US20200323669A1 - Endoluminal prosthesis deployment devices and methods - Google Patents
Endoluminal prosthesis deployment devices and methods Download PDFInfo
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- US20200323669A1 US20200323669A1 US16/915,390 US202016915390A US2020323669A1 US 20200323669 A1 US20200323669 A1 US 20200323669A1 US 202016915390 A US202016915390 A US 202016915390A US 2020323669 A1 US2020323669 A1 US 2020323669A1
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- Prior art keywords
- endoluminal prosthesis
- chassis
- section
- sheath
- catheter system
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
- A61F2/966—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2/06—Blood vessels
- A61F2/07—Stent-grafts
- A61F2002/072—Encapsulated stents, e.g. wire or whole stent embedded in lining
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2002/9505—Instruments specially adapted for placement or removal of stents or stent-grafts having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument
- A61F2002/9511—Instruments specially adapted for placement or removal of stents or stent-grafts having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument the retaining means being filaments or wires
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2002/9534—Instruments specially adapted for placement or removal of stents or stent-grafts for repositioning of stents
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
- A61F2/966—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
- A61F2002/9665—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod with additional retaining means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2210/0014—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol
Definitions
- the extension may extend through a wall of a distal end of the endoluminal prosthesis with the extension in a radially constrained state such that the extension at least partially captures a distal segment of the endoluminal prosthesis and restricts proximal displacement of the endoluminal prosthesis relative to the chassis.
- a catheter system may include a plurality of such rigid extensions.
- a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient include a flexible elongate chassis having a proximal end, a distal end, a distal section and an overall column strength sufficient for advancement of the chassis through a body lumen of a patient.
- a catheter system may also include a self-expanding tubular endoluminal prosthesis disposed in a constrained state over the distal section of the chassis.
- such a catheter system may include a thin, flexible, axial belt having a fixed end which is secured in fixed relation to the elongate catheter chassis and a free end which is disposed opposite the fixed end.
- Some embodiments of a method for deploying an endoluminal prosthesis in a body lumen of a patient include advancing a catheter system for deployment of an endoluminal prosthesis into the body lumen of the patient until the endoluminal prosthesis of the catheter system is disposed at a treatment site.
- An outer constraint may be removed from the endoluminal prosthesis while an axial belt restricts proximal axial movement of the endoluminal prosthesis relative to the chassis.
- Such an axial belt may include a fixed end which is secured in fixed relation to the elongate catheter chassis and a free end which is disposed opposite the fixed end.
- the axial belt forms a loop that extends proximally from the fixed end and free end through a distal segment of a wall of the endoluminal prosthesis with the free end of the axial belt releasably secured in fixed relation to the chassis with a circumferential belt which is disposed about the chassis and free end such that the loop captures a distal segment of the endoluminal prosthesis.
- the endoluminal prosthesis may be allowed to self-expand by removal of the constraint such that an outside surface of the endoluminal prosthesis contacts an inside surface of the patient's body lumen.
- a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient include a flexible elongate chassis having a proximal end, a distal end, and a column strength configured for advancement of the chassis through a body lumen of a patient.
- a catheter system may also include a self-expanding tubular endoluminal prosthesis disposed in a constrained state at the distal end of the chassis.
- such a catheter system may include a tubular everting sheath which has an inner section which includes a first diameter, a fixed end which is secured in fixed relation to the chassis and an endoluminal prosthesis section that is disposed over and radially constrains the endoluminal prosthesis in the constrained state.
- An outer constraint may be removed from the endoluminal prosthesis by proximally retracting a retraction end of an outer section of the tubular everting sheath.
- Such an outer section may be everted back over the endoluminal prosthesis section of the inner section and include a second diameter which is larger than the first diameter of the inner section.
- the endoluminal prosthesis may be thus allowed to self-expand as the endoluminal prosthesis section of the inner section is proximally everted so as to remove radial constraint from the endoluminal prosthesis.
- an outside surface of the endoluminal prosthesis may then engage an inside surface of the patient's body lumen.
- An outer constraint may thereafter be removed from the endoluminal prosthesis and the extension by proximally retracting a retraction end of an outer section of the tubular everting sheath.
- Retraction of the outer section may be carried out by the outer section being everted back over the endoluminal prosthesis section of the inner section during the proximal retraction while the extension prevents proximal axial movement of the endoluminal prosthesis relative to a flexible, elongate chassis of the catheter system.
- the endoluminal prosthesis and extension may then be allowed to self-expand such that an outside surface of the endoluminal prosthesis engages an inside surface of the patient's body lumen.
- the chassis and extension may be proximally retracted such that the extension passes axially through the wall of the distal end of the endoluminal prosthesis and no longer engages the distal segment of the endoluminal prosthesis.
- An end of the sheath is restrained and both ends of each of the tether loops are pulled on simultaneously in a direction away from the endoluminal prosthesis such that the tether loops are pulled through the inner lumen of the sheath and axial tension is thereby applied to the end of the endoluminal prosthesis such that the endoluminal prosthesis is radially compressed and constrained as it is pulled into a funnel section of the inner lumen of the sheath to an endoluminal prosthesis section within the inner lumen of the sheath. Thereafter, only one side of each of the tether loops is pulled on and an opposite end of each tether loop is released until each of the tether loops is pulled out of the endoluminal prosthesis and the inner lumen of the sheath.
- FIG. 1 is an elevation view of a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient disposed in a body lumen.
- FIG. 2 is an enlarged view in partial section of the catheter system and body lumen indicated by the encircled portion 2 - 2 of FIG. 1 .
- FIG. 4 is an elevation view in partial section of the endoluminal prosthesis of FIG. 2 in a fully deployed state.
- FIG. 6 is an elevation view of the elongate chassis and extensions of a catheter system embodiment.
- FIG. 11 is an elevation view of a section of an elongate chassis and extensions extending therefrom wherein the extensions have been cut from a tubular structure of the elongate chassis.
- FIG. 24 is an elevation view in partial section of the catheter system of FIG. 19 disposed within a patient's body lumen with an outer sheath proximally retracted and the endoluminal prosthesis of the catheter system partially deployed within the patient's body lumen.
- FIG. 25 is an elevation view in partial section of the catheter system of FIG. 19 disposed within a patient's body lumen with the endoluminal prosthesis fully deployed and engaging the patient's body lumen.
- FIG. 37 is an elevation view of an everting sheath embodiment of a catheter system embodiment.
- FIG. 46 shows a distal portion of the catheter system of FIG. 31 disposed in an iliac body lumen of a patient.
- FIG. 55 is an elevation view of the everting sheath of FIG. 53 with the endoluminal prosthesis completely loaded into an endoluminal prosthesis section of the everting sheath.
- FIG. 57 shows a more detailed view in partial section of the thin high tensile tether being pulled out of an end of the fully loaded endoluminal prosthesis of FIG. 56 .
- FIG. 58 shows the thin high tensile tether being pulled out of an end of the fully loaded endoluminal prosthesis of FIG. 56 .
- catheter system embodiments may be desirable to configure catheter system embodiments to maintain control of an axial position of an endoluminal prosthesis during deployment in order to maintain accuracy. It may also be desirable to minimize frictional forces within the various components of catheter system embodiments such that the catheter system embodiments function readily even in difficult to access and tortuous anatomies. In addition, minimizing frictional forces may be important when accessing body lumen target sites that are spatially remote from a point of access to the patient's body. Various catheter system embodiments are discussed herein that may be directed to achieving one or more such desirable attributes.
- the chassis may have any suitable configuration that provides both a sufficient flexibility in order to navigate a patient's body lumens 14 and structural strength in order to support the various structures secured thereto and functions carried out with the chassis 16 .
- the chassis may include an elongate tubular structure made from any suitable biocompatible polymer such as polyurethane, polytetrafluoroethylene (PTFE), polyethylene (PE), nylon, Pebax®, fluorinated ethylene propylene (FEP), polyimides, composite materials or the like.
- the self-expanding tubular endoluminal prosthesis 12 is shown disposed in a constrained state over the distal section of the chassis 16 with proximal axial displacement of the endoluminal prosthesis 12 being restricted by a plurality of extensions 24 that extend from the chassis 16 through a distal end 26 of the endoluminal prosthesis 12 .
- the proximal axial displacement of the endoluminal prosthesis 12 may be so restricted by one or more such extensions 24 .
- Each extension 24 may be a thin, flexible, resilient extension having a proximal end 28 which is secured in fixed relation to the elongate catheter chassis 16 and a distal end 30 which is disposed radially outward from an outside surface 32 of the chassis 16 and distal of the proximal end 28 of the extension 24 .
- the fixation of the proximal end 28 relative to the chassis may be facilitated by a base structure such as a high strength cylinder of material that may or may not be made from the same material as the extension 24 .
- Each of the extensions 24 may extend through a wall 34 of the distal end 26 of the endoluminal prosthesis 12 with the extension 24 in a radially constrained state such that the extension 24 at least partially captures a distal segment 36 of the endoluminal prosthesis 12 and restricts proximal displacement of the endoluminal prosthesis 12 relative to the chassis 16 as shown in FIG. 2 .
- the catheter system 10 may have 1 extension 24 to 10 extensions 24 , more specifically, 2 extensions 24 to 6 extensions 24 , and even more specifically, 3 extensions 24 to 4 extensions 24 .
- the angle 41 of the flexible extensions 24 with respect to the longitudinal axis 42 of the chassis may in some cases be defined by the angle between the longitudinal axis 42 of the chassis 16 and a line 44 extending from the proximal end 28 of the extension 24 to the distal end 30 of the extension 24 as shown in FIG. 8 .
- both the endoluminal prosthesis 12 and the extensions 24 may be radially constrained by an inward radial force and held in that constrained state by an inner surface 40 of the outer sheath 38 as shown in FIG. 2 .
- the distal segment 36 of the endoluminal prosthesis 12 captured by the extension 24 may include a high strength stent element 54 of a self-expanding stent 56 of the endoluminal prosthesis 12 as shown in FIGS. 2 and 3 .
- the stent element 54 captured by the extension 24 includes a crown section of the stent (not shown).
- a high strength stent element 54 may include a resilient and optionally superelastic material such as nickel titanium alloy or the like.
- the tubular endoluminal prosthesis 12 may be a tubular stent graft including at least one layer of thin, compliant material 70 secured to the self-expanding stent 56 .
- the thin compliant material 70 may include nylon mesh, PTFE, ePTFE or the like.
- the stent graft 12 may be a fully stented stent graft as shown in FIG. 9 wherein the helical resilient and undulating stent 56 which is secured to the tubular graft material 70 extends all the way from a distal end 26 of the stent graft to a proximal end of the stent graft.
- the endoluminal prosthesis may include a stent 56 made from a high strength superelastic metal alloy such as a nickel titanium or the like.
- Suitable treatment sites 74 for any of the catheter system embodiments 10 and method embodiments discussed herein may include a wide variety of indications such as treatment of vascular defects such as an aneurysm (not shown) or the like or any other suitable indication wherein an endovascular prosthesis 12 may be indicated.
- suitable treatment sites 74 may include healthy body lumen sections or substantially healthy body lumen sections that are adjacent to vascular defects. Deployment of endoluminal prostheses in such healthy body lumen sections may be desirable in some cases in order to extend a previously deployed endoluminal prosthesis 12 or for any other suitable indication.
- the extensions 24 may each include the proximal end 28 which is secured in fixed relation to the elongate catheter chassis 16 and the distal end 30 which is disposed radially outward from the outside surface 32 of the chassis 16 and distal of the proximal end 28 of the extension 24 as discussed above.
- Each of the one or more extensions 24 may also extend through the wall 34 of the distal end 26 of the endoluminal prosthesis 12 with the distal end 30 of the extension 24 held in a radially constrained state by the inner surface 40 of the outer sheath 38 , also as discussed above.
- the extensions 24 are so constrained such that each of the one or more extensions 24 at least partially captures the respective distal segment 36 of the endoluminal prosthesis 12 .
- the endoluminal prosthesis 12 is then allowed to self-expand such that an outside surface of the endoluminal prosthesis 12 contacts an inside surface 78 of the patient's body lumen 14 as shown in FIG. 3 .
- the chassis 16 and one or more extensions 24 may then be proximally retracted as a unit such that each of the extensions 24 slide axially through a respective perforation in the wall 34 of the distal end 26 of the endoluminal prosthesis 12 and the endoluminal prosthesis 12 is allowed to fully deploy and engage the inside surface 78 of the body lumen 14 of the patient as shown in FIG. 4 .
- an embodiment of an elongate chassis 80 that may be used in any suitable catheter system embodiment 10 discussed herein is shown that includes a tubular member 82 of flexible, resilient material that has a plurality extensions 84 configured for endoluminal prosthesis retention cut directly from the tubular member 82 of the elongate chassis 80 .
- Such an “as cut” configuration of the elongate chassis 80 may be made from any suitable high strength resilient materials such as stainless steel, and shape memory materials such as nickel titanium alloy and the like.
- a catheter system embodiment 100 for deploying an endoluminal prosthesis 12 in a body lumen 14 of a patient includes the flexible elongate chassis 16 having a proximal end 18 , a distal end 20 , a distal section 22 and an overall column strength sufficient for advancement of the chassis through a body lumen 14 of a patient.
- Such a catheter system 100 may also include a self-expanding tubular endoluminal prosthesis 12 disposed in a constrained state over the distal section 22 of the chassis 16 .
- a respective distal segment 36 of the endoluminal prosthesis 12 may be captured by the loop 108 of each of the one or more axial belts 102 .
- Each distal segment 36 may include the high strength stent element 54 of the self-expanding stent 56 of the endoluminal prosthesis 12 .
- the stent element 54 captured by each of the loops of the one or more axial belts 102 may include a crown section of the stent 56 (not shown).
- the high strength stent element 54 may include a resilient and optionally superelastic material such as nickel titanium alloy or the like.
- the tubular endoluminal prosthesis embodiments 12 discussed herein may be a tubular stent graft including at least one layer of thin, compliant material 70 secured to the self-expanding stent 56 as shown in FIGS. 9 and 10 .
- the thin compliant material 70 may include nylon mesh, PTFE, ePTFE or the like.
- the stent graft 12 may be a fully stented stent graft as shown in FIG.
- a catheter system 140 for deploying an endoluminal prosthesis in a body lumen of a patient includes a flexible elongate chassis 16 having a proximal end 18 , a distal end 20 , a distal section 22 and an overall column strength sufficient for advancement of the chassis 16 through a body lumen 14 of a patient.
- a catheter system 140 may also include a self-expanding tubular endoluminal prosthesis 12 disposed in a constrained state over the distal section 22 of the chassis 16 .
- the catheter system 140 may include a plurality of axial release wires 142 , with each axial release wire 142 having a proximal end, a distal end 144 and a distal section 146 .
- the distal section 146 of each release wire 142 may extend through a distal segment 36 of a wall 34 of the endoluminal prosthesis 12 with the distal section 146 releasably secured in fixed relation to a pair of axially spaced bushings, including a proximal most bushing 148 and a distal most bushing 150 .
- the bushings 148 , 150 are secured to and extend radially outward from the chassis 16 .
- Such a structure may be configured so as to form a loop structure 152 having a continuous enclosed structure formed between the distal section 146 , the axially spaced bushings 148 , 150 and an outside surface 32 of the chassis 16 , such that this loop structure 152 releasably captures s respective distal segment 36 of the endoluminal prosthesis 12 and restricts proximal displacement of the endoluminal prosthesis 12 relative to the chassis 16 .
- This configuration may also restrict outward radial displacement of the distal segments 36 which are captured by the respective loop structures 152 .
- the release wires 142 may be releasably secured to the spaced bushings 148 , 152 in a configuration wherein the release wires 142 are disposed through a longitudinal lumen 154 of the proximal most bushing 148 and a corresponding longitudinal lumen 156 of the distal most bushing 150 .
- the release wires 142 may be desirable for the release wires 142 to have sufficient stiffness in order to keep distal segments 36 of the endoluminal prosthesis 12 in fixed relation to the chassis 16 until the release wires 142 are withdrawn by proximal retraction from the handle 114 disposed at a proximal adapter 116 of the catheter system 140 .
