The method of placement of the intraluminal graft using a guide wire and catheter to him

 

(57) Abstract:

The invention relates to medicine, namely to cardiovascular surgery. How is the placement of the intraluminal graft through the aneurysm, which passes from the aorta at least one iliac artery within the patient's body using a guide wire. A catheter for delivery contains an elongated catheter having preferably fill the container adjacent to one end, which surrounds the cylinder intraluminal graft, which branches into two short tubular continue, and additional thin catheter containing the guide wire, which passes upstream through one of the first tubular continuations and downstream through another of the short tubular extensions of the graft. The invention provides for facilitating placement of the intraluminal graft with the use of a catheter for delivery, especially for the appropriate placement of the graft in the form of pants so that it bypasses the aneurysm, which runs from a single vessel such as the aorta, into one or more outgoing vessels such as the iliac artery. 3 C. and 45 C. p. F.-ly, 9 Il.

ntata in the branched artery and catheter for use in this way.

Prior art

It is well known that as a result of diseases of the arteries of people prone to developing stretch bags, known as aneurysms, which are prone to rupture. Usually aneurysm treated with radical surgery. This approach is risky for the patient and in many cases impossible due to other existing pathological conditions of the patient. He later received a number of proposals for placement of intraluminal graft, creating a bypass aneurysm, thereby isolating the active duct from the aneurysmal SAC. One such device is described in the patent Australia 78035/94.

Difficulties arise when placing such intraluminal grafts, when the aneurysm extends from a single artery on one or more branches off of the arteries. In this case, should be used so-called "transplant in the form of pants". In this transplant single tubular body is divided into two smaller tubular housing. The intention is that a single tubular housing is placed in a single artery, and two smaller tubular housing located, respectively, in the two outgoing arteries (such as the form of pants.

The present invention relates to a new method and catheter designed to facilitate the intraluminal placement of the graft in a branching artery.

Disclosure of the invention

In the first aspect of the present invention includes a catheter for delivery contains:

(a) an elongated catheter having a first end and a second end;

(b) intraluminal graft having a body located around the elongated catheter and the housing has at the first end of the tubular part located close to the first end of the elongated catheter at the second end branching to the first and second tubular continuation of the graft, and an elongated catheter extends up to the first tubular continuation of the graft and the tubular part;

(c) additional guide wire extending in the first direction through the first tubular continuation of the graft and protruding in the second great direction into the second tubular continuation of the transplant.

In another aspect the present invention consists of a method of placement of the intraluminal graft in a branching vessel within a patient's body, and the receptacle includes Izvestiya>/BR>(a) introducing one of the vessels after branching the first intraluminal graft having a body having at a first end of the tubular portion and the second end of which is branched to the first and second tubular continuation of the graft, and inside the first intraluminal graft placed guide wire, which extends in the first direction through the first tubular continuation of the transplant and is in a second different direction to the second tubular continuation of the graft;

(b) placing the first end of the first intraluminal graft and the second tubular continuation of the graft within the vessel before branching and smoothing of the graft until, when at least its first end will finish before contact with the surrounding vessel wall before branching;

(c) advancing the guide wire relative to the graft in the second other direction until, when it will be held in the other of the vessels after branching;

(d) introducing a second intraluminal graft having an end located upstream, and the end located downstream, in other vessels after branching and using nitropropene transplant until when its end located upstream, inside or surrounded by a second tubular continuation of the graft and its end located downstream, will be within the other of the vessels after branching and will rise to the formation located upstream end of the second intraluminal graft clutch directing fluid, with the continuation of the second tubular graft.

The catheter and method in accordance with this invention are preferably used grafts with extensible cylinders manufactured in accordance with the description of the patent Australia 78035/94, the contents of which are incorporated here by reference. An elongated catheter can be inflated balloon on one end or near it with the intraluminal graft is placed around the cylinder. For the implementation of the present invention can be used with other suitable raspylyaemye container or independently raspylyaemye stents.

In a preferred embodiment of the invention intraluminal grafts that are placed at least partially in the vessels after branching, presented in various diameters. This ensures the availability of the a rule operations in practice. In one embodiment, the implementation of the change of the diameter of the intraluminal graft is achieved cone, tapering into or expanding outward toward the outer diameter along at least part of the length of the rod. Alternatively, the change in diameter is provided a shorter cone stepper reduction or step increase between two essentially cylindrical parts of different diameters, which constitute the graft. Preferably located upstream ends of the intraluminal graft have a standard diameter in order to ensure a reliable connection with the respective continuations of the tubular intraluminal graft of the graft is placed entirely inside the vessel before branching.

The present invention is described below with reference to the placement of the graft in the form of pants in a branching artery, which is a typical method of application. However, the invention can be used in other blood vessels, such as veins and bile ducts.

