WO2006036373A2 - Endogreffe aortique thoracique - Google Patents

Endogreffe aortique thoracique Download PDF

Info

Publication number
WO2006036373A2
WO2006036373A2 PCT/US2005/029619 US2005029619W WO2006036373A2 WO 2006036373 A2 WO2006036373 A2 WO 2006036373A2 US 2005029619 W US2005029619 W US 2005029619W WO 2006036373 A2 WO2006036373 A2 WO 2006036373A2
Authority
WO
WIPO (PCT)
Prior art keywords
endograft
proximal end
main body
stent structure
body portion
Prior art date
Application number
PCT/US2005/029619
Other languages
English (en)
Other versions
WO2006036373A3 (fr
Inventor
Darwin Eton
Original Assignee
The University Of Miami
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by The University Of Miami filed Critical The University Of Miami
Publication of WO2006036373A2 publication Critical patent/WO2006036373A2/fr
Publication of WO2006036373A3 publication Critical patent/WO2006036373A3/fr

Links

Classifications

    • 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
    • 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
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
    • 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
    • A61F2/02—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
    • A61F2002/075—Stent-grafts the stent being loosely attached to the graft material, e.g. by stitching

Definitions

  • the present invention relates to a device for repairing aneurysms and, more particularly, to an aortic endograft for repairing aneurysms near the aortic arch.
  • the aortic wall may weaken due to degeneration with aging and arteriosclerosis, congenital defects, infection, injury and other conditions. Weakening of the aortic wall generally results in a ballooning of the wall referred to as an aneurysm.
  • Aneurysms affect the ability of the vessel lumen to conduct fluids and may be life threatening if rupture of the aortic wall results.
  • One conventional treatment for repairing aneurysms is to surgically remove part or all of the aneurysm and implant a vessel graft section as a replacement in the vessel.
  • Another conventional treatment is the percutaneous delivery of an endograft device to bridge the aneurysmal segment of the blood vessel.
  • Aortic endografts were designed in the 1990's to permit replacement of a diseased vessel segment from within the vessel (endovascularly) in lieu of open surgery.
  • An endograft typically includes a graft material, such as Dacron or PTFE 1 and a frame or support structure such as a balloon expandable or self-expanding stent structure.
  • the stent structure may be provided at each end of the graft or may extend along the length of the graft.
  • Endografts are typically introduced percutaneously into the patient's circulatory system on or in a delivery device.
  • catheter technology is used to deliver the entire graft to the target vessel segment via an open puncture wound in the femoral artery (in the groin) or in the iliac artery (pelvis) or via an infrarenal aortic graft, or the aorta itself (in the abdomen).
  • the endograft either self expands or is balloon expanded to anchor the stent structure(s) above and below the aneurysm.
  • the graft is held in place by the radial force of the stent(s) against the vessel wall, thereby sealing the weakened vessel segment from the circulatory flow. Isolating the aneurysm from the circulatory flow reduces pressure on the weakened vessel wall thereby reducing the likelihood of vascular rupture.
  • thoracic endografts are typically provided as a simple elongated tube, supported throughout their length with a stent.
  • a straight, tubular endograft is stiffened by a correspondingly straight stent skeleton, as depicted in FIGURE 1 , the graft can override the inner convexity of the arch.
  • stenosis will result. If a substantial ledge is created, then the severe stenosis resulting may create ischemia distally.
  • the ledge can be a source for embolus and generate untoward forces on the aorta wall opposite the ledge, possibly leading to perforation.
  • an endograft device comprising: an elongated, tubular graft main body portion having a longitudinal axis, a lumen defined therethrough and proximal and distal ends; a graft proximal end portion extending from said proximal end of said main body portion to terminate at a proximal end inlet opening, and having a lumen extending therethrough; said main body portion and said graft proximal end portion being formed of a graft material configured such that said proximal end inlet opening is disposed in a plane inclined at an angle of greater than zero degrees with respect to a transverse plane of said main body portion that is substantially perpendicular to said longitudinal axis of said main body portion.
  • the graft material is supported by a stent structure, said stent structure being provided at least to define and support a distal end of said main body portion and to define and support said graft proximal end portion, said stent structure being sufficiently rigid to define and substantially maintain a predetermined shape of said graft proximal end portion.
  • the stent structure may be integrated with the graft material or may be disposed in the interior of the graft material. In the latter case, the endograft may be placed first and the stent material separately placed therein, or the endograft may be mounted to the stent structure before placement.
  • the invention may also be embodied in a thoracic aortic endograft prosthesis comprising: a tubular main body portion and an arched proximal end portion integrally formed with said tubular main body and defining an arched segment extending from a proximal end of said tubular main body portion to an open proximal end, said arched proximal end portion being one of supported by and formed from a sufficiently rigid material so as to define and maintain a predefined shape in the absence of external forces, such that said open proximal end is disposed at an angle with respect to a plane perpendicular to a longitudinal axis of said tubular main body portion.