- the release wires 142 should still maintain sufficient flexibility to be advanced through tortuous body lumens 14 of the patient.
- Some release wire embodiments 142 may be made from high strength resilient flexible materials including metals and metal alloys such as nickel titanium alloy including superelastic nickel titanium alloy as well as stainless steel, composite materials and the like.
- the release wires 142 may have a cross section area of about 0.04 mm.sup.2 to about 0.06 mm.sup.2.
- the catheter system 140 may have 2 axial release wires 142 to 10 axial release wires 142 , more specifically, 2 axial release wires 142 to 6 axial release wires 142 , and even more specifically, having 3 axial release wires 142 to 4 axial release wires 142 .
- the respective distal segments 36 of the endoluminal prosthesis 12 captured by the release wires 142 may include a high strength stent element 54 of a self-expanding stent 56 of the endoluminal prosthesis 12 .
- the stent element 54 captured by each of the release wires 142 may include a crown section of the stent 56 .
- a high strength stent element 54 may include a resilient and optionally superelastic material such as nickel titanium alloy or the like.
- the chassis 16 may optionally include a guidewire lumen 58 extending from the proximal end 18 of the chassis 16 to the distal end 20 of the chassis 16 .
- the catheter system 140 may also include a nosecone 62 secured to the distal end 20 of the chassis 16 , the nosecone 62 including a shoulder portion 64 which may be disposed within a distal end 66 of a tubular outer sheath 38 .
- An inner surface 40 of the optional outer sheath 38 may be disposed over the endoluminal prosthesis and chassis and at least partially radially constrain the endoluminal prosthesis in the constrained state.
- the tubular endoluminal prosthesis 12 may be a tubular stent graft including at least one layer of thin, compliant material 70 secured to the self-expanding stent 56 .
- the thin compliant material 70 may include nylon mesh, PTFE, ePTFE or the like.
- the stent graft 12 may be a fully stented stent graft as shown in FIG. 9 wherein the helical resilient and undulating stent 56 which is secured to the tubular graft material 70 extends all the way from the distal end 26 of the stent graft 12 to the proximal end 72 of the stent graft 12 .
- the loop 152 formed between the release wires 142 , spaced bushings 148 , 150 and outside surface 32 of the chassis 16 serves to restrict axial movement in a proximal direction of the endoluminal prosthesis 12 due to frictional forces imposed on the endoluminal prosthesis 12 by proximal retraction of the optional outer sheath 38 at the initiation of the deployment process. In this way, the axial position of the endoluminal prosthesis 12 is maintained relative to the chassis 16 and body lumen 14 during the deployment process.
- a catheter system 170 for deploying an endoluminal prosthesis 12 in a body lumen 14 of a patient may include an optional flexible elongate chassis 16 having a proximal end 18 , a distal end 20 , a distal section 22 , a longitudinal axis 42 , and a column strength configured for advancement of the chassis 16 through a body lumen 14 of a patient.
- a catheter system 170 may also include a self-expanding tubular endoluminal prosthesis 12 disposed in a constrained state at a distal section 22 of the chassis 16 .
- the catheter system includes a tubular everting sheath 172 which has an inner section 174 .
- the tubular everting sheath 172 includes also the outer section 180 that is everted back over the endoluminal prosthesis section 178 of the inner section 174 and may also be everted back over some or all of the remainder of the inner section 174 that is proximal of the endoluminal prosthesis section 178 .
- the outer section 180 may include a retraction end 182 and a second diameter which is larger than the first diameter of the inner section 174 such that the outer section 180 is readily slideable over the inner section 174 during retraction of the retraction end 182 and eversion of the everting sheath 172 .
- a lubricating material 175 disposed between the inner section 174 and outer section 180 as shown in FIG. 35 may be used to reduce friction between these sections 174 , 180 during eversion.
- Suitable lubricating materials for the lubricating material 175 may include liquids, pastes, gels, including hydrogels as well as tubular structures formed from lubricious materials.
- various components of the catheter systems and/or endoluminal prosthesis devices discussed herein may include a type of PTFE material that is produced by a wet stretching method or the like that yields a closed cell microstructure having no distinct fibrils interconnecting adjacent nodes as described in commonly owned U.S. Pat. No. 8,728,372, filed by J. Humphrey et al. on Oct. 29, 2010, titled “PTFE Layers and Methods of Manufacturing”, which is hereby incorporated by reference herein in its entirety.
- PTFE layers having a variety of desirable properties. Scanning electron microscope (SEM) images of such materials show a generally closed cell microstructure that is substantially free of the conventional node and fibril microstructure commonly seen in expanded PTFE layers. Embodiments of the PTFE film may have low fluid-permeability, or no or substantially no fluid-permeability. One or more of PTFE layer may be used as a barrier layer to prevent a fluid such as a liquid or gas from permeating or escaping therethrough. At a magnification of 20,000, the microstructure of the stretched PTFE layer resembles a pocked-like structure that includes interconnected high density regions and pockets or pores between some of the high density regions.
- the closed cell microstructure of the PTFE layer provides a layer having low or substantially no fluid permeability that may be used as “a barrier layer” to prevent liquid from passing from one side of the PTFE layer to the opposite side. Though such a PTFE film or layer is configured to have low or substantially no fluid permeability, the PTFE layer nonetheless has a porosity.
- the PTFE layer typically has an average porosity from about 20% to about 80%, and specifically from about 30% and about 70%. In one embodiment, such a PTFE film has a porosity of about 30% to about 40%. In another embodiment, such a PTFE layer has a porosity of about 60% to about 70%.
- embodiments of methods may be modified so as to vary the average porosity and average pore size of the PTFE film in a continuum from 10 microns to 50 microns down to substantially less than about 0.1 micron.
- a PTFE layer may have a density from about 0.5 g/cm.sup.3 to about 1.5 g/cm.sup.3, and specifically from about g/cm.sup.3 to about 1.5 g/cm.sup.3.
- FIG. 39 illustrates a portion of the outer section 180 of the everting sheath 172 that includes a plurality of layers of material.
- the everting sheath includes three separate and distinct layers of material that may optionally be fused or bonded together over an entire surface or partial surface of each of the layers 187 A, 187 B, 187 C. Each of the layers may include the same materials or different materials.
- the number of layers 187 may be varied to achieve desired properties of the everting sheath 172 .
- the everting sheath may have 1 layer to 10 layers of material, more specifically, 2 layers to 6 layers, and even more specifically, 3 layers to 4 layers of material.
- one or more of the layers may include ePTFE that may or may not be anisotropically oriented and one or more layers of PTFE that has a closed cell microstructure with no distinct fibrils interconnecting adjacent nodes as discussed above.
- a layer of ePTFE material that has an anisotropic orientation providing greater strength in a circumferential direction may be of particular use for the inner section 174 of the everting sheath 172 which is subjected to outward radial forces of the constrained self-expanding endoluminal prosthesis 12 disposed in the endoluminal prosthesis section 178 of the inner section 174 .
- Any desired combination of these anisotropic materials may be used for the layers of multiple layer everting sheath embodiments 172 .
- the everting sheath 172 of the catheter system 170 may include an optional integral funnel section 190 disposed at the retraction end 182 of the outer section 180 of the everting sheath 172 as shown in FIG. 40 .
- the funnel section 190 may be useful for both loading the endoluminal prosthesis 12 into the everting sheath 172 as well as facilitating relative movement between the outer section 180 and inner section 174 during eversion.
- the funnel section 190 may have an inclusive funnel angle as indicated by arrow 192 in FIG. 40 , of 10 degrees to 40 degrees.
- the funnel section 190 may have a major diameter, indicated by arrow 194 in FIG.
- an optional integral retraction tether 196 may be secured to and extend from the integral funnel section 190 , as shown in FIGS. 37 and 40-41 , in order to further facilitate the eversion process and provide an anchor point for the retraction end of the everting sheath 172 .
- the integral retraction tether 196 may be secured to the retraction handle 186 .
- the tubular endoluminal prosthesis 12 may be a tubular stent graft including at least one layer of thin, compliant material 70 secured to a self-expanding stent 56 .
- the thin compliant material 70 may include nylon mesh, PTFE, ePTFE or the like.
- the stent graft 12 may be a fully stented stent graft as shown in FIG. 9 wherein the helical resilient and undulating stent 56 which is secured to the tubular graft material 70 extends all the way from a distal end 26 of the stent graft to the proximal end 72 of the stent graft 12 .
- a method for deploying the endoluminal prosthesis 12 in the body lumen 14 of a patient may include advancing the catheter system 170 into the body lumen 14 of the patient until the endoluminal prosthesis 12 of the catheter system 170 is disposed at the treatment site 74 in a constrained state as shown in FIG. 42 .
- advancing the catheter system 170 into the body lumen 14 of the patient may include advancing the catheter system over a guidewire 60 until the endoluminal prosthesis 12 of the catheter system is disposed at the treatment site 74 as discussed above in more detail with regard to other catheter system embodiments.
- FIG. 46 shows an endoluminal prosthesis 12 being deployed in an inner lumen 14 of an iliac artery of a patient.
- the deployment of such an endoluminal prosthesis 12 at such an iliac artery lumen may be carried out by any of the catheter system embodiments and corresponding methods of use discussed herein.
- the catheter system 210 includes a tubular everting sheath 172 which has an inner section 174 which includes a fixed end 176 which is secured in fixed relation to the chassis 16 and an endoluminal prosthesis section 178 that is disposed over and radially constrains the endoluminal prosthesis 12 and extensions 24 in the constrained state.
- the tubular everting outer sheath 172 may also have an outer section 180 that is everted back over the endoluminal prosthesis section 178 of the inner section 174 .
- the outer section also includes a retraction end 182 as shown in FIG. 31 which is disposed at an opposite end of the everting sheath 172 as the fixed end 176 .
- the catheter system 210 may include the same or similar features, dimensions or materials as those of any of the catheter systems discussed herein.
- the extensions 24 may lie substantially in a same plane as the longitudinal axis 42 of the chassis 16 . In some cases, substantially in the same plane includes within a thickness of the extension 24 of lying in the same plane as the longitudinal axis 42 of the chassis 16 .
- the plurality of extensions 24 is evenly distributed with respect to circumferential orientation about the chassis 16 .
- the extension 24 may have an s-shape in the unconstrained relaxed state as shown in more detail in FIG. 8 .
- the proximal most deflection 46 of the s-shape of the extension extends away from the chassis 16 and a distal most deflection 50 of the s-shape of the extension 24 extends towards the chassis 16 .
- the diameter of the outer section 180 may be greater than the first diameter of the inner section 174 by an amount of at least a wall thickness 184 of the outer section 180 of the tubular everting sheath 172 in some cases.
- the diameter of the outer section 180 may be greater than the diameter of the inner section 174 by an amount equal to 1 wall thickness of the everting sheath 172 to 4 wall thicknesses of the everting sheath 172 .
- the diameter of the inner section 174 and outer section 180 may be measured at a center of the wall thickness at diametrically opposed points of the wall of each respective section 174 , 180 .
- the proximal end 28 of the extensions 24 are secured in fixed relation to the elongate catheter chassis 16 and the distal ends 30 of the extensions 24 are disposed radially outward from an outside surface 32 of the chassis 16 distal of the proximal ends 28 of the extensions 24 such that allowing the endoluminal prosthesis 12 and extensions 24 to self-expand includes allowing the distal ends 30 of the extensions 24 to pivot outwardly away from the chassis 16 .
- loading a self-expanding endoluminal prosthesis 12 , as well as any associated catheter system components such as a chassis 16 etc., into any of the catheter systems discussed herein may be difficult, particularly since large radial and frictional forces may be mutually imposed between the various components of the catheter system.
- many of the components of such catheter systems may be fragile or easily damaged when subjected to improper types of forces and contact. As such, it may be desirable to have a suitable method for loading endoluminal prostheses 12 into a catheter system and into a constrained state. Referring to FIGS.
- the axial tension is applied to the endoluminal prosthesis 12 such that the endoluminal prosthesis 12 is thereby pulled into the inner lumen 222 of the everting sheath 172 to an endoluminal prosthesis section 178 , or any other desired section, within the inner lumen 222 of the sheath 172 as shown in FIG. 54 .
- the endoluminal prosthesis 12 is first pulled into the funnel section 190 prior to entering the inner section 174 .
- the funnel section 190 may be useful for guiding and compressing the endoluminal prosthesis into the inner section 174 .
- the loading method may also be used to load both an endoluminal prosthesis 12 and a corresponding chassis 16 including flexible resilient extensions 24 extending therefrom.
- the tether loops 220 may be used to pull the endovascular prosthesis, chassis and associated extensions 24 into the inner lumen 222 of the everting sheath 172 .
- both the self-expanding endoluminal prosthesis and distal ends 30 of the extensions 24 will be compressed and radially constrained.
- the combined structure may be pulled through the inner lumen 222 until the endoluminal prosthesis 12 is disposed at the endoluminal prosthesis section 178 of the inner section 174 or disposed at any other desired location within the inner lumen 222 .
- the sheath being loaded is an everting sheath 172 and pulling the tethers 220 may include pulling the tethers 220 through the everting sheath 172 until the endoluminal prosthesis 12 is disposed within and constrained by an endoluminal prosthesis section 178 of the inner section 174 of such an everting sheath 172 .
- such methods may also be used for any other suitable sheath embodiments, including any of the proximally retractable outer sheath embodiments discussed herein that are configured to at least partially constrain a self-expanding endoluminal prosthesis 12 , also as discussed above.
- the delivery system and method embodiments discussed herein may be particularly useful for endoluminal prosthesis embodiments which include one or more inflatable portions.
- inflatable endoluminal prosthesis embodiments that may be deployed by the systems and methods discussed herein are discussed in U.S. Pat. No. 7,147,660 filed by M. Chobotov et al. on Dec. 20, 2002, titled “Advanced Endovascular Graft” which is hereby incorporated by reference herein in its entirety.
Abstract
Description
- This application is a continuation application of U.S. patent application Ser. No. 15/737,881, filed Dec. 19, 2017, which is a national stage application under 35 U.S.C. § 371 of International Patent Application No. PCT/US2016/044583, filed Jul. 28, 2016, which claims priority from U.S. Provisional Patent Application Ser. No. 62/199,168, filed Jul. 30, 2015, and U.S. Provisional Patent Application Ser. No. 62/201,046, filed Aug. 4, 2015, all of which are incorporated by reference herein in their entirety.
- An aneurysm is a vascular defect indicated generally by an expansion and weakening of the wall of an artery of a patient. Aneurysms can develop at various sites within a patient's body. Thoracic aortic aneurysms (TAAs) or abdominal aortic aneurysms (AAAs) are manifested by an expansion and weakening of the aorta which is a serious and life threatening condition for which intervention is generally indicated. Existing methods of treating aneurysms include invasive surgical procedures with graft replacement of the affected vessel or body lumen or reinforcement of the vessel with a graft.
- Surgical procedures to treat aortic aneurysms can have relatively high morbidity and mortality rates due to the risk factors inherent to surgical repair of this disease as well as long hospital stays and painful recoveries. This is especially true for surgical repair of TAAs, which is generally regarded as involving higher risk and more difficulty when compared to surgical repair of AAAs. An example of a surgical procedure involving repair of an AAA is described in a book titled Surgical Treatment of Aortic Aneurysms by Denton A. Cooley, M. D., published in 1986 by W. B. Saunders Company.
- Due to the inherent risks and complexities of surgical repair of aortic aneurysms, minimally invasive endovascular repair has become a widely-used alternative therapy, most notably in treating AAAs. Early work in this field is exemplified by Lawrence, Jr. et al. in “Percutaneous Endovascular Graft: Experimental Evaluation”, Radiology (May 1987) and by Mirich et al. in “Percutaneously Placed Endovascular Grafts for Aortic Aneurysms: Feasibility Study,” Radiology (March 1989).