Preferably, intraluminal graft had such a length that each of the tubular extensions transplant ended higher on the I of each tubular continue with its associated distal artery. In an alternative device, intraluminal graft includes one tubular extension, long enough in order to speak in the first of distal arteries. In this case, another tubular continuation ends above the bifurcation, and the second tubular graft connects it continued with the second distal artery.

Guide wire, which extends upstream through the first tubular continuation of the graft and downstream across the second continuation is preferably very thin and essentially resistant to kinks. In one embodiment, the implementation of additional guide wire may extend through the channel in the body of the graft. In another embodiment, the implementation of additional catheter may extend upstream through the first tubular continuation of the graft and downstream of the second of the continuations of the tubular graft, and the additional catheter includes a guide wire. Especially preferred additional catheter 3 caliber. Additional catheter and guide wire can loosely be placed in the graft before packaging around the elongated catheter. Alternatives the first alternative portion of the catheter may be mutually intertwined or connected in another way with a part of the transplant. In another alternative, an additional catheter can be placed in a channel in the tissue of the wall of the graft. These various techniques designed for better retention of an additional guide wire and associated catheter in place during insertion of the graft in the arterial system.

In another aspect the present invention consists of a method of placement of the intraluminal graft through the aneurysm, which extends from the aorta in both iliac arteries inside the body of the patient, and the method comprises the steps:

(a) the incision or puncture to provide access to the femoral artery of the patient;

(b) introducing a first guide wire through the open femoral artery, corresponding iliac artery and the aorta so that it passes through the aneurysm;

(c) direction of the shell of the first catheter over the first guide wire as long as it passes through the aneurysm;

(d) removing the first guide wire;

(e) introducing a second relatively rigid guide wire through the sheath of the first catheter until, when he goes through the aneurysm;

(f) removing the shell of the first catheter;

(g) the direction which it will pass through the aneurysm;

(h) direction of the first catheter for delivery, which has deflated balloon adjacent to one end with the first intraluminal graft placed around the cylinder, the second guide wire and within the second sheath of the catheter is relatively larger diameter, and the first intraluminal graft has a body having at a first end of the tubular part, and a second end, which branches into first and second tubular continuation of the graft and within the first graft placed third catheter containing a third guide wire, which extends in the first direction through the first tubular continuation of the graft and in the second other direction in the second tubular continuation of the graft;

(i) positioning the first catheter for delivery so that the first end of the first graft is located upstream of the aneurysm;

(j) partial removal of the second sheath catheter with a larger diameter to release the first intraluminal graft;

(k) filling of the container and thus extending the first end of the first intraluminal graft as long as he engages with the wall of the aorta above aneurismal first and second tubular continuation of the graft;

(m) direction of the third guide wire in a second direction, down the stream to the other of the iliac and femoral arteries;

(n) the incision or puncture and extraction of the third guide wire from the other femoral artery;

(o) removing the third catheter through one femoral artery;

(R) direction of the shell of the fourth catheter according to a third guide wire and through the other of the iliac and femoral artery until, when he is inside the first transplant and will reach at least the top of the second tubular continuation of the graft;

(q) removing the third guide wire through one femoral artery;

(r) direction of the fourth guide wire of relatively large diameter through the shell of the fourth catheter until, when the guide wire will reach at least the top of the second tubular continuation of the graft;

(s) remove the shell of the fourth catheter through the other femoral artery;

(t) direction of the shell of the fifth catheter relative to the larger diameter of the fourth guide wire until, when the shell of the fifth catheter will reach at least the top of the second t the th cylinder, adjacent to one end with the second intraluminal graft having an end upstream and the end of the downstream located on both sides of the cylinder, the fourth guide wire and the inside of the shell of the fifth catheter with a larger diameter until, when the end upstream of the second transplant will be inside the second tubular continuation of the graft;

(v) partial removal of the shell of the fifth catheter to release the second intraluminal graft;

(w) filling the second catheter for delivery and thus expansion of the end upstream of the second intraluminal graft as long as he engages with the second tubular continuation of the graft;

(x) maintain the balloon in an inflated state upon removal of the first catheter for delivery of one femoral artery;

(u) the emptying of the container, as soon as the first catheter for delivery removed from one femoral artery;

(z) completely remove the shell of the fifth catheter through the other femoral artery;

(AA) the direction of the third catheter for delivery, which has deflated balloon adjacent to one end with the third intraluminal graft, keyshiacole and inside the shell of the second catheter until when the end of the upstream third of the graft will be inside the first tubular continuation of the graft;

(bb) partial removal of the shell of the second catheter to release the third intraluminal graft;

(it) fill the tank on the third catheter for delivery and thus expansion of the end upstream of the third intraluminal graft until, when he comes into engagement with the first tubular continuation of the graft;

(dd) the emptying of the container on the third catheter for delivery;

() remove the second catheter for delivery through the other femoral artery and third catheter for delivery through the first femoral artery;

(ff) the deletion of the fourth guide wire and the fifth corps of the catheter through the other femoral artery and the suturing of the incision or puncture in the artery;

(gg) the deletion of the second guide wire and the sheath of the second catheter through the first femoral artery and the suturing of the incision or puncture in the artery.

