pull the seal into abutment with a portion of the endoluminal implant or prosthesis when it is removed from the introducer catheter or sheath.

66 . An endoluminal seal for sealing of endoluminal implant or prosthesis, comprising release members attaching the seal to a distal or proximal portion of the endoluminal implant or prosthesis, for recapture of the implant or prosthesis in an introducer catheter or sheath after complete or partial expansion, wherein the release members engage or disengage to enable the seal to be pulled into an introducer catheter or sheath.

67. A method of sealing a lumen comprising implanting an endoluminal implant or prosthetic comprising one or more of the endoluminal seal of claim 12 affixed thereto into a wall of a lumen of a subject. .

68. The method of claim 67 comprising activating the rupture site of the endoluminal seal.

69. The method of claim 67 wherein the rupture site is activated by withdrawal of a wire attached thereto.

70. The method of claim 67 comprising attaching the endoluminal seal to a stent or valve prosthesis to form a salable endoluminal device and inserting the endoluminal device into an insertional catheter with a guidewire. 72

71. The method of claim 67 further comprising releasing a therapeutic, prophylactic or diagnostic agent or adhesive at the site of sealing.

72. A method for implanting an endoluminal seal for sealing an endoluminal implant or prosthesis to a wall of a lumen of a subject of claim 67, the endoluminal seal comprising: an expandable material, a first semi-permeable membrane adjacent to and containing the expandable material; a second removable impermeable membrane preventing fluid from reaching the impermeable membrane when the seal is stored in an aqueous environment, wherein the second impermeable membrane is removable by peeling, cracking, melting, or vaporization.

73. The method of claim 72 wherein the second impermeable membrane is applied with plasma vapour deposition, vacuum deposition, co-extrusion, or press lamination.

74. The method of claim 72 wherein the semi-permeable membrane has a porosity of between five and seventy microns. 73