- When deploying endoluminal prosthesis type devices by catheter or other suitable instrument, it may be advantageous to have a flexible and low profile endoluminal prosthesis such as a stent graft and catheter system for passage through the various guiding catheters as well as the patient's sometimes tortuous anatomy. Many of the existing endovascular prostheses and methods for treatment of aneurysms as well as other indications within body lumens of patients, while representing significant advancement over previous devices and methods, use systems having relatively large transverse profiles, often up to 24 French. Also, such existing systems may have greater than desired lateral stiffness, which can complicate the delivery process, particularly for use in treatment of vascular defect sites that include a high degree of curvature or angulation. Even with more flexible low profile delivery systems, deployment of endovascular prostheses in highly angulated and curved vessels may be problematic due to difficulties with visualization or imaging of the orientation of the prostheses during the deployment process. In addition, such angulated or tortuous anatomies may also induce undesirable amounts of friction between components of catheter systems that may make operation of the catheter system challenging in some situations. As such, minimally invasive endovascular treatment of aneurysms as well as other indications within a body lumen of a patient may not be available for many patients that would benefit from such a procedure and can be more difficult to carry out for those patients for whom the procedure is indicated.
- What have been needed are catheter systems and methods of using these catheter systems that are adaptable to a wide range of patient anatomies such that suitable endoluminal prostheses may be safely and reliably deployed using a flexible low profile catheter system.
- Some embodiments of a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient include a flexible elongate chassis having a proximal end, a distal end, a distal section and an overall column strength sufficient for advancement of the chassis through a body lumen of a patient. The catheter system may also include a self-expanding tubular endoluminal prosthesis disposed in a constrained state over the distal section of the chassis. In addition, such a catheter system may include a thin, flexible, resilient extension including a proximal end which is secured in fixed relation to the elongate catheter chassis and a distal end which is disposed radially outward from an outside surface of the chassis and distal of the proximal end of the extension. For such a catheter system, the extension may extend through a wall of a distal end of the endoluminal prosthesis with the extension in a radially constrained state such that the extension at least partially captures a distal segment of the endoluminal prosthesis and restricts proximal displacement of the endoluminal prosthesis relative to the chassis. In some cases, such a catheter system may include a plurality of such extensions.
- Some embodiments of a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient include a flexible elongate chassis having a proximal end, a distal end, a distal section and an overall column strength sufficient for advancement of the chassis through a body lumen of a patient. The catheter system may also include a self-expanding tubular endoluminal prosthesis disposed in a constrained state over the distal section of the chassis. In addition, the catheter system may also include a rigid extension having a proximal end which is secured in fixed relation to the elongate catheter chassis, and a distal end which is disposed radially outward from an outside surface of the chassis and distal of the proximal end of the extension. For such a catheter system, the extension may extend through a wall of a distal end of the endoluminal prosthesis with the extension in a radially constrained state such that the extension at least partially captures a distal segment of the endoluminal prosthesis and restricts proximal displacement of the endoluminal prosthesis relative to the chassis. In some cases, such a catheter system may include a plurality of such rigid extensions.
- Some embodiments of a method for deploying an endoluminal prosthesis in a body lumen of a patient include advancing a catheter system for deployment of an endoluminal prosthesis into the body lumen of the patient until the endoluminal prosthesis of the catheter system is disposed at a treatment site. An outer constraint may then be removed from the endoluminal prosthesis while an extension prevents proximal axial movement of the endoluminal prosthesis relative to the chassis. Such an extension may include a proximal end which is secured in fixed relation to an elongate catheter chassis and a distal end which is disposed radially outward from an outside surface of the chassis and distal of the proximal end of the extension. The extension also extends through a wall of a distal end of the endoluminal prosthesis with the extension in a radially constrained state such that the extension at least partially captures a distal segment of the endoluminal prosthesis. The endoluminal prosthesis is then allowed to self-expand such that an outside surface of the endoluminal prosthesis contacts an inside surface of the patient's body lumen. The chassis and extension may then be proximally retracted such that the extension passes axially through the wall of the distal end of the endoluminal prosthesis and fully disengages the endoluminal prosthesis.
- Some embodiments of a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient include a flexible elongate chassis having a proximal end, a distal end, a distal section and an overall column strength sufficient for advancement of the chassis through a body lumen of a patient. Such a catheter system may also include a self-expanding tubular endoluminal prosthesis disposed in a constrained state over the distal section of the chassis. In addition, such a catheter system may include a thin, flexible, axial belt having a fixed end which is secured in fixed relation to the elongate catheter chassis and a free end which is disposed opposite the fixed end. For such catheter system embodiments, the axial belt may form a loop that extends proximally from the fixed end and free end through a distal segment of a wall of the endoluminal prosthesis. The free end of the axial belt is releasably secured in fixed relation to the chassis with a circumferential belt which is disposed about the chassis and free end such that the loop captures a distal segment of the endoluminal prosthesis and restricts proximal displacement of the endoluminal prosthesis relative to the chassis.
- Some embodiments of a method for deploying an endoluminal prosthesis in a body lumen of a patient include advancing a catheter system for deployment of an endoluminal prosthesis into the body lumen of the patient until the endoluminal prosthesis of the catheter system is disposed at a treatment site. An outer constraint may be removed from the endoluminal prosthesis while an axial belt restricts proximal axial movement of the endoluminal prosthesis relative to the chassis. Such an axial belt may include a fixed end which is secured in fixed relation to the elongate catheter chassis and a free end which is disposed opposite the fixed end. The axial belt forms a loop that extends proximally from the fixed end and free end through a distal segment of a wall of the endoluminal prosthesis with the free end of the axial belt releasably secured in fixed relation to the chassis with a circumferential belt which is disposed about the chassis and free end such that the loop captures a distal segment of the endoluminal prosthesis. The endoluminal prosthesis may be allowed to self-expand by removal of the constraint such that an outside surface of the endoluminal prosthesis contacts an inside surface of the patient's body lumen. The circumferential belt is then released from the axial belt and axial belt from the distal segment of the endoluminal prosthesis so as to allow the endoluminal prosthesis to be fully deployed and engage the body lumen. The chassis and axial belt may then be proximally retracted such that the axial belt is withdrawn from the wall of the distal end of the endoluminal prosthesis.
- Some embodiments of a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient include a flexible elongate chassis having a proximal end, a distal end, a distal section and an overall column strength sufficient for advancement of the chassis through a body lumen of a patient. Such a catheter system may also include a self-expanding tubular endoluminal prosthesis disposed in a constrained state over the distal section of the chassis. In addition, such a catheter system may include a plurality of axial release wires, with each axial release wire having a proximal end, a distal end and a distal section. For such an embodiment, the distal section of each release wire may extend through a distal segment of a wall of the endoluminal prosthesis with the distal section releasably secured in fixed relation to a pair of axially spaced bushings which are secured to and extend radially outward from the chassis. Such a structure may be configured so as to form a loop structure or otherwise enclosed structure between the distal section, the axially spaced bushings and an outside surface of the chassis, such that this loop structure releasably captures a distal segment of the endoluminal prosthesis and restricts proximal displacement of the endoluminal prosthesis relative to the chassis.
- Some embodiments of a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient include a flexible elongate chassis having a proximal end, a distal end, and a column strength configured for advancement of the chassis through a body lumen of a patient. Such a catheter system may also include a self-expanding tubular endoluminal prosthesis disposed in a constrained state at the distal end of the chassis. In addition, such a catheter system may include a tubular everting sheath which has an inner section which includes a first diameter, a fixed end which is secured in fixed relation to the chassis and an endoluminal prosthesis section that is disposed over and radially constrains the endoluminal prosthesis in the constrained state. The tubular everting sheath may also have an outer section that is everted back over the endoluminal prosthesis section of the inner portion. The outer section may include a retraction end and a second diameter which is larger than the first diameter of the inner section such that the outer section is readily slideable over the inner section during retraction of the retraction end and eversion of the everting sheath.
- Some embodiments of a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient may include a flexible elongate chassis having a proximal end, a distal end, and a column strength configured for advancement of the chassis through a body lumen of a patient. Such a catheter system may also include a self-expanding tubular endoluminal prosthesis disposed in a constrained state at the distal end of the chassis. In addition, such a catheter system may include a tubular everting sheath which has an inner section which includes a fixed end which is secured in fixed relation to the chassis and an endoluminal prosthesis section that is disposed over and radially constrains the endoluminal prosthesis in the constrained state. The tubular everting sheath may also have an outer section that is everted back over the endoluminal prosthesis section of the inner portion. The outer section may also include a retraction end. The everting sheath may also include a PTFE material having a closed cell microstructure with no distinct fibrils interconnecting adjacent nodes such that the outer section is readily slideable over the inner section.
- Some embodiments of a method for deploying an endoluminal prosthesis in a body lumen of a patient include advancing a catheter system for deployment of an endoluminal prosthesis into the body lumen of the patient until the endoluminal prosthesis of the catheter system is disposed at a treatment site in a constrained state. The endoluminal prosthesis is held in the constrained state by an endoluminal prosthesis section of an inner section of a tubular everting sheath. In some cases, the inner section may have a first diameter and a fixed end which is secured in fixed relation to an elongate chassis of the catheter system. An outer constraint may be removed from the endoluminal prosthesis by proximally retracting a retraction end of an outer section of the tubular everting sheath. Such an outer section may be everted back over the endoluminal prosthesis section of the inner section and include a second diameter which is larger than the first diameter of the inner section. The endoluminal prosthesis may be thus allowed to self-expand as the endoluminal prosthesis section of the inner section is proximally everted so as to remove radial constraint from the endoluminal prosthesis. As the endoluminal prosthesis self-expands, an outside surface of the endoluminal prosthesis may then engage an inside surface of the patient's body lumen.
- Some embodiments of a method for deploying an endoluminal prosthesis in a body lumen of a patient include advancing a catheter system for deployment of an endoluminal prosthesis into the body lumen of the patient until the endoluminal prosthesis of the catheter system is disposed at a treatment site in a constrained state. For such a catheter system, the endoluminal prosthesis may be held in the constrained state by an endoluminal prosthesis section of an inner section of a tubular everting sheath. Such a tubular everting sheath may include a PTFE material having a closed cell microstructure with no distinct fibrils interconnecting adjacent nodes. The inner section may include a fixed end which is secured in fixed relation to an elongate chassis of the catheter system. An outer constraint may then be removed from the endoluminal prosthesis by proximally retracting a retraction end of an outer section of the tubular everting sheath. Such an outer section may be everted back over the endoluminal prosthesis section of the inner section. The endoluminal prosthesis may then be allowed to self-expand as the endoluminal prosthesis section of the inner section is proximally everted so as to remove radial constraint from the endoluminal prosthesis. As the endoluminal prosthesis self-expands, an outside surface of the endoluminal prosthesis may engage an inside surface of the patient's body lumen.
- Some embodiments of a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient may include a flexible elongate chassis having a proximal end, a distal end, a distal section and an overall column strength sufficient for advancement of the chassis through a body lumen of a patient. The catheter system may also include a self-expanding tubular endoluminal prosthesis disposed in a constrained state over the distal section of the chassis and a thin, flexible, resilient extension that extends through a wall of a distal end of the endoluminal prosthesis. The extension may be disposed in a radially constrained state such that the extension at least partially captures a distal segment of the endoluminal prosthesis and restricts proximal displacement of the endoluminal prosthesis relative to the chassis. The extension may include a proximal end which is secured in fixed relation to the elongate catheter chassis and a distal end which is disposed radially outward from an outside surface of the chassis and distal of the proximal end of the extension. In addition, the catheter system may further include a tubular everting sheath which has an inner section which includes a fixed end which is secured in fixed relation to the chassis and an endoluminal prosthesis section that is disposed over and radially constrains the endoluminal prosthesis and extension in the constrained state. The tubular everting outer sheath may also have an outer section that is everted back over the endoluminal prosthesis section of the inner portion, the outer section including a retraction end which is disposed at an opposite end of the everting sheath relative to the fixed end.
- Some embodiments of a method for deploying an endoluminal prosthesis in a body lumen of a patient may include advancing a catheter system for deployment of an endoluminal prosthesis into the body lumen of the patient until the endoluminal prosthesis of the catheter system is disposed at a treatment site. For such a catheter system, the endoluminal prosthesis and a resilient, flexible, extension that at least partially captures a distal segment of the endoluminal prosthesis may both be held in a constrained state by an endoluminal prosthesis section of an inner section of a tubular everting sheath. An outer constraint may thereafter be removed from the endoluminal prosthesis and the extension by proximally retracting a retraction end of an outer section of the tubular everting sheath. Retraction of the outer section may be carried out by the outer section being everted back over the endoluminal prosthesis section of the inner section during the proximal retraction while the extension prevents proximal axial movement of the endoluminal prosthesis relative to a flexible, elongate chassis of the catheter system. The endoluminal prosthesis and extension may then be allowed to self-expand such that an outside surface of the endoluminal prosthesis engages an inside surface of the patient's body lumen. Finally, the chassis and extension may be proximally retracted such that the extension passes axially through the wall of the distal end of the endoluminal prosthesis and no longer engages the distal segment of the endoluminal prosthesis.
- Some embodiments of a method of loading an endoluminal prosthesis into a sheath which is configured to constrain the endoluminal prosthesis include passing a plurality of thin high tensile tethers loops through an end of the endoluminal prosthesis. The plurality of tether loops is also passed through an inner lumen of the sheath. An end of the sheath is restrained and both ends of each of the tether loops are pulled on simultaneously in a direction away from the endoluminal prosthesis such that the tether loops are pulled through the inner lumen of the sheath and axial tension is thereby applied to the end of the endoluminal prosthesis such that the endoluminal prosthesis is radially compressed and constrained as it is pulled into a funnel section of the inner lumen of the sheath to an endoluminal prosthesis section within the inner lumen of the sheath. Thereafter, only one side of each of the tether loops is pulled on and an opposite end of each tether loop is released until each of the tether loops is pulled out of the endoluminal prosthesis and the inner lumen of the sheath.
- Certain embodiments are described further in the following description, examples, claims and drawings. These features of embodiments will become more apparent from the following detailed description when taken in conjunction with the accompanying exemplary drawings.