Brief description of drawings

Fig. 1 is a schematic illustration of the Central projection in the context of a patient with aortic aneurysm, which was intraluminal device is activated Tilney projection of one embodiments of a tubular intraluminal graft for use in accordance with the method, described with reference to Fig. 1.

Fig. 3 is a view in cross section along the diameter through the intraluminal graft depicted in Fig. 2.

Fig. 4 is a detail view in vertical projection at one end of the intraluminal graft depicted in Fig. 2.

Fig. 5 is a detailed perspective view of the first end of the intraluminal graft depicted in Fig. 4, showing how alternating peaks kinks end of the wire transplant repelled radially outward during insertion of the graft.

Fig. 6 and 6A are views in sectional view in the vertical projection of the two implementation options are possible branched grafts that are installed on the catheter for delivery for use in the present method.

Fig. 6b is an enlarged view of filled cylinders, respectively adjacent to the free end of the catheter and guide wire, filled with balloons.

Fig. 6C is a view in longitudinal section of the device shown in Fig. 6b, filled with balloons.

Fig. 6d is a simplified view in RNA Fig. 7a-7i show the stages of implementation of the method in accordance with the present invention.

Fig. 8A-8f are simplified vertical projection of other alternative intraluminal grafts for use in the method in accordance with the present invention.

Fig. 9 is a view in sectional view in elevation of a variant of implementation of the tubular graft is mounted on the catheter for delivery, which can be used when implementing this method.

The preferred embodiment of the invention

Branched grafts, or transplants in the form of pants 10, 10A and 10b are adapted for insertion through the femoral artery of the patient to achieve the bypass and aneurysm occlusion of the aorta extending into the left iliac artery. As can be seen in Fig. 1, the aorta 11 is connected with the left and right iliac arteries 13 and 12. Aortic aneurysm is located between the renal arteries 14 and 15 and iliac arteries 12 and 13 with the aneurysm extends down the left iliac artery 13.

Each intraluminal graft (as shown in Fig. 2-5) may include corrugated tube 16 from platonovka 16 is reinforced along its length by a number of individual or spaced at intervals of wires 17 stainless steel (each of which may be represented generally closed sinusoidal shape). The first end of the housing graft contains the edge, and the edge of the first end serrate between each protruding tip of the first wire. Wire adjacent to the first end of the body of the graft, are less intervals from each other than the wire between the two ends of the body of the graft. Wire 17 is preferably thin as possible and usually have a diameter of from 0.3 to 0.4 mm and can be sewn to the body of the graft. Wire 17 are ductility and can be bent into any desired shape, i.e. they are not in any substantial degree elastic, so that they could physically to finish, coming in contact with the aorta, and not to kill due to their own elasticity. Each of the wires 17 is woven into the fabric of the tube 16 so that the alternating peaks bending each wire 17 are located outside the tube 16 with the rest of the wire 17 within the tube 16 (except the terminal wires 17, as will be described herein below). The ends of each wire 17 are located outside of the tube 16 and twisted together to form a tail 18. Although the depicted ends twisted together to form a tail 18, the ends can also be pressed WML the outer surface of the tube 16.

The end of the wire 17A hang over the respective ends of the tube 16 so that alternating vertices of the excesses of these wires 17A extend in the longitudinal direction beyond the ends of the tube 16. The end of the wire 17A preferably have an amplitude of approximately 6 mm, and the wavelength is such that six to eight vertices of the kinks are located at intervals around the circumference of the graft with a diameter of 22 mm, the Following two adjacent wires 17 are preferably spaced as close as possible to the end of the wire 17A and respectively have an amplitude of 4 mm and 5 mm, in Other words, the first wire has a large amplitude and a smaller wavelength than most of the other wires in the body of the graft. These original wire will usually have the same wavelength as the final wire 17A. Then throughout the transplant wire 17 are spaced at intervals of 15 mm, have an amplitude of 6 mm and have essentially the same initial wavelength, and the final wire 17A. The wavelength wires essentially constant along the length of the body of the graft.