  • the invention is also embodied in a method for endografting a blood vessel to repair a thoracic aortic aneurysm comprising the steps of: providing an endograft including a tubular main body portion and an arched proximal end portion integrally formed with said tubular main body and defining an arched segment extending from a proximal end of said tubular main body to an open proximal end, percutaneously delivering the endograft in an aneurysmal aortic segment so that the endograft extends across the aneurysmal segment to bridge the same; securing the endograft at least at proximal and distal ends thereof with respect to the aortic vessel; and supporting said arched proximal end portion so as to define and maintain a predefined shape in the absence of external forces, such that said open proximal end is disposed at an angle with respect to a plane perpendicular to a longitudinal axis of said tubular main body portion.
  • the endograft is supported by being one of supported by and formed from a sufficiently rigid material to define and maintain said predefined shape.
  • the endograft may comprises a stent structure or have stent structure disposed within said tubular main body.
  • said securing may comprise expanding said stent structure.
  • FIGURE 1 is a schematic view, partly in cross-section, illustrating a prior art aortic endograft
  • FIGURE 2 is a schematic view, partly in cross-section, depicting an aortic endograft provided in accordance with the invention disposed in an aneurysmal segment of the aorta;
  • FIGURE 3 is a schematic prospective view of an aortic endograft according to a first embodiment of the invention.
  • FIGURE 4 is a schematic prospective view of a second embodiment of an aortic endograft according to the invention.
  • the present invention provides an aortic endograft having a proximal end that is preformed as a curved end to conform to the aortic arch to provide better hemodynamics and eliminate graft slippage.
  • conventional aortic endografts are provided as a straight tube 10 disposed in the descending portion 12 of the aortic arch 14.
  • the curve in the aortic arch 14 presents a problem for such grafts and a stenosis can exist if the graft overrides the inner convexity of the arch, as shown at 16.
  • the vascular aortic endograft 110 of the invention provides a periscope shaped proximal end 118 that is angled to follow the natural curvature of the aortic arch 114 and so as to terminate with an inlet opening 120 defined in a plane that is substantially perpendicular to the central axis of the aortic vessel.
  • the endograft device or assembly 110 may be generically characterized as comprised of an angled proximal end 118 and a generally tubular main body 122 having a support frame or stent 124, 126 for engaging the vessel adjacent the proximal or upstream and distal or downstream ends of the aneurysm to support and anchor the endograft with respect thereto.
  • the stent structure may extend the entire length of the endograft structure or may be provided by generally discrete stent portions 124, 126 at proximal and distal ends of the endograft assembly, as in the illustrated embodiment.
  • the stent 124, 126 may be located external or internal to the graft body, or imbedded within the graft material itself. Furthermore, the graft material may be placed and then the stent(s) placed within the graft material to define the final shape of and anchor the graft material or, in the alternative, the endograph already supported on stent(s) may be placed.
  • the stent structure is preferably and advantageously formed from nitenol or another known temperature responsive, self-expanding memory metal.
  • the stent structure may be provided as an expandable mesh, or other expandable configuration, that is adapted to be mechanically expanded at the target site in the blood vessel by, e.g., the inflatable balloon of a conventional delivery catheter.
  • the stent/endograft delivery catheters are known in the art and may be adapted to deliver the endograft of the invention, and for clarity, the delivery catheter is not illustrated in the accompanying drawings.
  • the inlet 120, 220 to the aortic endograft generally corresponds to an inner diameter of the aortic vessel 114 in which it is disposed, and the hood or elbow portion 118, 218 of the endograft 110, 210 is angled to define a gradual transition to the straight, main body portion 122, 222 of the endograft.
  • the diameter of the endograft inlet 120, 220 generally corresponds to the diameter of the straight, main body portion of the endograft.
  • the particular angle ⁇ of the plane of the endograft inlet 120, 200 relative to a transverse plane of the main body of the endograft may be varied from an orientation that is generally perpendicular, as shown in FIGURE 4, to an orientation inclined with respect thereto, as shown in FIGURES 2-3.
  • the plane of the endograft inlet is defined at an angle of between about 45 and 90° with respect to a transverse plane of the straight, main body portion 122, 222 of the endograft and the endograft's outer wall is continuously curved from the inlet opening to the top or proximal end of the straight portion of the endograft. Most preferably, the angle is between about 70 and 90°.
  • the stent structure that defines the shape of the endograft is preformed to define the angled, periscope or elbow shape.
  • the endograft is made from a soft and malleable material and is supported throughout its length with a self expanding stent structure that is preformed to assume the desired periscope or elbow configuration.
  • the endograft may be stent supported substantially only at its ends.
  • the stent structure 126, 226 provided at the distal end may be a substantially cylindrical tube or cuff and the stent structure 124, 224 provided at the proximal end would be preformed to define the desired angled end of the endograft.
  • Dacron is the preferred material for the endograft, but the invention is not limited to that material and other suitable materials, such as PTFE, are known and may be provided instead.
  • the entire graft is delivered to the target segment of the aorta via an open puncture wound in the femoral artery (in the groin) or in the iliac artery (pelvis) or via an infrarenal aortic graft, or the aorta itself (in the abdomen).
  • the endograft of the invention is adapted to deal with aneurysms distal to the subclavian artery but the endograft is provided to bridge the entire length of the aneurysm and needs to anchor into an area of the arch which is not aneurysmal.
  • the stent structure itself is adapted to provide a significant radial force that springs the graft open so it locks into the aorta.
  • a balloon may be used to expand the stent graft further, if necessary for the endograft to secure to the aorta by radial force.
  • stent anchors such as pins on the stent, may be provided to more assuredly anchor the stent structure in position in the aorta.