-
FIG. 1 is an elevation view of a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient disposed in a body lumen. -
FIG. 2 is an enlarged view in partial section of the catheter system and body lumen indicated by the encircled portion 2-2 ofFIG. 1 . -
FIG. 3 is an elevation view in partial section of the endoluminal prosthesis ofFIG. 2 in a partially deployed state. -
FIG. 4 is an elevation view in partial section of the endoluminal prosthesis ofFIG. 2 in a fully deployed state. -
FIG. 5 is an elevation view in partial section of the endoluminal prosthesis ofFIG. 2 in a fully deployed state with an elongate chassis and extensions of the catheter system withdrawn from the patient's body lumen. -
FIG. 6 is an elevation view of the elongate chassis and extensions of a catheter system embodiment. -
FIG. 7 is a transverse cross section of the elongate chassis ofFIG. 6 indicated by lines 7-7 ofFIG. 6 . -
FIG. 8 is an enlarged elevation view of an extension embodiment. -
FIG. 9 is an elevation view of an endoluminal prosthesis embodiment as shown inFIGS. 2-5 . -
FIG. 10 is a transverse cross section of the endoluminal prosthesis embodiment ofFIG. 9 taken along lines 10-10 ofFIG. 9 . -
FIG. 11 is an elevation view of a section of an elongate chassis and extensions extending therefrom wherein the extensions have been cut from a tubular structure of the elongate chassis. -
FIG. 12 is a transverse cross section of the elongate chassis and extensions ofFIG. 11 taken along lines 12-12 ofFIG. 11 . -
FIG. 13 is an elevation view of the elongate chassis, extensions and nosecone of a catheter system embodiment. -
FIG. 14 is a transverse cross section of the elongate chassis and extensions ofFIG. 13 taken along lines 14-14 ofFIG. 13 . -
FIG. 15 is an elevation view of partial section of a distal portion of a catheter system embodiment. -
FIG. 16 is a transverse cross section of the outer sheath, nosecone and extensions of the catheter system ofFIG. 15 taken along lines 16-16 ofFIG. 15 . -
FIG. 17 is an elevation view of an elongate chassis, extensions and nosecone of a catheter system embodiment. -
FIG. 18 is a transverse cross section of the elongate chassis of the catheter system ofFIG. 17 taken along lines 18-18 ofFIG. 17 . -
FIG. 19 is an elevation view of a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient. -
FIG. 20 is an enlarged view in partial section of the catheter system indicated by the encircled portion 20-20 ofFIG. 19 . -
FIG. 21 is an enlarged view in partial section of the catheter system indicated by the encircled portion 21-21 ofFIG. 20 . -
FIG. 22 is a transverse cross section of the catheter system ofFIG. 21 taken along lines 22-22 ofFIG. 21 . -
FIG. 23 is an elevation view in partial section of the catheter system ofFIG. 19 disposed within a patient's body lumen. -
FIG. 24 is an elevation view in partial section of the catheter system ofFIG. 19 disposed within a patient's body lumen with an outer sheath proximally retracted and the endoluminal prosthesis of the catheter system partially deployed within the patient's body lumen. -
FIG. 25 is an elevation view in partial section of the catheter system ofFIG. 19 disposed within a patient's body lumen with the endoluminal prosthesis fully deployed and engaging the patient's body lumen. -
FIG. 26 is an elevation view in partial section of a distal portion of a catheter system embodiment for delivery of an endoluminal prosthesis in a body lumen of a patient. -
FIG. 27 is an elevation view in partial section of a distal portion of a catheter system embodiment for delivery of an endoluminal prosthesis in a body lumen of a patient. -
FIG. 28 is an enlarged view of the distal portion of the catheter system ofFIG. 27 . -
FIG. 29 is a transverse cross section of the elongate chassis of the catheter system ofFIG. 28 taken along lines 29-29 ofFIG. 28 . -
FIG. 30 is an elevation view of the catheter system ofFIG. 27 disposed within a body lumen of a patient and the endoluminal prosthesis of the catheter system deployed and engaged with an inner surface of the body lumen. -
FIG. 31 is an elevation view of a catheter system for deploying an endoluminal prosthesis in a body lumen of a patient. -
FIG. 32 is an enlarged view in partial section of the catheter system and body lumen indicated by the encircled portion 32-32 ofFIG. 31 . -
FIG. 33 is an enlarged view in partial section of the catheter system and body lumen indicated by the encircled portion 33-33 ofFIG. 31 . -
FIG. 34 is a transverse cross section of the catheter system ofFIG. 33 taken along lines 34-34 ofFIG. 33 . -
FIG. 35 is an enlarged elevation view in section of a wall portion of the catheter system indicated by the encircled portion 35-35 shown inFIG. 32 . -
FIG. 36 is a transverse cross section of the catheter system ofFIG. 32 taken along lines 36-36 ofFIG. 32 . -
FIG. 37 is an elevation view of an everting sheath embodiment of a catheter system embodiment. -
FIG. 38 is an enlarged view of a transition section between an inner section and an outer section of the everting sheath ofFIG. 37 as indicated by the encircled portion 38-38 ofFIG. 37 . -
FIG. 39 is an enlarged view of a wall portion of the outer section of the everting sheath ofFIG. 38 as indicated by the encircled portion 39-39 ofFIG. 38 . -
FIG. 40 is an enlarged view of a funnel section disposed at a retraction end of the outer section of the everting sheath ofFIG. 37 as indicated by the encircled portion 40-40 ofFIG. 37 . -
FIG. 41 is an end view of the outer section of the everting sheath ofFIG. 37 . -
FIG. 42 is an elevation view in partial section showing a distal portion of the catheter system ofFIG. 31 disposed within a body lumen of a patient. -
FIG. 43 is an elevation view in partial section showing a distal portion of the catheter system ofFIG. 31 disposed within a body lumen of a patient with an everting sheath partially retracted and an endoluminal prosthesis of the catheter system partially deployed. -
FIG. 44 is an elevation view in partial section showing a distal portion of the catheter system ofFIG. 31 disposed within a body lumen of a patient with an everting sheath partially retracted and an endoluminal prosthesis of the catheter system partially deployed. -
FIG. 45 is an elevation view in section showing the endoluminal prosthesis of the catheter system ofFIG. 31 fully deployed and engaging an inside surface of the patient's body lumen. -
FIG. 46 shows a distal portion of the catheter system ofFIG. 31 disposed in an iliac body lumen of a patient. -
FIG. 47 is an enlarged view in partial section of another embodiment of the catheter system and body lumen indicated by the encircled portion 32-32 ofFIG. 31 that includes flexible resilient extensions operatively secured to the chassis and passing through a distal segment of an endoluminal prosthesis embodiment. -
FIG. 48 is an elevation view in partial section showing a distal portion of the catheter system ofFIG. 31 disposed within a body lumen of a patient, the catheter system including the optional extensions operatively secured to the chassis as shown inFIG. 47 . -
FIG. 49 is an elevation view in partial section showing a distal portion of the catheter system ofFIG. 48 disposed within a body lumen of a patient with an everting sheath partially retracted and an endoluminal prosthesis of the catheter system partially deployed. -
FIG. 50 is an elevation view in partial section showing a distal portion of the catheter system ofFIG. 48 disposed within a body lumen of a patient with an everting sheath. -
FIG. 51 is an elevation view in partial section showing a distal portion of the catheter system ofFIG. 48 disposed within a body lumen of a patient with an everting sheath completely retracted and the optional extensions retracted from the endoluminal prosthesis. -
FIG. 52 is an elevation view in section showing the endoluminal prosthesis of the catheter system ofFIG. 48 fully deployed and engaging an inside surface of the patient's body lumen. -
FIG. 53 is an elevation view of an endoluminal prosthesis embodiment and optional elongate catheter chassis being loaded into an everting sheath embodiment. -
FIG. 54 is an elevation view of the everting sheath embodiment ofFIG. 53 with the endoluminal prosthesis and elongate catheter chassis being drawn into the funnel section of the everting sheath such that the endoluminal prosthesis and resilient extensions of the optional chassis are radially constrained. -
FIG. 55 is an elevation view of the everting sheath ofFIG. 53 with the endoluminal prosthesis completely loaded into an endoluminal prosthesis section of the everting sheath. -
FIG. 56 shows a thin high tensile tether being pulled through the everting sheath and out of an end of the fully loaded endoluminal prosthesis ofFIG. 55 . -
FIG. 57 shows a more detailed view in partial section of the thin high tensile tether being pulled out of an end of the fully loaded endoluminal prosthesis ofFIG. 56 . -
FIG. 58 shows the thin high tensile tether being pulled out of an end of the fully loaded endoluminal prosthesis ofFIG. 56 . - The drawings illustrate embodiments of the technology and are not limiting. For clarity and ease of illustration, the drawings may not be made to scale and, in some instances, various aspects may be shown exaggerated or enlarged to facilitate an understanding of particular embodiments.
- As discussed above, there is a need for catheter systems for deployment of endoluminal prostheses that can reliably and accurately deliver such devices to a wide variety of body lumen target sites within a patient. In order to achieve this, it may be desirable to configure catheter system embodiments to maintain control of an axial position of an endoluminal prosthesis during deployment in order to maintain accuracy. It may also be desirable to minimize frictional forces within the various components of catheter system embodiments such that the catheter system embodiments function readily even in difficult to access and tortuous anatomies. In addition, minimizing frictional forces may be important when accessing body lumen target sites that are spatially remote from a point of access to the patient's body. Various catheter system embodiments are discussed herein that may be directed to achieving one or more such desirable attributes. In addition, various methods of using such catheter systems or methods of preparing or manufacturing such catheter systems are also discussed. With regard to terms used to describe the orientation of the various catheter systems discussed herein, the term “distal” is used to describe a position or direction away from a user of a catheter system and the term “proximal” is used to describe a position or direction towards a user of a catheter system. The same convention also applies to endoluminal prostheses components of such catheter systems. Although it is common to describe a “proximal” end of endoluminal prosthesis devices as being that end which is disposed towards a flow of blood of a patient, this convention is not adopted herein.
- Referring to
FIGS. 1-10 , acatheter system 10 is shown that is configured to control an axial position of a self-expandingendoluminal prosthesis 12 during deployment. In particular, thecatheter system 10 for deploying theendoluminal prosthesis 12 in abody lumen 14 of a patient is shown which may include a flexibleelongate chassis 16 having aproximal end 18, adistal end 20, adistal section 22 and an overall column strength configured for advancement of thechassis 16 through abody lumen 14 of a patient. In some cases, theelongate chassis 16 may be configured for atraumatic passage throughtortuous body lumens 14 of a patient, such as tortuous arteries or veins of a patient's vasculature. The chassis may have any suitable configuration that provides both a sufficient flexibility in order to navigate a patient'sbody lumens 14 and structural strength in order to support the various structures secured thereto and functions carried out with thechassis 16. In some cases, the chassis may include an elongate tubular structure made from any suitable biocompatible polymer such as polyurethane, polytetrafluoroethylene (PTFE), polyethylene (PE), nylon, Pebax®, fluorinated ethylene propylene (FEP), polyimides, composite materials or the like. - The self-expanding
tubular endoluminal prosthesis 12 is shown disposed in a constrained state over the distal section of thechassis 16 with proximal axial displacement of theendoluminal prosthesis 12 being restricted by a plurality ofextensions 24 that extend from thechassis 16 through adistal end 26 of theendoluminal prosthesis 12. The proximal axial displacement of theendoluminal prosthesis 12 may be so restricted by one or moresuch extensions 24. Eachextension 24 may be a thin, flexible, resilient extension having aproximal end 28 which is secured in fixed relation to theelongate catheter chassis 16 and adistal end 30 which is disposed radially outward from anoutside surface 32 of thechassis 16 and distal of theproximal end 28 of theextension 24. The fixation of theproximal end 28 relative to the chassis may be facilitated by a base structure such as a high strength cylinder of material that may or may not be made from the same material as theextension 24. Each of theextensions 24 may extend through awall 34 of thedistal end 26 of theendoluminal prosthesis 12 with theextension 24 in a radially constrained state such that theextension 24 at least partially captures adistal segment 36 of theendoluminal prosthesis 12 and restricts proximal displacement of theendoluminal prosthesis 12 relative to thechassis 16 as shown inFIG. 2 . For some embodiments, thecatheter system 10 may have 1extension 24 to 10extensions 24, more specifically, 2extensions 24 to 6extensions 24, and even more specifically, 3extensions 24 to 4extensions 24. - The
catheter system 10 may optionally include a tubularouter sheath 38 which is disposed over theendoluminal prosthesis 12 andchassis 16 and which includes aninner surface 40 that constrains theendoluminal prosthesis 12 in the constrained state. Theinner surface 40 of the outer sheath may also be configured to radially restraindistal ends 30 of theextensions 24 in a radially constrained state as shown inFIG. 2 . Such a radially constrained state of theextensions 24 provides more leverage for theextensions 24 to restrict proximal axial movement of theendoluminal prosthesis 12 because the radial constraint on the distal ends 30 of theextensions 24 prevents them from pivoting in a proximal direction when proximal tension is applied to theendoluminal prosthesis 12. As such, for some embodiments, theextensions 24 may havedistal ends 30 that extend radially outward from thechassis 16 in a relaxed unconstrained state by a distance similar to a radius of theendoluminal prosthesis 12 to be deployed when thatendoluminal prosthesis 12 is also in an unconstrained state. In some instances, anangle 41 that theflexible extensions 24 form with respect to alongitudinal axis 42 ofchassis 16 may be about 5 degrees to about 50 degrees with theextension 24 in a relaxed unconstrained state as shown inFIG. 8 . Theangle 41 of theflexible extensions 24 with respect to thelongitudinal axis 42 of the chassis may in some cases be defined by the angle between thelongitudinal axis 42 of thechassis 16 and aline 44 extending from theproximal end 28 of theextension 24 to thedistal end 30 of theextension 24 as shown inFIG. 8 . - Because of the springy resilience of some
extension embodiments 24, the distal ends 30 of theseextensions 24 may be easily passed through thewall 34 of theendoluminal prosthesis 12 when both theendoluminal prosthesis 12 and theextensions 24 are in a relaxed unconstrained state. Thereafter both theendoluminal prosthesis 12 and theextensions 24 may be radially constrained by an inward radial force and held in that constrained state by aninner surface 40 of theouter sheath 38 as shown inFIG. 2 . In order to achieve both a proper flexibility and resilience as well as sufficiently strong bending moment in order to resists failing under an axial load from theendoluminal prosthesis 12 during proximal retraction of theouter sheath 38, someextension embodiments 24 may be made from a resilient high strength material such as a metal alloy or composite material. For some embodiments, theextensions 24 may be made from or include superelastic nickel titanium alloy. For some such embodiments, theextensions 24 may include a transverse cross section area of about 0.08 mm.sup.2 to about 1 mm.sup.2. For some embodiments, theextensions 24 may have a length of about 4 mm to about 25 mm. - As shown in
FIG. 7 , theextension 24 lies substantially in a same plane as thelongitudinal axis 42 of thechassis 16. In some cases, the meaning of the phrase substantially in the same plane may include lying within a thickness of theextension 24 of lying in the same plane as thelongitudinal axis 42 of thechassis 16. For some embodiments, the plurality ofextensions 24 is evenly distributed with respect to circumferential orientation about thechassis 16. For example, for suchcatheter system embodiment 10 havingextensions 24, theextensions 24 would be spaced about 120 degrees apart from each other about thelongitudinal axis 42 of thechassis 16. In some instances, theextension 24 may have an s-shape in the unconstrained relaxed state as shown in more detail inFIG. 8 . For the embodiment shown, a proximalmost deflection 46 of the s-shape of theextension 24 extends away from the chassis as indicated byarrow 48 and a distalmost deflection 50 of the s-shape of theextension 24 extends towards the chassis as indicated byarrow 52. The outward facing curvature of the proximalmost deflection 46 may be useful in order to provide a smooth rounded profile for passage within a constraining tubular structure such as theouter sheath 38 oreverting sheath 172 discussed below. The proximalmost deflection 46 may also be useful for providing a gap between theouter surface 32 of the chassis and theextensions 24 to accommodate thedistal section 36 of the endoluminal prosthesis which may be at least partially mechanically captured by the extension so as to restrict proximal axial movement of theendoluminal prosthesis 12. The optional distalmost deflection 50 may be useful in some circumstances for loading theendoluminal prosthesis 12 anddistal segments 36 thereof onto therespective extensions 24. The outwardly pointed direction of the proximal ends 28 of theextensions 24 may be useful to facilitate penetration of theextensions 24 through thewall 34 of theendoluminal prosthesis 12 when both theextensions 24 andendoluminal prosthesis 12 are in a relaxed unconstrained state. - For some embodiments, the
distal segment 36 of theendoluminal prosthesis 12 captured by theextension 24 may include a highstrength stent element 54 of a self-expandingstent 56 of theendoluminal prosthesis 12 as shown inFIGS. 2 and 3 . In some cases, thestent element 54 captured by theextension 24 includes a crown section of the stent (not shown). A highstrength stent element 54 may include a resilient and optionally superelastic material such as nickel titanium alloy or the like. - For some embodiments, the