Because the aneurysm extends beyond the bifurcation of the iliac AANII at the same time, blood flow to each of the iliac arteries 12 and 13. Instead of using a single tubular graft in the present method uses three separate tubular graft 10, 10A and 10b. Below the downstream end of the first graft 10 is provided with a fork for a pair of short extensions 19a, 19b of the tubular graft 10. Short continuation 19a, 19b of the tubular graft can be passively raspravljati blood flow or actively raspravljati with the expansion of the cylinder or spring self-unfolding.

As best shown in Fig. 8a-8f, each of the parts 10A and 10b of the graft, which are adapted to discharge into the respective iliac artery 12, 13, is located upstream end having a common diameter. Located upstream ends are interconnected with corresponding extensions 19a, 19b of the graft 10, adapted for location inside of the aorta 11. Preferably, it is a mutual connection is achieved by means of a balloon smoothing or spring independent smoothing located upstream of the ends so that there is frictional engagement between the respective disposable upstream ends and sequels 15 parts 10A and 10b of the graft may be provided with varying diameters with the to match the diameter of the iliac arteries, which are implanted parts 10A and 10b of the graft.

The change in diameter may be provided a short part 31 with a step decrease (see Fig. 8C), or part 32 with a step increase (see Fig. 8d. ), or the area of the cone 33 and 34 extending along the length of the part 10A or 10b of the graft (see Fig. 8E and 8f).

Now the method of placement of the intraluminal graft will be described with reference to Fig. 7a-7i. When the process is done, the incision or puncture to access one of the femoral arteries (e.g., located on the same side), which departs from the corresponding iliac artery, and using the needle Seldinger technique as in the femoral artery is entered flexible guide wire with a diameter of a 0.035" with a flexible tip and is performed through the femoral artery and then the iliac artery 12 in the aorta 11 so that the wire passes through the aneurysm. Then to stop the bleeding on the wire is introduced hemostatic sheath 8 gauge. To provide opportunities angiogram, the patient is injected angiographic catheter for determining the position of the renal arteries 14, 15 and other relevant anatomica and then through the angiographic catheter into the aorta 11 is hardened guide wire Amplatz (JUA) 23 (diameter 0,035") (see Fig. 7a). After removal of the angiographic catheter hard guide wire 23 remains in situ. Then in the aorta 11 along the guide wire 23 is entered, the shell 21 of the catheter, preferably 24 gauge, and trocar (see Fig. 7a). Then in the shell 21 is inserted balloon catheter 24.

As more particularly shown in Fig. 6, a balloon catheter 24 is a catheter for delivery, pre-Packed with branched graft 10 having first and second tubular continue 19a, 19b, separated at the point of branching 40, and a thin catheter 25 containing the guide wire 26 extending in the first direction up through the first tubular continuation 19a and then another in the second direction in the second continuation 19b transplant.

The catheter 24 and a thin catheter 25 can be connected together below the graft 10 in a common shell 56 of the catheter, which is used to best ensure the correct positioning of the catheter 25 and the guide wire 26 when placing the graft 10 in the vessel. In addition to slip through the tubular continue 19a, 19b graft catheter 25 can be fixed in place in the graft 10 before the introduction of the graft 10 in Zavoloka 26 shown in Fig. 6 inside the catheter 25 can be easily understood that the first and second tubular extensions 19a, 19b can only be positioned guide wire 26. In the alternative device shown in Fig. 6A, the guide wire 26 is placed inside the tubular channel 22 formed in the body of the graft 10. The channel 22 is used to ensure that the guide wire 26 remains in the desired position in the first and second tubular extensions 19a, 19b after packaging of the graft 10 around the cylinder 20 and before placement of the balloon catheter 24 in the aorta 11.

When the balloon catheter 24 is placed inside the aorta 11 in the desired position, the sheath 21 is partially removed to release the graft 10 and the filled container 20 (see Fig. 7b). The filling of the container 20 of the catheter 24 extends above the downstream end of the first graft 10 and causes it engages located upstream of the end wall of the aorta above the aneurysm, but downstream from the renal arteries 14 and 15. The first graft 10 has such a length that the short tubular continue 19a, 19b of the graft is located completely inside the aorta 11. Then the balloon 20 is emptied, but the balloon catheter 24 still left in place (see Fig. 7C). 19b transplant.

A thin catheter 25 is preferably a catheter 3 caliber and the guide wire 26 from neperedavaemost material so that the guide wire 26 can move relative to the catheter 25 in the direction downstream (see Fig. 7C). The guide wire 26 may have at its end a small fill the cylinder 55 or other device in the flow resistance, as shown in Fig. 6. The container 55 may be filled in order to help the direction of the flow guide wire 26 in the opposite iliac artery 13 advancing the guide wire 26. The guide wire 26 preferably contains a nitinol core with a hydrophilic coating. The container 50 may also be present at the free end of the catheter 25. Details of examples of such cylinders 50, 55 in more detail is shown in Fig. 6b and 6C. The cylinders 50, 55 are filled in order to help accordingly, the catheter 25 and the guide wire 26 to be transported by the blood stream and directed into the opposite iliac artery 13.