Landscapes

  • Health & Medical Sciences (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Pulmonology (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Apparatus For Radiation Diagnosis (AREA)
  • Prostheses (AREA)

Abstract

Cette invention concerne une endogreffe dont une partie d'extrémité proximale est recourbée de manière à définir un coude ou une forme en périscope. Le but recherché est d'obtenir une interface plus contiguë avec la courbure de la crosse de l'aorte et par là-même d'éviter une sténose, d'empêcher une embolie sans créer des lignes tendues pouvant provoquer une lésion de l'artère sous-jacente par l'endogreffe.
PCT/US2005/029619 2004-09-16 2005-08-19 Endogreffe aortique thoracique WO2006036373A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US61020704P 2004-09-16 2004-09-16
US60/610,207 2004-09-16

Publications (2)

Publication Number Publication Date
WO2006036373A2 true WO2006036373A2 (fr) 2006-04-06
WO2006036373A3 WO2006036373A3 (fr) 2006-08-17

Family

ID=36119343

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2005/029619 WO2006036373A2 (fr) 2004-09-16 2005-08-19 Endogreffe aortique thoracique

Country Status (1)

Country Link
WO (1) WO2006036373A2 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2016145391A1 (fr) * 2015-03-11 2016-09-15 The Arizona Board Of Regents On Behalf Of The University Of Arizona Système de greffe cardiovasculaire expansible

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6468301B1 (en) * 2000-03-27 2002-10-22 Aga Medical Corporation Repositionable and recapturable vascular stent/graft

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6468301B1 (en) * 2000-03-27 2002-10-22 Aga Medical Corporation Repositionable and recapturable vascular stent/graft

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2016145391A1 (fr) * 2015-03-11 2016-09-15 The Arizona Board Of Regents On Behalf Of The University Of Arizona Système de greffe cardiovasculaire expansible
US10426593B2 (en) 2015-03-11 2019-10-01 Arizona Board Of Regents On Behalf Of The University Of Arizona Expansible cardiovascular graft system

Also Published As

Publication number Publication date
WO2006036373A3 (fr) 2006-08-17

Similar Documents

Publication Publication Date Title
US5693088A (en) Intraluminal vascular graft
US7674284B2 (en) Endoluminal graft
JP5340565B2 (ja) 腹部大動脈瘤（ａａａ）装置のステント用の捩れた固定棘部
JP3773594B2 (ja) ステントと血管移植片の結合アセンブリ
JP4284366B2 (ja) ファスナーの受け取りおよび保持のためにサイズ決めされ構成されたプロテーゼシステムおよび方法
EP0790810B1 (fr) Kit d'un catheter d'introduction et greffe pour refection d'anevrisme
US9211183B2 (en) Thoracic stent graft with guide arrangement
JP5220329B2 (ja) ステントグラフト装置
US20060089704A1 (en) Vascular graft and deployment system
US20020082684A1 (en) Intravascular prosthetic and method
AU2010201067B1 (en) Thoracic stent graft
WO2004006807A2 (fr) Methodes et appareils servant a reparer des anevrismes
JP2008049156A (ja) ステントグラフトのシール領域を接続する構造
US20180008442A1 (en) Branch endograft delivery
US9849006B2 (en) Methods and apparatuses for treating vessels
US10888414B2 (en) Aortic dissection implant
US20170231750A1 (en) Alignment system for multiple branch endografts
WO2006036373A2 (fr) Endogreffe aortique thoracique

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A2

Designated state(s): AE AG AL AM AT AU AZ BA BB BG BR BW BY BZ CA CH CN CO CR CU CZ DE DK DM DZ EC EE EG ES FI GB GD GE GH GM HR HU ID IL IN IS JP KE KG KM KP KR KZ LC LK LR LS LT LU LV MA MD MG MK MN MW MX MZ NA NG NI NO NZ OM PG PH PL PT RO RU SC SD SE SG SK SL SM SY TJ TM TN TR TT TZ UA UG US UZ VC VN YU ZA ZM ZW

AL Designated countries for regional patents

Kind code of ref document: A2

Designated state(s): GM KE LS MW MZ NA SD SL SZ TZ UG ZM ZW AM AZ BY KG KZ MD RU TJ TM AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HU IE IS IT LT LU LV MC NL PL PT RO SE SI SK TR BF BJ CF CG CI CM GA GN GQ GW ML MR NE SN TD TG

NENP Non-entry into the national phase in:

Ref country code: DE

122 Ep: pct application non-entry in european phase