chassis 16 may optionally include aguidewire lumen 58 to slidably house aguidewire 60 extending from theproximal end 18 of thechassis 16 to thedistal end 20 of thechassis 16. In some instances, thecatheter system 10 may also include anosecone 62 secured to adistal end 20 of thechassis 16. Thenosecone 62 may include ashoulder portion 64 which is disposed within adistal end 66 of the tubularouter sheath 38 which may also be disposed over theendoluminal prosthesis 12 andchassis 16. Theouter sheath 38 includes theinner surface 40 that at least partially radially constrains theendoluminal prosthesis 12 andextensions 24 in the constrained state. For some such embodiments, referring specifically toFIGS. 13-16 , theshoulder portion 64 of thenosecone 62 may further optionally include one or more elongate longitudinally orientedslots 68 which are configured to accept thedistal end 30 of correspondingextensions 24 when theextensions 24 are in the radially constrained state. Some embodiments of these longitudinally orientedslots 68 may be disposed so as to be substantially parallel to and lie substantially in the same plane as thelongitudinal axis 42 of thechassis 16. The longitudinally orientedslots 68 in thenosecone 62 may be useful in some instances for stabilizing the distal ends 30 of the one ormore extensions 24 when disposed in the radially constrained state. The distal ends 30 of the extensions may lie in theslots 68 between thenosecone 62 and theinner surface 40 of theouter sheath 38. Theslots 68 may, in some instances, make a radial depth of about 0.2 mm to about 3 mm and a circumferential width of about 0.2 mm to about 3 mm. For some embodiments, the slots may have an axial length of about 1 mm to about 10 mm and may in some cases extend all or most of an axial length of theshoulder portion 64. - In some cases, the
tubular endoluminal prosthesis 12 may be a tubular stent graft including at least one layer of thin,compliant material 70 secured to the self-expandingstent 56. For some of these embodiments, the thincompliant material 70 may include nylon mesh, PTFE, ePTFE or the like. In some instances, thestent graft 12 may be a fully stented stent graft as shown inFIG. 9 wherein the helical resilient and undulatingstent 56 which is secured to thetubular graft material 70 extends all the way from adistal end 26 of the stent graft to a proximal end of the stent graft. For some embodiments, the endoluminal prosthesis may include astent 56 made from a high strength superelastic metal alloy such as a nickel titanium or the like. - In use, referring back to
FIGS. 1-5 , a method embodiment for deploying theendoluminal prosthesis 12 in thebody lumen 14 of the patient may include advancing thecatheter system 10 into thebody lumen 14 of the patient until theendoluminal prosthesis 12 is disposed at atreatment site 74. In some cases, it may be desirable to advance thecatheter system 10 to the treatment site over theguidewire 60 which may be previously disposed across atreatment site 74, which may be moved along ahead of thecatheter system 10 in a step by step approach or by any other suitable method.Suitable treatment sites 74 for any of the catheter system embodiments 10 and method embodiments discussed herein may include a wide variety of indications such as treatment of vascular defects such as an aneurysm (not shown) or the like or any other suitable indication wherein anendovascular prosthesis 12 may be indicated. In addition,suitable treatment sites 74 may include healthy body lumen sections or substantially healthy body lumen sections that are adjacent to vascular defects. Deployment of endoluminal prostheses in such healthy body lumen sections may be desirable in some cases in order to extend a previously deployedendoluminal prosthesis 12 or for any other suitable indication. - An outer constraint, such as the outer constraint of the
outer sheath 38, may then be removed from theendoluminal prosthesis 12 while theextensions 24 prevent proximal axial movement of theendoluminal prosthesis 12 relative to thechassis 16 due to frictional forces between theouter surface 76 of theendoluminal prosthesis 12 and theinner surface 40 of theouter sheath 38 during proximal retraction of theouter sheath 38. In such cases as shown inFIG. 3 , the outer constraint may be removed by proximally retracting theouter sheath 38 of thecatheter system 10 which both releases the radial constraint of theouter sheath 38 on theendoluminal prosthesis 12 but also imposes an axial force in a proximal direction on theendoluminal prosthesis 12 due to the frictional interaction between theinner surface 40 of theouter sheath 38 and outsidesurface 76 of theendoluminal prosthesis 12. An inner transverse dimension of theouter sheath 38 will typically be less than an outer transverse dimension of theendoluminal prosthesis 12 in a relaxed unconstrained state. Theextensions 24 may each include theproximal end 28 which is secured in fixed relation to theelongate catheter chassis 16 and thedistal end 30 which is disposed radially outward from theoutside surface 32 of thechassis 16 and distal of theproximal end 28 of theextension 24 as discussed above. Each of the one ormore extensions 24 may also extend through thewall 34 of thedistal end 26 of theendoluminal prosthesis 12 with thedistal end 30 of theextension 24 held in a radially constrained state by theinner surface 40 of theouter sheath 38, also as discussed above. Theextensions 24 are so constrained such that each of the one ormore extensions 24 at least partially captures the respectivedistal segment 36 of theendoluminal prosthesis 12. As the outer constraint is removed, theendoluminal prosthesis 12 is then allowed to self-expand such that an outside surface of theendoluminal prosthesis 12 contacts aninside surface 78 of the patient'sbody lumen 14 as shown inFIG. 3 . Thechassis 16 and one ormore extensions 24 may then be proximally retracted as a unit such that each of theextensions 24 slide axially through a respective perforation in thewall 34 of thedistal end 26 of theendoluminal prosthesis 12 and theendoluminal prosthesis 12 is allowed to fully deploy and engage theinside surface 78 of thebody lumen 14 of the patient as shown inFIG. 4 . - Referring to
FIGS. 11 and 12 , an embodiment of anelongate chassis 80 that may be used in any suitablecatheter system embodiment 10 discussed herein is shown that includes atubular member 82 of flexible, resilient material that has aplurality extensions 84 configured for endoluminal prosthesis retention cut directly from thetubular member 82 of theelongate chassis 80. Such an “as cut” configuration of theelongate chassis 80 may be made from any suitable high strength resilient materials such as stainless steel, and shape memory materials such as nickel titanium alloy and the like. For shape memory embodiments, theextensions 84 may be heat set into any of the shapes and configurations as discussed above with regard to the other extension embodiments including the same or similar length, cross section area, s-shape configuration angle formed with respect to thelongitudinal axis 42 of thechassis extensions 84 may be cut from thetubular chassis 80 by any suitable method including laser cutting, water jet cutting, wire EDM or the like. - Referring to
FIGS. 17 and 18 , an embodiment of anelongate chassis 16 including substantiallyrigid extensions 86 configured for endoluminal prosthesis retention for use in catheter system embodiments 10 for deploying anendoluminal prosthesis 12 in abody lumen 14 of a patient is shown. Theelongate chassis 16 may have one or more suchrigid extension embodiments 86 secured in a fixed relation thereto. Therigid extension embodiments 86 may include aproximal end 88 which is secured in fixed relation to theelongate catheter chassis 16 and adistal end 90 which is disposed radially outward from anoutside surface 32 of thechassis 16 and distal of theproximal end 88 of theextension 86. Such substantiallyrigid extension embodiments 86 may extend through a respective perforation in thewall 34 of adistal end 26 of theendoluminal prosthesis 12 such that theextensions 86 at least partially capture thedistal segment 36 of theendoluminal prosthesis 12 and restrict proximal displacement of theendoluminal prosthesis 12 relative to thechassis 16. In this sense, therigid extensions 86 may function similarly to theextensions 24 discussed above. The term substantially rigid used in this context herein is meant to includeextensions 86 the distal ends 90 of which are not deflected or displaced during normal use by an amount more than about 1 mm with respect to thechassis 16 due to forces imposed by theendoluminal prosthesis 12 on theextensions 86 during deployment of theendovascular graft 12. The extension embodiments 86 may otherwise have the same or similar lengths as the lengths discussed above with regard to the flexible resilient extension embodiments 24. The distal ends 90 of the substantiallyrigid extensions 86 may be disposed with agap 92 between distal ends 90 of theextensions 86 and theoutside surface 32 of thechassis 16 of about 0.5 mm to about 5 mm. The substantiallyrigid extensions 86 may be made from any suitable high strength material or materials including metal and metal alloys such as stainless steel, nickel titanium, composite materials or the like. - Referring to
FIGS. 19-22 , acatheter system embodiment 100 for deploying anendoluminal prosthesis 12 in abody lumen 14 of a patient is shown. The catheter system includes the flexibleelongate chassis 16 having aproximal end 18, adistal end 20, adistal section 22 and an overall column strength sufficient for advancement of the chassis through abody lumen 14 of a patient. Such acatheter system 100 may also include a self-expandingtubular endoluminal prosthesis 12 disposed in a constrained state over thedistal section 22 of thechassis 16. In addition, thecatheter system 100 may include one or more thin, flexible,axial belts 102 with eachaxial belt 102 having afixed end 104 which is secured in fixed relation to theelongate catheter chassis 16 and afree end 106 which is disposed opposite thefixed end 104. For such catheter system embodiments, eachaxial belt 102 may form aloop 108 that extends proximally from thefixed end 104 andfree end 106 through adistal segment 36 of awall 34 of theendoluminal prosthesis 12. Thefree end 106 of eachaxial belt 102 may be releasably secured in fixed relation to thechassis 16 with acircumferential belt 110 which is disposed about thechassis 16 and free ends 106. Thecircumferential belt 110 may be configured to apply an inward radial force on thefree end 106 of eachaxial belt 102 sufficient to releasably secure eachfree end 106 in fixed relation to thechassis 16. The inward radial force of the circumferential belt may be generated by tension ofcircumferential belt 110 squeezing the free ends 106 against theoutside surface 32 of thechassis 16. In such a fixed relation, the loop is configured to capture thedistal segments 36 of theendoluminal prosthesis 12 around which theloops 108 are disposed so as to restrict proximal displacement of theendoluminal prosthesis 12 relative to thechassis 16. - For some such embodiments, the
circumferential belt 110 may be releasably secured around the free ends 106 andchassis 16 in a tensioned state by atrigger wire 112 which passes through looped ends 118 of thecircumferential belt 110. Such atrigger wire 112 may extend axially along or within thechassis 16 from thecircumferential belt 110 to theproximal end 18 of thechassis 16 and ultimately to adeployment handle 114 of aproximal adapter 116. The deployment handle 114 may be actuated so as to apply axial translation of thetrigger wire 112 in a proximal direction and retract the trigger wire from theend loops 118. In some cases, it may be desirable for thetrigger wire 112 to have sufficient stiffness in order to keepend loops 118 of thecircumferential belt 110 in fixed relation to each other until thetrigger wire 112 is withdrawn while still maintaining sufficient flexibility to be advanced throughtortuous body lumens 14 of the patient. Some triggerwire embodiments 112 may be made from high strength resilient flexible materials including metals and metal alloys such as nickel titanium alloy including superelastic nickel titanium alloy as well as stainless steel, composite materials and the like. In some cases, thetrigger wire 112 may have a cross section area of about 0.002 mm.sup.2 to about 0.06 mm.sup.2, more specifically, about 0.04 mm.sup.2 to about 0.05 mm.sup.2. - For those catheter system embodiments that include a plurality of
axial belts 102, the plurality ofaxial belts 102 may be evenly distributed about thechassis 16 with respect to circumferential orientation about thechassis 16. For some embodiments, the one or moreaxial belts 102 may have a length of about 10 mm to about 25 mm. For some embodiments, each of the one or moreaxial belts 102 may have a transverse cross section area of about 0.002 mm.sup.2 to about 0.16 mm.sup.2, more specifically, about 0.05 mm.sup.2 to about 0.09 mm.sup.2. In some cases, thecatheter system 100 may include 1axial belt 102 to 10axial belts 102, more specifically, 2axial belts 102 to 6axial belts 102 and even more specifically, 3axial belts 102 to 4axial belts 102. In some cases, theaxial belt 102 and releasablecircumferential belt 110 may be made from any suitable high tensile flexible material including solid wires or braided or stranded filaments of metals including metal alloys such as stainless steel, superelastic nickel titanium as well as solid, braided or stranded filaments of high strength polymers such as nylon, aramid fibers and the like. - In some cases, a respective
distal segment 36 of theendoluminal prosthesis 12 may be captured by theloop 108 of each of the one or moreaxial belts 102. Eachdistal segment 36 may include the highstrength stent element 54 of the self-expandingstent 56 of theendoluminal prosthesis 12. In addition, thestent element 54 captured by each of the loops of the one or moreaxial belts 102 may include a crown section of the stent 56 (not shown). The highstrength stent element 54 may include a resilient and optionally superelastic material such as nickel titanium alloy or the like. - For some embodiments, the
chassis 16 may optionally include aguidewire lumen 58 extending from theproximal end 18 of thechassis 16 to thedistal end 20 of thechassis 16. In some instances, thecatheter system 100 may also include anosecone 62 secured to thedistal end 20 of thechassis 16. The nosecone may have ashoulder portion 64 which is disposed within adistal end 66 of the tubularouter sheath 38. The optional tubularouter sheath 38 which is disposed over theendoluminal prosthesis 12 andchassis 16 may include aninner surface 40 that at least partially radially constrains theendoluminal prosthesis 12 in the constrained state. - In some cases, the tubular
endoluminal prosthesis embodiments 12 discussed herein may be a tubular stent graft including at least one layer of thin,compliant material 70 secured to the self-expandingstent 56 as shown inFIGS. 9 and 10 . For some of these embodiments, the thincompliant material 70 may include nylon mesh, PTFE, ePTFE or the like. In some instances, thestent graft 12 may be a fully stented stent graft as shown inFIG. 9 wherein the helical resilient and undulatingstent 56 which is secured to thetubular graft material 70 extends all the way from adistal end 26 of thestent graft 12 to aproximal end 72 of thestent graft 12. - In use, referring to
FIGS. 23-25 , a method for deploying theendoluminal prosthesis 12 in thebody lumen 14 of a patient may include advancing thecatheter system 100 into thebody lumen 14 of the patient until theendoluminal prosthesis 12 of the catheter system is disposed at atreatment site 74 as shown inFIG. 23 . In some cases, it may be desirable to advance thecatheter system 100 to thetreatment site 74 over theguidewire 60 which may be previously disposed across atreatment site 74, which may be moved along ahead of thecatheter system 100 in a step by step approach or by any other suitable method. An outer constraint, such as theouter sheath 38, may be removed from theendoluminal prosthesis 12 while theaxial belts 102 restrict proximal axial movement of theendoluminal prosthesis 12 relative to the chassis as shown inFIG. 24 . Removal of the outer constraint on theendoluminal prosthesis 12 may include proximal retraction of theouter sheath 38 as indicated by arrow 120 inFIG. 23 . In some cases, theouter sheath 38 may be proximally retracted by applying proximal tension to the retraction handle 67 relative to thechassis 16. As discussed above, theaxial belts 102 may include thefixed end 104 which is secured in fixed relation to theelongate catheter chassis 16 and thefree end 106 which is disposed opposite thefixed end 104. Theaxial belts 102 form theloops 108 that extend proximally from the fixed ends 104 andfree ends 106 through thedistal segment 36 of thewall 34 of theendoluminal prosthesis 12. The free ends 106 of theaxial belts 102 are releasably secured in fixed relation to thechassis 16 with thecircumferential belt 110 which is disposed about thechassis 16 and free ends 106. Theloops 108 of each of the one or moreaxial belts 102 capture and restrict axial movement in a proximal direction of the respectivedistal segments 36 of theendoluminal prosthesis 12. Theendoluminal prosthesis 12 may be allowed to self-expand by removal of the constraint, such as by proximal retraction of anouter sheath 38, such that anoutside surface 76 of theendoluminal prosthesis 12 contacts aninside surface 78 of the patient'sbody lumen 14. The tension of thecircumferential belt 110 and resulting inward radial force may then be released from the one or moreaxial belts 102 by proximal retraction of thetrigger wire 112 from theend loops 118 of thecircumferential belt 110. The free ends 106 of theaxial belts 102 are thereby released from thedistal segments 36 of theendoluminal prosthesis 12. In this way, theendoluminal prosthesis 12 is allowed to further self-expand and be fully deployed and engage theinside surface 78 of thebody lumen 14. Thechassis 16 and one or moreaxial belts 102 may then be proximally retracted such that theaxial belts 102 are withdrawn from respective perforations in thewall 34 of the distal end of theendoluminal prosthesis 12 as shown inFIG. 25 . - Referring to
FIG. 26 , another embodiment of acatheter system 126 is shown which has an endoluminal prosthesis restraint system which is similar to that of thecatheter system 100 ofFIGS. 19-22 . However, instead of eachloop 108 of eachaxial belt 102 extending from thefixed end 104 around thedistal segment 36 and back to thefree end 106, as is the case withcatheter system 100 ofFIGS. 19-25 , theaxial belts 128 of thecatheter system embodiment 126 ofFIG. 26 extend distally from afixed end 130 which is secured to thechassis 16, through a respective perforation in thewall 34, around adistal segment 36 of theendovascular prosthesis 12 and then to afree end 132. The free ends 132 may be similarly releasably secured in fixed relation to thechassis 16 with acircumferential belt 110 andtrigger wire 112 arrangement with the same or similar arrangement to that of thecatheter system embodiment 100 ofFIGS. 19-22 with the same or similar features, dimensions and materials. - Referring to