An enlarged image of the cylinders 50, 55, adjacent respectively to the free ends of the catheter 25 and the guide wire 26 shown in Fig. 6b and 6C, shows, clearance 53 is sealed, and on the outer surface of the catheter 25 is formed a small hole 51. Latex balloon 50 in a circle attached to the outer surface of the catheter 25 to 50A. When you fill the tank 50, the fluid or gas is pumped through a second lumen 53 so that she or he passes through the hole 51 and fills the container 50. Similarly, the guide wire 26 has a lumen 54 through which air may be introduced to blow the cylinder 55, which is located at the free end of the guide wire 26.

Although the preferred fill the cylinders, can be used other expandable device. For example, in alternative implementations the cylinders 50, 55 on the catheter 25 and the guide wire 26 may be replaced raspravljati umbrella. An example of the type of umbrella that can be used is shown in Fig. 6d. The umbrella 70 is located at the free end of the guide wire 26. The umbrella 70, which is depicted in the expanded configuration of Fig. 6d, straightening out the wire 71, which extends through an opening 72 in the guide wire 26. The wire 71 is attached to the supports 72 so that when the lead wire back support 71 72 pivotally moved apart unfolding umbrella 70. Although the umbrella 70 is the 25. In another alternative, the cylinder 55 on the guide wire 26, as shown in Fig. 6E, may be replaced by a small solid bead 80 of a material such as epoxy resin or titanium. The bead 80 preferably has a larger profile than the guide wire 26.

In certain applications it is desirable after placement of the catheter 25 in the desired position in the vessel to further expand the container 50 at the free end of the catheter 25 until, when the container 50 engages with the wall of the vessel and hold the catheter 25 in the desired position within the vessel to provide additional attachment while holding the guide wire 26 through the vessel.

After proper placement of the guide wire 26 in the opposite femoral artery, the blood flow in the femoral artery ends by means of clamping and is arteriotomy. When a guide wire 26 is fully aimed in the opposite femoral artery, the guide wire 26 is simply removed by pulling the guide wire through the rupture or puncture in the artery. When a guide wire 26 was not fully directed in the opposite femoral artery, over against boloki 26 and pulling her back toward the site of the incision or puncture to remove it. After removing the guide wire 26 a thin catheter 25 is then removed through the same side and another catheter 27 is inserted through the opposite femoral artery up the guide wire 26 until, when he is inside the first graft 10 and reaches at least the upper part of the second tubular continue 19b (see Fig. 7d). A thin guide wire 26 is then removed through the opposite femoral artery in the catheter 27 is introduced thicker guide wire 30. Then the catheter 27 is removed and a rigid guide wire 30 is entered, the shell 21A of the catheter, preferably 24 gauge, and trocar (see Fig. 7E).

Before advancing the guide wire 26 in the opposite iliac and femoral artery sheath catheter (which may be similar to the shell 21 of the catheter) may move upstream through the opposite femoral and iliac artery to reduce any tortuosity, which may be present in these arteries and, thus, to facilitate the sending, through them, the guide wire 26.

Then, as depicted in Fig. 9, through the shell 21A of the catheter can enter the second balloon catheter 24A, coconutgrove tubular continue 19b and inside iliac artery 13 at its lower end. The container 20A on the catheter 24A is filled so that the upper end of the graft 10A comes into frictional engagement with the second tubular continuation 19b (see Fig. 7f). The filling of the container 20A on the catheter 24A supports the graft 10A during removal of the first balloon catheter 24 through the artery 12 on the same side. Then the balloon 20A on the catheter 24 is emptied and the catheter 24 is held in place to provide permanent fixation of the graft 10, 10A in the aorta 11, while placed third graft 10b.

Then the shell 21A catheter is removed (see Fig. 7f and 7g) and the shell 21 on the guide wire 23 is inserted third balloon catheter on which the Packed tubular graft 10b (third balloon catheter and graft 10b may be identical to that shown in Fig. 9). He pushed until, when he located upstream end will be inside the first tubular continue 19a, and he then placed after partial removal of the shell 21. Thus, the third graft 10b, located on the third balloon catheter in its located upstream end is forced into contact with the first tubular continuation 19a, and its located downstream end in kontse, and the incision or puncture on the opposite side sutured. Now is the second angiographic examination, and if the grafts 10, 10A and 10b are positioned correctly, the hemostatic sheath 21 is removed and the incision or puncture in the right femoral artery is sutured. As a result, there is a functioning graft in the form of pants, bypass the aneurysm as shown in Fig. 7i.