FIGS. 27-29 , a catheter system 140 for deploying an endoluminal prosthesis in a body lumen of a patient includes a flexibleelongate chassis 16 having aproximal end 18, adistal end 20, adistal section 22 and an overall column strength sufficient for advancement of thechassis 16 through abody lumen 14 of a patient. Such a catheter system 140 may also include a self-expandingtubular endoluminal prosthesis 12 disposed in a constrained state over thedistal section 22 of thechassis 16. In addition, the catheter system 140 may include a plurality ofaxial release wires 142, with eachaxial release wire 142 having a proximal end, adistal end 144 and adistal section 146. Thedistal section 146 of eachrelease wire 142 may extend through adistal segment 36 of awall 34 of theendoluminal prosthesis 12 with thedistal section 146 releasably secured in fixed relation to a pair of axially spaced bushings, including a proximalmost bushing 148 and a distalmost bushing 150. Thebushings chassis 16. Such a structure may be configured so as to form aloop structure 152 having a continuous enclosed structure formed between thedistal section 146, the axially spacedbushings outside surface 32 of thechassis 16, such that thisloop structure 152 releasably captures s respectivedistal segment 36 of theendoluminal prosthesis 12 and restricts proximal displacement of theendoluminal prosthesis 12 relative to thechassis 16. This configuration may also restrict outward radial displacement of thedistal segments 36 which are captured by therespective loop structures 152. - For some embodiments, the
release wires 142 may be releasably secured to the spacedbushings release wires 142 are disposed through alongitudinal lumen 154 of the proximalmost bushing 148 and a correspondinglongitudinal lumen 156 of the distalmost bushing 150. In some cases, it may be desirable for thelongitudinal lumens bushings outside surface 158 of therelease wire 142 disposed therein. In these cases, the substantially close fit of thelongitudinal lumens release wire 142 disposed therein. In some cases, correspondinglongitudinal lumens most bushing 148 and distalmost bushing 150 may be coaxial or otherwise aligned with each other. In some cases, the spacing and configuration of thebushings longitudinal lumens bushings most bushing 148 and a proximal end of the distalmost bushing 150 may be about 4 mm to about 16 mm and agap 160 between thelongitudinal lumens bushings outside surface 32 of thechassis 16 may be about 0.5 mm to about 5 mm in some cases. - For some embodiments, the plurality of
axial release wires 142 may be evenly distributed with respect to circumferential orientation about thechassis 16 and spacedbushings Such release wires 142 may extend axially along or within thechassis 16 from the spacedbushings proximal end 18 of thechassis 16 and be coupled to a deployment handle, such as deployment handle 114 disposed on aproximal adapter 116 shown inFIG. 19 . In some cases, it may be desirable for therelease wires 142 to have sufficient stiffness in order to keepdistal segments 36 of theendoluminal prosthesis 12 in fixed relation to thechassis 16 until therelease wires 142 are withdrawn by proximal retraction from thehandle 114 disposed at aproximal adapter 116 of the catheter system 140. However, therelease wires 142 should still maintain sufficient flexibility to be advanced throughtortuous body lumens 14 of the patient. Somerelease wire embodiments 142 may be made from high strength resilient flexible materials including metals and metal alloys such as nickel titanium alloy including superelastic nickel titanium alloy as well as stainless steel, composite materials and the like. In some cases, therelease wires 142 may have a cross section area of about 0.04 mm.sup.2 to about 0.06 mm.sup.2. In some cases, the catheter system 140 may have 2axial release wires 142 to 10axial release wires 142, more specifically, 2axial release wires 142 to 6axial release wires 142, and even more specifically, having 3axial release wires 142 to 4axial release wires 142. - In some cases, the respective
distal segments 36 of theendoluminal prosthesis 12 captured by therelease wires 142 may include a highstrength stent element 54 of a self-expandingstent 56 of theendoluminal prosthesis 12. In addition, thestent element 54 captured by each of therelease wires 142 may include a crown section of thestent 56. A highstrength stent element 54 may include a resilient and optionally superelastic material such as nickel titanium alloy or the like. - For some embodiments, the
chassis 16 may optionally include aguidewire lumen 58 extending from theproximal end 18 of thechassis 16 to thedistal end 20 of thechassis 16. In some instances, the catheter system 140 may also include anosecone 62 secured to thedistal end 20 of thechassis 16, thenosecone 62 including ashoulder portion 64 which may be disposed within adistal end 66 of a tubularouter sheath 38. Aninner surface 40 of the optionalouter sheath 38 may be disposed over the endoluminal prosthesis and chassis and at least partially radially constrain the endoluminal prosthesis in the constrained state. - In some cases, the
tubular endoluminal prosthesis 12 may be a tubular stent graft including at least one layer of thin,compliant material 70 secured to the self-expandingstent 56. For some of these embodiments, the thincompliant material 70 may include nylon mesh, PTFE, ePTFE or the like. In some instances, thestent graft 12 may be a fully stented stent graft as shown inFIG. 9 wherein the helical resilient and undulatingstent 56 which is secured to thetubular graft material 70 extends all the way from thedistal end 26 of thestent graft 12 to theproximal end 72 of thestent graft 12. - In use, as shown in
FIGS. 28 and 30 , deployment of theendoluminal prosthesis 12 may begin with proximal retraction of the optionalouter sheath 38 by applying axial tension to the retraction handle 67 which is secured to theproximal end 69 of theouter sheath 38 as shown inFIG. 19 . During proximal retraction of theouter sheath 38, proximal displacement of theendoluminal prosthesis 12 is restricted by theloop structures 152 which mechanically capture respectivedistal segments 36 of theendoluminal prosthesis 12. As discussed above, a proximal axial force may be generated on the endoluminal prosthesis during retraction of theouter sheath 38 due to frictional engagement between theouter surface 76 of theendoluminal prosthesis 12 and theinner surface 40 of theouter sheath 38. The frictional engagement may be due to the outward radial force of the radially constrained self-expandingstent 56 of some embodiments of the endoluminal prosthesis pushing theoutside surface 76 against theinner surface 40 of theouter sheath 38. - Once the
outer sheath 38 has been proximally retracted, therelease wires 142 may then be proximally retracted from the respectivelongitudinal lumens bushings longitudinal lumens 156 of the distalmost bushing 150 as shown inFIG. 28 may be carried out. Once therelease wires 142 have been disengaged from at least the distalmost bushing 150 anddistal segments 36 of theendoluminal prosthesis 12, theendoluminal prosthesis 12 will be allowed to self-expand and engage aninside surface 78 of thebody lumen 14 of the patient as shown inFIG. 30 . Prior to proximal retraction of therelease wires 142, theloop 152 formed between therelease wires 142, spacedbushings outside surface 32 of thechassis 16 serves to restrict axial movement in a proximal direction of theendoluminal prosthesis 12 due to frictional forces imposed on theendoluminal prosthesis 12 by proximal retraction of the optionalouter sheath 38 at the initiation of the deployment process. In this way, the axial position of theendoluminal prosthesis 12 is maintained relative to thechassis 16 andbody lumen 14 during the deployment process. - Referring to
FIGS. 31-41 , some embodiments of acatheter system 170 for deploying anendoluminal prosthesis 12 in abody lumen 14 of a patient may include an optional flexibleelongate chassis 16 having aproximal end 18, adistal end 20, adistal section 22, alongitudinal axis 42, and a column strength configured for advancement of thechassis 16 through abody lumen 14 of a patient. Such acatheter system 170 may also include a self-expandingtubular endoluminal prosthesis 12 disposed in a constrained state at adistal section 22 of thechassis 16. The catheter system includes atubular everting sheath 172 which has aninner section 174. The inner section includes a first diameter, afixed end 176 which is secured in fixed relation to thechassis 16 and anendoluminal prosthesis section 178 that is disposed over and radially constrains theendoluminal prosthesis 12 in the constrained state. Thefixed end 176 may be disposed at the distal end of the inner section and in some cases, theinner section 174 may be secured in fixed relation to thechassis 16 at a position that is adjacent a proximal end of theendoluminal prosthesis section 178. Theendoluminal prosthesis section 178 is generally disposed at a distal end of theinner section 174 opposite thefixed end 176 and adjacent thedistal section 22 of thechassis 16. Theinner section 174 joins anouter section 180 at a transition point where there may optionally be a transition in the diameter, thickness and/or material of theeverting sheath 172. A first diameter of theinner section 174 is indicated byarrows 179 shown inFIG. 38 . - The
tubular everting sheath 172 includes also theouter section 180 that is everted back over theendoluminal prosthesis section 178 of theinner section 174 and may also be everted back over some or all of the remainder of theinner section 174 that is proximal of theendoluminal prosthesis section 178. Theouter section 180 may include aretraction end 182 and a second diameter which is larger than the first diameter of theinner section 174 such that theouter section 180 is readily slideable over theinner section 174 during retraction of theretraction end 182 and eversion of theeverting sheath 172. Theretraction end 182 is secured to aretraction handle 186 that may be used to apply proximal axial tension to theouter section 180 relative to thechassis 16 andinner section 174 in order to pull theouter section 180 back over theinner section 174 to evert theeverting sheath 172. As such, it may be desirable in some cases for theoptional chassis 16 to have sufficient column strength to resist the axial tension applied to theretraction end 182 of theouter section 180 during eversion of theeverting sheath 172. The second diameter of theouter section 180 is indicated byarrows 181 shown inFIG. 38 . - For
catheter system embodiments 170 that include the stepped ormulti-diameter everting sheath 172, the diameter of theouter section 180 may be greater than the first diameter of theinner section 174 by an amount of at least a wall thickness, indicated byarrows 184 shown inFIG. 38 , of theouter section 180 of thetubular everting sheath 172 in some cases. For some embodiments, thethickness 184 of the wall of the everting sheath may be about 0.05 mm to about 2 mm. This dual diameter arrangement may be useful in order to reduce friction and tensile forces on theouter section 180 required to evert thetubular everting sheath 172. For some embodiments, a lubricatingmaterial 175 disposed between theinner section 174 andouter section 180 as shown inFIG. 35 may be used to reduce friction between thesesections lubricating material 175 may include liquids, pastes, gels, including hydrogels as well as tubular structures formed from lubricious materials. - Some embodiments of the everting sheath may also include a PTFE material that has a closed cell microstructure with no distinct fibrils interconnecting adjacent nodes such that the outer section is readily slideable over the inner section due at least in part to the lubricious and supple nature of this type of material. Catheter system embodiments that include an everting sheath having a PTFE material with a closed cell microstructure with no distinct fibrils may also optionally be configured without the dual diameter everting sheath wherein the
inner section 174 has a different diameter than theouter section 180. As discussed above, various components of the catheter systems and/or endoluminal prosthesis devices discussed herein may include a type of PTFE material that is produced by a wet stretching method or the like that yields a closed cell microstructure having no distinct fibrils interconnecting adjacent nodes as described in commonly owned U.S. Pat. No. 8,728,372, filed by J. Humphrey et al. on Oct. 29, 2010, titled “PTFE Layers and Methods of Manufacturing”, which is hereby incorporated by reference herein in its entirety. - Manufacture of these types of specialized PTFE materials may be carried out by any suitable method. Such PTFE materials may be produced by compounding PTFE resin powder with a lubricant material, stretching agent, or combination thereof, and then extruding that compounded material through an extruder such as a ram extruder. The extrudate may then be calendered in order to thin and mechanically work the extrudate. After calendering, one side or both sides of the calendered PTFE layer are sprayed with an isoparaffin-based stretching agent at a prescribed temperature so that the PTFE film or layer is flooded and fully saturated through the thickness of the PTFE layer. The saturated, calendered PTFE layer may then be stretched in a direction that is substantially orthogonal to the calendering direction by a tentering machine to reduce a thickness of the PTFE layer and form a stretched PTFE layer. The stretched PTFE layer may have a thickness of about 0.00005 inch to about 0.005 inch; specifically, the stretched PTFE layer may have a thickness of about 0.0002 inch to about 0.002 inch. The PTFE layer typically is tentered or stretched at an elevated temperature above the glass transition temperature, specifically, from about 80.degree. F. to about 100.degree. F., more specifically, about 85.degree. F. to about 95.degree. F. Wet tentering with the stretching agent allows the PTFE layer to be thinned without creating substantial porosity and fluid permeability in the stretched PTFE layer. While the stretched PTFE layer will have porosity, its porosity and pore size typically will not be large enough to be permeable to liquids, and often will be small enough to have substantially no fluid permeability. In addition, the stretched PTFE layer embodiment does not have the conventional node and fibril microstructure but instead has a closed cell microstructure in which boundaries of adjacent nodes are directly connected with each other. The fluid-impermeable stretched PTFE film or layer typically may have a density from about 0.5 g/cm.sup.3 to about 1.5 g/cm.sup.3, but it may have a larger or smaller density for some embodiments. In addition, with regard to all of the methods of processing layers of PTFE discussed above, any of the PTFE layers produced by these methods may also be sintered at any point in the above processes in order to substantially fix the microstructure of the PTFE layer. A typical sintering process may be to expose the PTFE layer to a temperature of about 350.degree. C. to about 380.degree. C. for several minutes; specifically, about 2 minutes to about 5 minutes. The various methods discussed above may be used to produce PTFE layers having a variety of desirable properties. Scanning electron microscope (SEM) images of such materials show a generally closed cell microstructure that is substantially free of the conventional node and fibril microstructure commonly seen in expanded PTFE layers. Embodiments of the PTFE film may have low fluid-permeability, or no or substantially no fluid-permeability. One or more of PTFE layer may be used as a barrier layer to prevent a fluid such as a liquid or gas from permeating or escaping therethrough. At a magnification of 20,000, the microstructure of the stretched PTFE layer resembles a pocked-like structure that includes interconnected high density regions and pockets or pores between some of the high density regions. The PTFE film may be considered to have a closed cell network structure with interconnected strands connecting high density regions in which a high density region grain boundary is directly connected to a grain boundary of an adjacent high density region. Unlike conventional expanded PTFE (“ePTFE”) which typically has a substantial node and fibril microstructure that is discernable when viewed at a SEM magnification of 20,000, such a PTFE layer lacks the distinct, parallel fibrils that interconnect adjacent nodes of ePTFE and has no discernable node and fibril microstructure when viewed at a SEM magnification of 20,000. The closed cell microstructure of the PTFE layer provides a layer having low or substantially no fluid permeability that may be used as “a barrier layer” to prevent liquid from passing from one side of the PTFE layer to the opposite side. Though such a PTFE film or layer is configured to have low or substantially no fluid permeability, the PTFE layer nonetheless has a porosity. The PTFE layer typically has an average porosity from about 20% to about 80%, and specifically from about 30% and about 70%. In one embodiment, such a PTFE film has a porosity of about 30% to about 40%. In another embodiment, such a PTFE layer has a porosity of about 60% to about 70%. Porosity as described in these figures is meant to indicate the volume of solid PTFE material as a percentage of the total volume of the PTFE film. An average pore size in the PTFE layer may be less than about 20 microns, and specifically less than about 0.5 micron. In one embodiment, such a PTFE layer has an average pore size of from about 0.01 micron to about 0.5 micron. As can be appreciated, if tissue ingrowth is desired, the PTFE film may have an average pore size of greater than about 6.0 microns. As described below, depending on the desired properties of the resultant PTFE layer, embodiments of methods may be modified so as to vary the average porosity and average pore size of the PTFE film in a continuum from 10 microns to 50 microns down to substantially less than about 0.1 micron. In some cases, such a PTFE layer may have a density from about 0.5 g/cm.sup.3 to about 1.5 g/cm.sup.3, and specifically from about g/cm.sup.3 to about 1.5 g/cm.sup.3. While the density of the PTFE film is typically less than a density for a fully densified PTFE layer (e.g., 2.1 g/cm.sup.3), if desired, the density of the PTFE layer may be densified to a higher density level so that the density of the PTFE layer is comparable to a fully densified PTFE layer. Such a PTFE film embodiment may have an average thickness that is less than about 0.005 inch, specifically from about 0.00005 inch to about 0.005 inch, and more specifically from about 0.0001 inch to about 0.002 inch.