The operation may be performed using General anesthesia, epidural anesthesia, or, in appropriate cases, using only local anesthesia.

Specialists in this field will be clear that, as shown in the specific embodiments of, the invention can be made of multiple variants and/or modifications without departure from the spirit and scope of the invention described in a broad sense. Therefore, these implementations should be considered in all respects as illustrative and not restrictive.

1. A catheter for delivery containing (a) an elongated catheter having a first end and a second end; (b) intraluminal graft having a body located around the elongated catheter and the housing has at the first end of the tubular part located the favors of the graft, moreover, the elongated catheter passes up the first tubular continuation of the graft and the tubular part; (C) additional guide wire passing in the first direction through the first tubular continuation of the graft and protruding in a second different direction to the second tubular continuation of the transplant.

2. A catheter for delivery under item 1, characterized in that the additional guide wire passes through the channel in the body of the graft.

3. A catheter for delivery under item 1, characterized in that the elongated catheter has filled the container adjacent to the first end, and intraluminal graft is located around the balloon.

4. A catheter for delivery under item 1, characterized in that the portion of the intraluminal graft, located near the first end, is independently raspravljati.

5. A catheter for delivery on p. 1, wherein one of the tubular extensions of the graft has a greater length than the other tubular continuation of the transplant.

6. A catheter for delivery under item 1, characterized in that the guide wire is relatively thin and resistant to kinks.

7. Catamenia graft and through the tubular part of the body of the graft.

8. A catheter for delivery under item 1, characterized in that the body of the graft circumferentially supported along its length by a number of separate, spaced at intervals of wires, each of which has a closed sinusoidal, continuously curved configuration having a striped top.

9. A catheter for delivery under item 1, characterized in that the body of the graft circumferentially supported along its length by a number of separate, spaced at intervals of wires, in which each of the wires are intertwined with the body of the graft so that the alternating part of each wire on the outside of the body of the graft with the remaining parts of each wire inside the graft.

10. A catheter for delivery under item 1, characterized in that the additional guide wire passes in the first direction through the first tubular continuation of the graft, and in a second direction, the second tubular continuation of the graft, and the additional catheter includes an additional guide wire.

11. A catheter for delivery to p. 10, characterized in that the additional catheter is a catheter 3 caliber.

1 the ez first tubular continuation of the graft and in a second direction, the second tubular continuation of the graft and through him.

13. A catheter for delivery to p. 10, characterized in that the additional catheter is connected to parts of its length with an elongated catheter.

14. A catheter for delivery to p. 10, characterized in that the guide wire protrudes from the free end of the additional catheter.

15. A catheter for delivery to p. 10, characterized in that at least a portion of the catheter is connected at least with a part of the intraluminal graft.

16. A catheter for delivery to p. 15, characterized in that the additional catheter is mounted in a channel in the body of the graft.

17. A catheter for delivery under item 1, characterized in that the first and second tubular continuation adapted to enter into engagement with the other tubular intraluminal graft.

18. A catheter for delivery under item 17, wherein the further tubular intraluminal graft varies in outside diameter along its length.

19. A catheter for delivery under item 18, characterized in that the change of the outer diameter is provided with a cone-shaped narrowing of the inside of the graft along part of its length.

20. A catheter for delivery under item 18, characterized in that Thu is its length.

21. A catheter for delivery under item 18, characterized in that the first part of the further tubular intraluminal graft has a first outer diameter, and the second part has a different outer diameter.

22. A catheter for delivery under item 1, characterized in that the body of the graft circumferentially reinforced near its first end a number of separate, spaced at intervals of ductile wires, each of which has a generally closed sinusoidal shape, and the first wire is located close to the first end so that alternating vertices of the kinks or the top of the first wire protrude at least part of the first end.

23. A catheter for delivery to p. 22, wherein the first wire has a greater amplitude than the next adjacent wire, and preferably the following two adjacent wire.

24. A catheter for delivery to p. 22, characterized in that the wire adjacent to the first end of the graft are with smaller intervals than the wire distal to the first end.

25. A catheter for delivery to p. 22, characterized in that the body of the graft is made of polyester, polytetrafluoroethylene, polyurethane is the body of the graft.

27. A catheter for delivery under item 26, characterized in that the ends of each wire are twisted together outside the body of the graft.

28. A catheter for delivery under item 1, characterized in that the housing is tubular graft circumferentially supported along its length by a number of separate, spaced at intervals of ductile wires, the first wire is located near the first end of the body of the graft so that the first part of the wire protrude from the at least part of the first end.

29. A catheter for delivery on p. 28, characterized in that each of the wires are intertwined with the body of the graft so that the alternating part of each wire on the outside of the body of the graft with the remaining parts of each wire inside the graft.

30. A catheter for delivery on p. 28, characterized in that the body of the graft contains many holes, and each of the wires threaded through holes so that a stripe of each wire on the outside of the body of the graft with the remaining parts of each wire inside the graft.

31. A catheter for delivery on p. 28, characterized in that the wire is sewn on the sa transplant is equipped with a wire, which has alternating peaks kinks or the top, passing beyond the adjacent end of the body of the graft.

33. A catheter for delivery in p. 32, characterized in that the wire adjacent to the first end of the body of the graft, are less intervals from each other than the wire between the two ends of the body of the graft.

34. A catheter for delivery under item 33, wherein the first wire has a large amplitude and a smaller wavelength than most of the other wires in the body of the graft.

35. A catheter for delivery on p. 28, wherein each wire has a closed, essentially sinusoidal, continuously curved configuration having alternating peaks and rolling peaks of the first wire protrude at least the first end.

36. A catheter for delivery in p. 35, characterized in that the wavelength wires essentially constant along the length of the body of the graft.

37. A catheter for delivery in p. 35, wherein the first wire has a greater amplitude than the wire adjacent to it.

38. A catheter for delivery in p. 35, characterized in that is it the tip of the first wire.

39. A catheter for delivery on p. 28, characterized in that each wire has two opposite end, and both ends of each wire are connected together outside the body of the graft.

40. A catheter for delivery on p. 39, characterized in that the United ends of adjacent wires are in opposite directions along the body of the graft.

41. A catheter for delivery on p. 39, characterized in that both ends of each wire are twisted or pressed together.

42. The method of placement of the intraluminal graft in a branching vessel within a patient's body, and the receptacle includes a single vessel before branching, branching on a couple of vessels after branching, the method includes (a) an introduction to one of the vessels after branching the first intraluminal graft having a body having at a first end of the tubular portion and the second end of which is branched to the first and second tubular continuation of the graft, the housing is located around the first elongated catheter and inside the first intraluminal graft placed guide wire, which is held in the first direction through the first of trubka is spuntata, (b) placing the first end of the first intraluminal graft and the second tubular continuation of the graft within the vessel before branching and extending this transplant until, when, at least, its first end will finish before contact with the surrounding vessel wall before branching, (C) advancing the guide wire relative to the graft in the second other direction until, when it will be held in the other of the vessels after branching, and (d) introducing a second intraluminal graft having an end located upstream, and the end located downstream, in other vessels after branching, and the use of a guide wire or other guide wire placed in its position, advancement of the second intraluminal graft until, when its end located upstream, inside or surrounded by a second tubular continuation of the graft and its end located downstream, will be within the other of the vessels after branching and will rise to the formation located upstream end of the second intraluminal graft clutch directing fluid, with the continuation of the second is svetoga transplant to another of the vessels after branching and promote it as long when his end of the upstream located within the second tubular continue transplant, includes (a) the direction of the second elongated catheter that has a deflated balloon, located adjacent to the upstream end of the second intraluminal graft positioned around the balloon, the guide wire of smaller diameter and inside the sheath catheter with a larger diameter, pre-placed in another vessel after branching and vessel before the branch, (b) partial removal of the sheath of the catheter to release the second intraluminal graft, (C) filling of the container and thus the extension is located upstream of the end of the second intraluminal graft as long when he engages with the second tubular continuation of the graft, (d) maintaining the container in a filled condition during removal of the first elongated catheter from one vessel after branching, and (e) emptying the tank after the first catheter for delivery removed from one vessel after branching.

44. The method according to p. 42, wherein the steps of introducing the first intraluminal graft in one of the vessels after branching and rclocal (a) the direction of the first elongated catheter which has a deflated balloon attached to one end with the first end of the first intraluminal graft, located around the balloon, the guide wire of smaller diameter and inside the sheath catheter with a larger diameter, previously housed in the same vessel after branching and vessel before the branch, (b) partial removal of the sheath of the catheter to release the first intraluminal graft, (C) filling of the container and thus the extension of the first end of the first intraluminal graft as long as he engages with the wall of the vessel before branching, and (d) emptying of the bladder.

45. The method according to p. 42, characterized in that it further (e) introducing the third intraluminal graft having an end located upstream, and the end located downstream, in one vessel after branching, and promote the third intraluminal graft until, when its end located upstream, inside or surrounding the first tubular continuation of the graft and its end located downstream, will be within the same vessel after branching and will rise to the formation located upstream by the limit transplant.