- In some cases, the
everting sheath 172 orsections layers FIG. 39 . In addition, aneverting sheath 172 including a single layer of material or any section of an everting sheath formed from a plurality of layers 187 may include for example, any suitable pliable, low friction material such as PTFE, ePTFE, the PTFE having a closed cell microstructure with no distinct fibrils interconnecting adjacent nodes as discussed above or any suitable material. -
FIG. 39 illustrates a portion of theouter section 180 of theeverting sheath 172 that includes a plurality of layers of material. For the embodiment shown, the everting sheath includes three separate and distinct layers of material that may optionally be fused or bonded together over an entire surface or partial surface of each of thelayers everting sheath 172. For some embodiments, the everting sheath may have 1 layer to 10 layers of material, more specifically, 2 layers to 6 layers, and even more specifically, 3 layers to 4 layers of material. In some instances, for evertingsheath embodiments 172 that include multiple layers, one or more of the layers may include ePTFE that may or may not be anisotropically oriented and one or more layers of PTFE that has a closed cell microstructure with no distinct fibrils interconnecting adjacent nodes as discussed above. - In some cases, for everting
sheath embodiments 172 that include PTFE material and particularly ePTFE material, any of the one or more layers of the everting sheath material may include an anisotropic orientation that provides a greater strength in a first direction relative to a second direction perpendicular to the first direction. For example, a layer of ePTFE material that has an anisotropic orientation providing greater strength in a longitudinal direction may be of particular use for theouter section 180 of theeverting sheath 172 which is subjected to longitudinal tensile forces during eversion of theeverting sheath 172. For other embodiments, a layer of ePTFE material that has an anisotropic orientation providing greater strength in a circumferential direction may be of particular use for theinner section 174 of theeverting sheath 172 which is subjected to outward radial forces of the constrained self-expandingendoluminal prosthesis 12 disposed in theendoluminal prosthesis section 178 of theinner section 174. Any desired combination of these anisotropic materials may be used for the layers of multiple layereverting sheath embodiments 172. - For some embodiments of the
catheter system 170, any of the evertingsheath embodiments 172 may further include one or more thin, elongate, high tensile retraction tethers 188 disposed between adjacent layers 187 of the layered tubular structure of theeverting sheath 172 and extending longitudinally along theendoluminal prosthesis section 178 andouter section 180 of theeverting sheath 172 as shown inFIGS. 39 and 40 . For single layereverting sheath embodiments 172, such retraction tethers 188 may be secured to either surface of the everting sheath. In some cases, the one or more retraction tethers may be helically wound about a tubular structure of theeverting sheath 172 as shown inFIG. 40 . For the embodiment shown inFIG. 39 , theretraction tether 188 is disposed between thefirst layer 187A and the second layer 1876. Thethird layer 187C is secured to thesecond layer 187B. Theretraction tether 188 may also be disposed between thesecond layer 187B and thethird layer 187C. For 4 layer everting sheath embodiments (not shown) the retraction tether may be disposed between a first layer and second layer, between the second layer and third layer, or between the third layer and a fourth layer. The retraction tethers 188 may be useful for reinforcing and/or gripping theeverting sheath 172 during the eversion process. As such, it may be desirable to secure a retraction end of the retraction tethers 188 to theretraction handle 186. - In some cases, the
everting sheath 172 of thecatheter system 170 may include an optionalintegral funnel section 190 disposed at theretraction end 182 of theouter section 180 of theeverting sheath 172 as shown inFIG. 40 . Thefunnel section 190 may be useful for both loading theendoluminal prosthesis 12 into theeverting sheath 172 as well as facilitating relative movement between theouter section 180 andinner section 174 during eversion. In some cases, thefunnel section 190 may have an inclusive funnel angle as indicated byarrow 192 inFIG. 40 , of 10 degrees to 40 degrees. For some embodiments, thefunnel section 190 may have a major diameter, indicated byarrow 194 inFIG. 40 , at an opening thereof that is greater than an outer diameter of theendoluminal prosthesis 12 in a relaxed expanded state. For some embodiments, an optionalintegral retraction tether 196 may be secured to and extend from theintegral funnel section 190, as shown inFIGS. 37 and 40-41 , in order to further facilitate the eversion process and provide an anchor point for the retraction end of theeverting sheath 172. As such, theintegral retraction tether 196 may be secured to theretraction handle 186. - In some cases, an optional a
nosecone 62 may be secured to thedistal end 20 of thechassis 16, thenosecone 62 including ashoulder portion 64 which is disposed within adistal end 198 of thetubular everting sheath 172. Thenosecone 62 may be secured to thechassis 16 in an axial position which is distal of theendoluminal prosthesis 12 for some embodiments. In some instances, thechassis 16 may include aguidewire lumen 58 extending from theproximal end 18 of thechassis 16 to thedistal end 20 of thechassis 16. Thechassis 16 may further include an axial length of about 50 cm to about 200 cm for any of the embodiments discussed herein. For the embodiments shown, aproximal adapter 19 is secured to theproximal end 18 of thechassis 16 and is configured to provide an interface for a user of thecatheter system 170 for manipulating the proximal end of thecatheter system 170 or introducing materials or devices such asguidewires 60 or the like into various lumens of thecatheter system 170. - In some cases, the
tubular endoluminal prosthesis 12 may be a tubular stent graft including at least one layer of thin,compliant material 70 secured to a self-expandingstent 56. For some of these embodiments, the thincompliant material 70 may include nylon mesh, PTFE, ePTFE or the like. In some instances, thestent graft 12 may be a fully stented stent graft as shown inFIG. 9 wherein the helical resilient and undulatingstent 56 which is secured to thetubular graft material 70 extends all the way from adistal end 26 of the stent graft to theproximal end 72 of thestent graft 12. - In use, referring to
FIGS. 42-45 , a method for deploying theendoluminal prosthesis 12 in thebody lumen 14 of a patient may include advancing thecatheter system 170 into thebody lumen 14 of the patient until theendoluminal prosthesis 12 of thecatheter system 170 is disposed at thetreatment site 74 in a constrained state as shown inFIG. 42 . In some cases, advancing thecatheter system 170 into thebody lumen 14 of the patient may include advancing the catheter system over aguidewire 60 until theendoluminal prosthesis 12 of the catheter system is disposed at thetreatment site 74 as discussed above in more detail with regard to other catheter system embodiments. Theendoluminal prosthesis 12 may be held in the radially constrained state by the inward radial constraint imposed by a substantially non-expandableinside surface 200 theendoluminal prosthesis section 178 of theinner section 174 of thetubular everting sheath 172. This outer constraint on theendoluminal prosthesis 12 may then be fully or partially removed from theendoluminal prosthesis 12 by proximally retracting and displacing theretraction end 182 of theouter section 180 of thetubular everting sheath 172 relative to thechassis 16 andinner section 174 by an eversion process. - During the eversion process, the
retraction end 182 andouter section 180 of theeverting sheath 172 are pulled back proximally relative to thechassis 16 while theinner section 174 remains stationary but peels up at the distal end as it folds back over on itself due to the axial displacement of theouter section 180 connected thereto. This process may be continued until theouter section 180 and distal portion of theinner section 174 are everted proximally back from theendoluminal prosthesis section 178 of theinner section 174 as shown inFIG. 43 . That is, eversion is carried out until theendoluminal prosthesis section 178 of theinner section 174 has been peeled back thereby exposing the endoluminal prosthesis and completely removing the inward radial constraint of theendoluminal prosthesis section 178. Theendoluminal prosthesis 12 will thus be allowed to self-expand due to this removal of the outer constraint. As theendoluminal prosthesis 12 self-expands, anoutside surface 76 of theendoluminal prosthesis 12 may then engage aninside surface 78 of the patient'sbody lumen 14 as shown inFIG. 44 . In most cases, theretraction end 182 of theouter section 180 is proximally retracted until theeverting sheath 172 and the constraint imposed by theendoluminal prosthesis section 178 of theeverting sheath 172 is completely removed from theendoluminal prosthesis 12. - This method for deploying the
endoluminal prosthesis 12 withcatheter system 170 may be used to deploy any suitable variety of endoluminal prosthesis to anysuitable target sites 74.FIG. 46 shows anendoluminal prosthesis 12 being deployed in aninner lumen 14 of an iliac artery of a patient. The deployment of such anendoluminal prosthesis 12 at such an iliac artery lumen may be carried out by any of the catheter system embodiments and corresponding methods of use discussed herein. - In some cases, it may be useful to combine the endoluminal prosthesis retention capabilities of any of the catheter system embodiments 10, 100, 126, 140 discussed above with the everting sheath deployment capabilities of the
catheter system 170 or any other everting sheath catheter system discussed herein. In this way, the axial position of the endoluminal prosthesis may be efficiently maintained during eversion of theeverting sheath 172. Referring toFIG. 47 , some embodiments of acatheter system embodiment 210 may include a flexibleelongate chassis 16 having aproximal end 18, adistal end 20, adistal section 22, alongitudinal axis 42, and an overall column strength sufficient for advancement of thechassis 16 through abody lumen 14 of a patient. Thecatheter system 210 may also include a self-expandingtubular endoluminal prosthesis 12 disposed in a constrained state over thedistal section 22 of thechassis 16 and one or more thin, flexible,resilient extensions 24 that extend through awall 34 of adistal end 26 of theendoluminal prosthesis 12. Theextensions 24 may be disposed in a radially constrained state such that eachextension 24 at least partially captures adistal segment 36 of theendoluminal prosthesis 12 and restricts proximal displacement of theendoluminal prosthesis 12 relative to the chassis. Theextensions 24 may each include aproximal end 28 which is secured in fixed relation to theelongate catheter chassis 16 and adistal end 30 which is disposed radially outward from anoutside surface 32 of thechassis 16 and distal of theproximal end 28 of theextension 24. Thecatheter system 210 includes atubular everting sheath 172 which has aninner section 174 which includes afixed end 176 which is secured in fixed relation to thechassis 16 and anendoluminal prosthesis section 178 that is disposed over and radially constrains theendoluminal prosthesis 12 andextensions 24 in the constrained state. The tubular evertingouter sheath 172 may also have anouter section 180 that is everted back over theendoluminal prosthesis section 178 of theinner section 174. The outer section also includes aretraction end 182 as shown inFIG. 31 which is disposed at an opposite end of theeverting sheath 172 as thefixed end 176. In general, thecatheter system 210 may include the same or similar features, dimensions or materials as those of any of the catheter systems discussed herein. - The
everting sheath 172 is disposed over theendoluminal prosthesis 12 andchassis 16 and includes aninner surface 200 of theendoluminal prosthesis section 178 that constrains the endoluminal prosthesis in the constrained state. Theinner surface 200 also radially constrains the distal ends 30 of theextensions 24 in a radially constrained state as shown inFIG. 47 . Such a radially constrained state of the distal ends 30 of theextensions 24 may provide more leverage for theextensions 24 to restrict proximal axial movement of theendoluminal prosthesis 12 because the radial constraint on the distal ends 30 of theextensions 24 prevents them from pivoting in a proximal direction when proximal tension is applied to theendoluminal prosthesis 12. For some embodiments, theextensions 24 may havedistal ends 30 that extend radially outward from the chassis in a relaxed unconstrained state by a distance similar to a radius of theendoluminal prosthesis 12 to be deployed when thatendoluminal prosthesis 12 is also in an unconstrained state. In some instances, an angle theflexible extensions 24 form with respect to thelongitudinal axis 42 ofchassis 16 may be 5 degrees to 50 degrees with theextension 24 in a relaxed unconstrained state as shown inFIG. 8 . The angle of theflexible extension 24 with respect to thelongitudinal axis 42 of thechassis 16 may in some cases be defined by the angle between thelongitudinal axis 42 of thechassis 16 and a line extending from theproximal end 28 of theextension 24 to thedistal end 30 of theextension 24 as shown inFIG. 8 . - Because of the resilience of some
extension embodiments 24, the distal ends 30 of theseextensions 24 may be easily passed through thewall 34 of theendoluminal prosthesis 12 when both theendoluminal prosthesis 12 and theextension 24 are in a relaxed unconstrained state. Both theendoluminal prosthesis 12 and theextension 24 may be radially constrained by an inward radial force and held in that constrained state by theinner surface 200 of the of theinner section 174 of theeverting sheath 172 as shown inFIG. 47 . In order to achieve both a proper flexibility and resilience as well as sufficiently strong bending moment in order to resists failing under an axial load from theendoluminal prosthesis 12, someextension embodiments 24 may be made from a resilient high strength material such as a metal alloy or composite material. For some embodiments, theextensions 24 may be made from or include superelastic nickel titanium alloy. For some such embodiments, theextension 24 may include a transverse cross section area of about 0.08 mm.sup.2 to about 1 mm.sup.2. For some embodiments, theextension 24 may have a length of about 4 mm to about 25 mm. In some cases, thecatheter system 210 may include 1extension 24 to 10extensions 24, more specifically 2extensions 24 to 6extensions 24 and even more specifically 3extensions 24 to 4extensions 24. - In some cases, as shown in
FIG. 7 and discussed above, theextensions 24 may lie substantially in a same plane as thelongitudinal axis 42 of thechassis 16. In some cases, substantially in the same plane includes within a thickness of theextension 24 of lying in the same plane as thelongitudinal axis 42 of thechassis 16. For some embodiments, the plurality ofextensions 24 is evenly distributed with respect to circumferential orientation about thechassis 16. In some cases, theextension 24 may have an s-shape in the unconstrained relaxed state as shown in more detail inFIG. 8 . For the embodiment shown, the proximalmost deflection 46 of the s-shape of the extension extends away from thechassis 16 and a distalmost deflection 50 of the s-shape of theextension 24 extends towards thechassis 16. - For some embodiments, the
distal segment 36 of theendoluminal prosthesis 12 captured by theextension 24 includes a highstrength stent element 54 of a self-expandingstent 56 of theendoluminal prosthesis 12 as shown inFIG. 47 . In some cases, thestent element 54 captured by theextension 24 includes a crown section of the stent. A highstrength stent element 54 may include a resilient and optionally superelastic material such as nickel titanium alloy or the like. - For some embodiments, the
chassis 16 may optionally include aguidewire lumen 58 extending from theproximal end 18 of thechassis 16 to thedistal end 20 of thechassis 16. In some instances, thecatheter system 210 may also include anosecone 62 secured to adistal end 20 of thechassis 16 in an axial position which is distal of theendoluminal prosthesis 12. Thenosecone 62 may also include ashoulder portion 64 which is disposed within adistal end 198 of atubular everting sheath 172. For some embodiments, thetubular everting sheath 172 may be disposed over theendoluminal prosthesis 12 andchassis 16 and include aninner surface 200 that at least partially radially constrains theendoluminal prosthesis 12 and one ormore extensions 24 in the constrained state. For some such embodiments, referring specifically toFIGS. 13-16 , theshoulder portion 64 of thenosecone 62 may further optionally include one or more elongate longitudinally orientedslots 68 which are configured to accept thedistal end 30 of thecorresponding extensions 24 when theextensions 24 are in the radially constrained state. Some embodiments of these longitudinally orientedslots 68 may be disposed so as to be substantially parallel to and lie substantially in the same plane as thelongitudinal axis 42 of thechassis 16. The longitudinally orientedslots 68 in thenosecone 62 may be useful in some instances for stabilizing the distal ends 30 of the one ormore extensions 24 when disposed in the radially constrained state. - In some cases, the
tubular endoluminal prosthesis 12 may be a tubular stent graft including at least one layer of thin,compliant material 70 secured to a self-expandingstent 56. For some of these embodiments, the thincompliant material 70 may include nylon mesh, PTFE, ePTFE or the like. In some instances, thestent graft 12 may be a fully stented stent graft, as shown inFIG. 9 and discussed above, wherein the helical resilient and undulatingstent 56 which is secured to thetubular graft material 70 extends all the way from a distal end of the stent graft to a proximal end of thestent graft 12. - For
catheter system embodiments 210 that include the stepped ormulti-diameter everting sheath 172, as shown inFIGS. 37-39 , the diameter of theouter section 180 may be greater than the first diameter of theinner section 174 by an amount of at least awall thickness 184 of theouter section 180 of thetubular everting sheath 172 in some cases. For some embodiments, the diameter of theouter section 180 may be greater than the diameter of theinner section 174 by an amount equal to 1 wall thickness of theeverting sheath 172 to 4 wall thicknesses of theeverting sheath 172. For some cases, the diameter of theinner section 174 andouter section 180 may be measured at a center of the wall thickness at diametrically opposed points of the wall of eachrespective section - The
catheter system 210 includes thetubular everting sheath 172 with theinner section 174 which includes afixed end 176 which is secured in fixed relation to thechassis 16 and theendoluminal prosthesis section 178 that is disposed over and radially constrains theendoluminal prosthesis 12 and one ormore extensions 24 in the constrained state. Thetubular everting sheath 172 includes theouter section 180 that is everted back over theendoluminal prosthesis section 178 of theinner section 174 as shown inFIG. 47 . Theouter section 180 of these embodiments may include theretraction end 182 which may optionally be secured to the retraction handle 186 which is disposed at a proximal section of thecatheter system 210 and which is axially slidable with respect to thechassis 16. Theeverting sheath 172 may include a PTFE material having a closed cell microstructure with no distinct fibrils interconnecting adjacent nodes such that the outer section is readily slideable over the inner section. Catheter system embodiments that include an everting sheath including a PTFE material having a closed cell microstructure with no distinct fibrils may be configured with or without the dualdiameter everting sheath 172 wherein theinner section 174 has a different diameter than theouter section 180 as discussed in more detail above. - In some cases, the
everting sheath 172 orsections FIG. 39 and discussed above. Aneverting sheath 172 including a single layer of material or any layer of an everting sheath formed from a plurality of layers may include any suitable pliable, low friction material such as nylon mesh, PTFE, ePTFE, the PTFE having a closed cell microstructure with no distinct fibrils interconnecting adjacent nodes as discussed above or any other suitable material. - In some cases, for everting
sheath embodiments 172 that include PTFE material and particularly ePTFE material, the everting sheath material may include an anisotropic orientation that provides a greater strength in a first direction relative to a second direction perpendicular to the first direction. For example, a layer of ePTFE material that has an anisotropic orientation providing greater strength in a longitudinal direction may be of particular use for anouter section 180 of theeverting sheath 172 which is subjected to longitudinal tensile forces during eversion of theeverting sheath 172. For other embodiments, a layer of ePTFE material that has an anisotropic orientation providing greater strength in a circumferential direction may be of particular use for aninner section 174 of theeverting sheath 172 which is subjected to outward radial forces of the constrained self-expandingendoluminal prosthesis 12 disposed in theendoluminal prosthesis section 178 of theinner section 174. - For some embodiments of the
catheter system 210, any of the evertingsheath embodiments 172 may further include one or more thin, elongate, high tensile retraction tethers 188 disposed between adjacent layers of the layered tubular structure of theeverting sheath 172 and extending longitudinally along theendoluminal prosthesis section 178 andouter section 180 of theeverting sheath 172 as shown inFIGS. 39 and 40 . For single layereverting sheath embodiments 172, such retraction tethers 188 may be secured to either surface of theeverting sheath 172. In some cases, the one or more retraction tethers 188 may be helically wound about a tubular structure of theeverting sheath 172 as shown inFIG. 40 and discussed above. - In some cases, the
everting sheath 172 of thecatheter system 210 may include an optionalintegral funnel section 190 disposed at theretraction end 182 of theouter section 180 of theeverting sheath 172 as shown inFIGS. 40 and 41 . Thefunnel section 190 may be useful for both loading anendoluminal prosthesis 12 into theeverting sheath 172 as well as facilitating relative movement between theouter section 180 andinner section 174 during eversion. In some cases, thefunnel section 190 may have aninclusive funnel angle 192 of 10 degrees to 40 degrees. For some embodiments, thefunnel section 190 may have a major diameter at an opening thereof that is greater than an outer diameter of theendoluminal prosthesis 12 to be deployed in a relaxed expanded state. For some embodiments, an optionalintegral retraction tether 196 may be secured to and extend from theintegral funnel section 190, as shown inFIGS. 37 and 40-41 , in order to further facilitate the eversion process and provide an anchor point for theretraction end 182 of theeverting sheath 172. - The
chassis 16 may further include an axial length of 50 cm to 200 cm for some embodiments. For the embodiments discussed herein, aproximal adapter 19 may be secured to theproximal end 18 of thechassis 16 and configured to provide an interface for a user of thecatheter system 210 for manipulating thecatheter system 210 or introducing materials or devices such asguidewires 60 or the like into various lumens of thecatheter system 210. - In use, referring to
FIGS. 48-52 , a method for deploying theendoluminal prosthesis 12 in abody lumen 14 of a patient may include advancing thecatheter system 210 for deployment of theendoluminal prosthesis 12 into thebody lumen 14 of the patient until theendoluminal prosthesis 12 of thecatheter system 210 is disposed at atreatment site 74 as shown inFIG. 48 . In some cases, thecatheter system 210 may be advanced over theguidewire 60 as shown inFIG. 48 . For such acatheter system 210, theendoluminal prosthesis 12 and the resilient, flexible,extension 24 that at least partially captures thedistal segment 36 of theendoluminal prosthesis 12 may both be held in a constrained state by theendoluminal prosthesis section 178 of theinner section 174 of thetubular everting sheath 172. The outer constraint may thereafter be removed from theendoluminal prosthesis 12 and theextensions 24 by proximally retracting theretraction end 182 of theouter section 180 of thetubular everting sheath 172 as seen inFIG. 49 . Retraction of theouter section 180 may be carried out by theouter section 180 being everted back over theendoluminal prosthesis section 178 of theinner section 174 during the proximal retraction as indicated by thearrow 212 inFIG. 49 . This eversion process may be carried out while theextensions 24 prevent proximal axial movement of theendoluminal prosthesis 12 relative to a flexible,elongate chassis 16 of thecatheter system 210. In some cases, theouter section 180 is proximally retracted until theeverting sheath 172 and constraint imposed by theendoluminal prosthesis section 178 thereof is completely removed from theendoluminal prosthesis 12 andextensions 24 as shown inFIG. 50 . - The
endoluminal prosthesis 12 and distal ends 30 of theextensions 24 may thereafter self-expand until anoutside surface 76 of theendoluminal prosthesis 12 engages aninside surface 78 of the patient'sbody lumen 14 as shown inFIG. 50 . Finally, thechassis 16 andextensions 24 may be proximally retracted as indicated byarrow 214 inFIG. 50 , such that theextensions 24 pass axially through perforations in thewall 34 of thedistal end 26 of theendoluminal prosthesis 12 and no longer capture the respectivedistal segments 36 of theendoluminal prosthesis 12, as shown inFIG. 51 . Thechassis 16 andextensions 24 may be further proximally retracted until they are no longer disposed within thelumen 216 of theendoluminal prosthesis 12 as shown inFIG. 52 . - For the embodiment shown, the
proximal end 28 of theextensions 24 are secured in fixed relation to theelongate catheter chassis 16 and the distal ends 30 of theextensions 24 are disposed radially outward from anoutside surface 32 of thechassis 16 distal of the proximal ends 28 of theextensions 24 such that allowing theendoluminal prosthesis 12 andextensions 24 to self-expand includes allowing the distal ends 30 of theextensions 24 to pivot outwardly away from thechassis 16. - For some of the catheter system embodiments discussed above, loading a self-expanding
endoluminal prosthesis 12, as well as any associated catheter system components such as achassis 16 etc., into any of the catheter systems discussed herein may be difficult, particularly since large radial and frictional forces may be mutually imposed between the various components of the catheter system. In addition, many of the components of such catheter systems may be fragile or easily damaged when subjected to improper types of forces and contact. As such, it may be desirable to have a suitable method for loadingendoluminal prostheses 12 into a catheter system and into a constrained state. Referring toFIGS. 53-58 , a method of loading a self-expanding (or any other suitable type) ofendoluminal prosthesis 12 into a sheath, such as the evertingsheath embodiments 172 discussed above, is shown. The method embodiment shown includes passing a plurality of thin hightensile tether loops 220 through an end of theendoluminal prosthesis 12 as shown inFIG. 53 . The plurality oftether loops 220 may also be passed through aninner lumen 222 of theeverting sheath 172 also as shown inFIG. 53 . In some cases, thetether loops 220 may be made from any suitable high tensile flexible material including solid wires or braided or stranded filaments of metals including metal alloys such as stainless steel, superelastic nickel titanium as well as high strength polymers such as nylon, aramid fibers and the like. - An end of the
everting sheath 172 may be restrained such as by theintegral retraction tether 196 of thefunnel section 190 as discussed above and shown inFIG. 53 or by any other suitable method. Both ends of each of thetether loops 220 may be pulled on with axial tension being simultaneously applied to both ends of eachtether loop 220 in a direction away from theendoluminal prosthesis 12. The axial tension is applied to both ends of eachtether loop 220 such that thetether loops 220 are pulled through theinner lumen 222 of theeverting sheath 172 and axial tension is thereby applied to the end of theendoluminal prosthesis 12. The axial tension is applied to theendoluminal prosthesis 12 such that theendoluminal prosthesis 12 is thereby pulled into theinner lumen 222 of theeverting sheath 172 to anendoluminal prosthesis section 178, or any other desired section, within theinner lumen 222 of thesheath 172 as shown inFIG. 54 . As shown inFIG. 53 theendoluminal prosthesis 12 is first pulled into thefunnel section 190 prior to entering theinner section 174. Thefunnel section 190 may be useful for guiding and compressing the endoluminal prosthesis into theinner section 174. Thereafter, by pulling on only one side of each of thetether loops 220 and releasing an opposite end of eachtether loop 220, each of thetether loops 220 may slide through and be completely pulled out of theendoluminal prosthesis 12 and theinner lumen 222 of thesheath 178 as shown inFIGS. 56-58 . - As shown in
FIGS. 53-58 , the loading method may also be used to load both anendoluminal prosthesis 12 and a correspondingchassis 16 including flexibleresilient extensions 24 extending therefrom. In such instances, thetether loops 220 may be used to pull the endovascular prosthesis, chassis and associatedextensions 24 into theinner lumen 222 of theeverting sheath 172. As this combined structure is being drawn into theinner lumen 222 due to the axial tension applied to thetether loops 220, both the self-expanding endoluminal prosthesis anddistal ends 30 of theextensions 24 will be compressed and radially constrained. The combined structure may be pulled through theinner lumen 222 until theendoluminal prosthesis 12 is disposed at theendoluminal prosthesis section 178 of theinner section 174 or disposed at any other desired location within theinner lumen 222. - As shown in
FIGS. 53-58 , the sheath being loaded is aneverting sheath 172 and pulling thetethers 220 may include pulling thetethers 220 through theeverting sheath 172 until theendoluminal prosthesis 12 is disposed within and constrained by anendoluminal prosthesis section 178 of theinner section 174 of such aneverting sheath 172. However, such methods may also be used for any other suitable sheath embodiments, including any of the proximally retractable outer sheath embodiments discussed herein that are configured to at least partially constrain a self-expandingendoluminal prosthesis 12, also as discussed above. - The delivery system and method embodiments discussed herein may be particularly useful for endoluminal prosthesis embodiments which include one or more inflatable portions. Such inflatable endoluminal prosthesis embodiments that may be deployed by the systems and methods discussed herein are discussed in U.S. Pat. No. 7,147,660 filed by M. Chobotov et al. on Dec. 20, 2002, titled “Advanced Endovascular Graft” which is hereby incorporated by reference herein in its entirety.
- Delivery catheter embodiments discussed herein may include some or all of the features, dimensions or materials of delivery systems discussed in commonly owned U.S. Patent Application Publication No. 2004/0138734, published Jul. 15, 2004, filed Oct. 16, 2003, by Chobotov et al., titled “Delivery System and Method for Bifurcated Graft” and in PCT International Publication No. WO 02/083038, published Oct. 24, 2002, filed Apr. 11, 2001, by Chobotov et al., titled “Delivery System and Method for Bifurcated Graft” each of which is incorporated by reference herein in its entirety.
- Endoluminal prosthesis embodiments discussed herein may include some or all of the features, dimensions or materials of the prostheses discussed in commonly owned U.S. Patent Publication No. 2009/0099649, filed Oct. 3, 2008, by Chobotov et al., titled Modular Vascular Graft for Low Profile Percutaneous Delivery, which is incorporated by reference herein in its entirety.
- Examples of deployment devices, alignment devices, radiopaque markers delivery methods and the like that may be used in conjunction with any suitable system or component thereof discussed herein may be found in commonly owned U.S. Patent Application No. 2011/0218609, filed Feb. 9, 2011, by M. Chobotov et al., and titled “Fill Tube Manifold and Delivery Methods for Endovascular Graft”, and U.S. Patent Publication No. 2013/0268048, filed Mar. 15, 2013, by J. Watson et al., and titled “Delivery Catheter for Endovascular Device”, U.S. Patent Publication No. 2013/0268044, filed Mar. 13, 2013, by D. Parsons et al., and titled “Durable Stent Graft with Tapered Struts and Stable Delivery Methods and Devices”, each of which is hereby incorporated by reference herein in its entirety.
- The entirety of each patent, patent application, publication and document referenced herein hereby is incorporated by reference. Citation of the above patents, patent applications, publications and documents is not an admission that any of the foregoing is pertinent prior art, nor does it constitute any admission as to the contents or date of these publications or documents.
- Modifications may be made to the foregoing without departing from the basic aspects of the embodiments discussed. Although embodiments have been described in substantial detail with reference to one or more specific embodiments, those of ordinary skill in the art will recognize that changes may be made to the embodiments specifically disclosed in this application, yet these modifications and improvements are within the scope and spirit of the disclosure.
- Embodiments illustratively described herein suitably may be practiced in the absence of any element(s) not specifically disclosed herein. Thus, for example, in each instance herein any of the terms “comprising,” “consisting essentially of,” and “consisting of” may be replaced with either of the other two terms. The terms and expressions which have been employed are used as terms of description and not of limitation and use of such terms and expressions do not exclude any equivalents of the features shown and described or portions thereof, and various modifications are possible. The term “a” or “an” can refer to one of or a plurality of the elements it modifies (e.g., “a reagent” can mean one or more reagents) unless it is contextually clear either one of the elements or more than one of the elements is described. Thus, it should be understood that although embodiments have been specifically disclosed by representative embodiments and optional features, modification and variation of the concepts herein disclosed may be resorted to by those skilled in the art, and such modifications and variations are considered within the scope of this disclosure.
- Certain embodiments of the technology are set forth in the claim(s) that follow(s).
Claims (20)
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- 2016-07-28 WO PCT/US2016/044583 patent/WO2017019913A1/en active Application Filing
- 2016-07-28 JP JP2017565180A patent/JP7083249B2/en active Active
- 2016-07-28 US US15/737,881 patent/US10695206B2/en active Active
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Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20070208350A1 (en) * | 2006-03-06 | 2007-09-06 | Gunderson Richard C | Implantable medical endoprosthesis delivery systems |
US8968381B2 (en) * | 2009-04-15 | 2015-03-03 | Cook Medical Technologies Llc | Everting deployment system and handle |
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US20180296378A1 (en) | 2018-10-18 |
JP7450662B2 (en) | 2024-03-15 |
JP7083249B2 (en) | 2022-06-10 |
JP2018522633A (en) | 2018-08-16 |
JP2022119931A (en) | 2022-08-17 |
EP3328326A1 (en) | 2018-06-06 |
WO2017019913A1 (en) | 2017-02-02 |
EP3328326A4 (en) | 2019-03-20 |
US10695206B2 (en) | 2020-06-30 |
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