46. The method according to p. 45, wherein the step of introducing a third intraluminal graft in one vessel after branching and promote it until, when his end of the upstream will be located inside the first tubular continue transplant, includes (a) the direction of the third elongated catheter that has a deflated balloon, located adjacent to the upstream end of the third intraluminal graft positioned around the balloon, the guide wire of smaller diameter and inside the sheath catheter with a larger diameter, previously housed in the same vessel after branching and vessel before the branch, (b) partial removal of the sheath of the catheter to release the third intraluminal graft, (C) filling of the container and thus the extension is located upstream of the end of the third intraluminal graft until, when he comes into engagement with the first tubular continuation of the graft, and (d) emptying of the bladder.

47. The method of placement of the intraluminal graft through the aneurysm, which passes from the aorta at least one iliac artery within the patient's body, and the method includes (a) wyprawa wire through the open femoral artery, the corresponding iliac artery and the aorta so that it passes through the aneurysm, (C) the direction of the shell of the first catheter over the first guide wire until, when she goes through the aneurysm, (d) removing the first guide wire, (e) the introduction of a second relatively rigid guide wire through the sheath of the first catheter until, when she goes through the aneurysm, (f) removing the shell of the first catheter, (g) the direction of the second sheath of the catheter relative to the larger diameter of the second guide wire as long as it passes through the aneurysm, (h) the direction of the first elongated catheter for delivery, which has deflated balloon adjacent to one end with the first intraluminal graft placed around the cylinder, the second guide wire and the inside of the shell of the second catheter with a larger diameter, and the first intraluminal graft has a body having at a first end of the tubular part, and a second end, which branches into first and second tubular continuation of the graft and within the first graft placed third catheter containing a third guide wire that passes in the first direction cheie transplant, (i) placing a first elongated catheter so that the first end of the first graft is located upstream of the aneurysm, (j) partial removal of the shell of the second catheter with a larger diameter to release the first intraluminal graft, (k) filling of the container and thus the extension of the first end of the first intraluminal graft as long as he engages with the wall of the aorta above the aneurysm, (l) emptying of the balloon to allow blood flow down to the first transplant, stretching the first and second tubular continuation of the graft, (m) the third direction of the guide wire in a second direction, down the stream to the other of the iliac and femoral arteries (n) an incision or puncture and removing the third guide wire from the other femoral artery, (o) removing the third catheter through one femoral artery, (b) the direction of the shell of the fourth catheter according to a third guide wire and through the other femoral and iliac artery until, when it will be inside the first transplant and will reach at least the top of the second tubular continuation of the graft, (q) removing the third guide Profiler through the shell of the fourth catheter until when the guide wire will reach at least the top of the second tubular continuation of the graft (s) removing the shell of the fourth catheter through the other femoral artery, (t) the direction of the fifth shell of the catheter relative to the larger diameter of the fourth guide wire until, when the shell of the fifth catheter will reach at least the top of the second tubular continuation of the graft, (u) the direction of the second elongated catheter that has a deflated balloon adjacent to one end with the second intraluminal graft having an end upstream and the end of the downstream located on both sides of the cylinder, according to a fourth guide wire and the inside of the shell of the fifth catheter with a larger diameter until, when the end upstream of the second transplant will be inside the second tubular continuation of the graft, (v) partial removal of the shell of the fifth catheter to release the second intraluminal graft, (w) filling of the container at the second catheter for delivery and thus the extension of the end upstream of the second intraluminal graft as long as he engages with the second tubular continuation tdnas femoral artery, (u) the emptying of the container, as soon as the first elongated catheter removed from one femoral artery, (z) the complete removal of the shell of the fifth catheter through the other femoral artery (AA) the third direction of the elongated catheter, which has a deflated balloon adjacent to one end with the third intraluminal graft having an end upstream and the end of the downstream located on both sides of the cylinder, the second guide wire and the inside of the shell of the second catheter until, when the end of the upstream third of the graft will be inside the first tubular continuation of the graft, (bb) partial removal of the shell of the second catheter to release the third intraluminal graft, (SS) the filling of the container on the third elongated catheter and thus the extension of the end upstream of the third intraluminal graft until, when he comes into engagement with the first tubular continuation of the graft, (dd) the emptying of the container on the third elongated catheter (her) removing the second elongated catheter through the other femoral artery and third elongated catheter through the first femoral artery, (ff) removing the fourth guide wire and obolochnoy guide wire and sheath of the second catheter through the first femoral artery and closure of the incision or puncture in the artery.

48. The method according to p. 47, characterized in that on the alternative stage (1) first and second tubular continuation of the graft, respectively, extend fillable tank or are independently raspravljati.

 

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