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CN-122028870-A - Single-access delivery method and system for branch vascular treatment

CN122028870ACN 122028870 ACN122028870 ACN 122028870ACN-122028870-A

Abstract

The present disclosure relates generally to methods for delivering an expandable endoluminal prosthetic device through a single access site. More particularly, the present disclosure relates to methods for placement of endoprostheses to treat aneurysmal common iliac arteries.

Inventors

  • G.A. JOHNSON
  • M.J. Sackett

Assignees

  • W.L.戈尔及同仁股份有限公司

Dates

Publication Date
20260512
Application Date
20241010
Priority Date
20231010

Claims (20)

  1. 1. A method of delivering a device to a target vascular site, the method comprising: Advancing a main endoprosthesis through an external access site in a patient's body to a location adjacent a bifurcation of a main vessel, the main endoprosthesis comprising a body branching into a first leg and a second leg, wherein the main vessel branches into a first branch and a second branch at the bifurcation; Deploying the primary endoprosthesis; advancing a guide reversing system from the external access site through the first branch of the main vessel into the first leg of the main endoprosthesis; advancing a guide member through the first branch of the main vessel through the external access site into the first leg of the main endoprosthesis and into the main body of the main endoprosthesis; Guiding the guide member back into the second leg of the main endoprosthesis and into the second branch of the main vessel using the guide reversing system; advancing a supplemental endoprosthesis into the second leg of the primary endoprosthesis on the guide member through the external access site, and The auxiliary endoprosthesis is deployed.
  2. 2. The method of claim 1, wherein the main vessel is the descending aorta.
  3. 3. The method of claim 1 or 2, wherein guiding the guide member back into the second leg of the main endoprosthesis and into the second branch of the main vessel using the guide reversing system comprises (i) steering the guide member back into the second branch with a steering sheath and/or (ii) snare the guide member with a snare and pulling the guide member back into the second branch with the snare.
  4. 4. A method according to any one of claims 1 to 3, wherein the auxiliary endoprosthesis comprises a main body branching into a first leg and a second leg.
  5. 5. The method of any one of claims 1-4, wherein the auxiliary endoprosthesis is deployed in the first leg of the primary endoprosthesis to couple the primary endoprosthesis and the auxiliary endoprosthesis.
  6. 6. The method of any one of claims 1-5, further comprising guiding a second guide member through the external access site and the first branch of the main vessel into the second leg of the main endoprosthesis.
  7. 7. The method as recited in claim 6, further comprising: Advancing a second auxiliary endoprosthesis into the second leg of the primary endoprosthesis on the second guide member through the external access site, and The second auxiliary endoprosthesis is deployed in the second leg of the primary endoprosthesis to couple the second auxiliary endoprosthesis and the primary endoprosthesis.
  8. 8. The method of claim 7, wherein the second auxiliary endoprosthesis comprises a main body branching into a first leg and a second leg.
  9. 9. The method according to any one of claims 1 to 8, further comprising: Guiding the guide member back through the first leg of the auxiliary endoprosthesis into the second leg of the main endoprosthesis and into the second branch of the main vessel using the guide reversing system; Advancing a third auxiliary endoprosthesis comprising a main body lumen into the first leg of the auxiliary endoprosthesis on the guide member through the external access site, and The third auxiliary endoprosthesis is deployed in the first leg of the auxiliary endoprosthesis to couple the auxiliary endoprosthesis and the third auxiliary endoprosthesis.
  10. 10. The method of claim 9, wherein the third auxiliary endoprosthesis comprises a body lumen without any branches.
  11. 11. The method according to any one of claims 1 to 10, further comprising: Guiding the guide member back into the second leg of the primary endoprosthesis through the second leg of the secondary endoprosthesis and into the second branch of the main vessel using the guide reversing system; advancing a fourth auxiliary endoprosthesis into the second leg of the auxiliary endoprosthesis on the guide member through the external access site, and Deploying the fourth auxiliary endoprosthesis in the second leg of the auxiliary endoprosthesis to couple the auxiliary endoprosthesis and the fourth auxiliary endoprosthesis.
  12. 12. The method of claim 11, wherein the fourth auxiliary endoprosthesis comprises a body lumen without any branches.
  13. 13. A method according to claim 11 or 12 when dependent on claim 9 or 10, wherein the fourth auxiliary endoprosthesis and the third auxiliary endoprosthesis are substantially similar.
  14. 14. The method of claim 7 or 8 or any one of claims 9 to 13 when dependent on claim 7 or 8, further comprising: Guiding the guide member back into the first leg of the primary endoprosthesis through the first leg of the second auxiliary endoprosthesis and into the first branch of the main vessel using the guide reversing system; Advancing a fifth auxiliary endoprosthesis into the first leg of the second auxiliary endoprosthesis on the guide member through the external access site, and Deploying the fifth auxiliary endoprosthesis in the first leg of the second auxiliary endoprosthesis to couple the second auxiliary endoprosthesis and the fifth auxiliary endoprosthesis.
  15. 15. The method of claim 14, wherein the fifth auxiliary endoprosthesis comprises a body lumen without any branches.
  16. 16. The method of claim 7 or 8 or any one of claims 9 to 15 when dependent on claim 7 or 8, further comprising: Guiding the guide member back into the first leg of the primary endoprosthesis through the second leg of the second secondary endoprosthesis and into the first branch of the main vessel using the guide reversing system; Advancing a sixth auxiliary endoprosthesis into the second leg of the second auxiliary endoprosthesis on the guide member through the external access site, and Deploying the sixth auxiliary endoprosthesis in the second leg of the second auxiliary endoprosthesis to couple the second auxiliary endoprosthesis and the sixth auxiliary endoprosthesis.
  17. 17. The method of claim 16, wherein the sixth auxiliary endoprosthesis comprises a main body lumen.
  18. 18. A delivery system for delivering a device to a target vascular site through a single external access site, the system comprising: A primary endoprosthesis configured to be implanted through an external access site in a patient's body at a bifurcation adjacent a main vessel bifurcation into a first bifurcation and a second bifurcation, the primary endoprosthesis comprising a main body bifurcated into a first leg and a second leg; A guide member advanceable through the first branch of the main vessel through the external access site into the first leg of the main endoprosthesis and into the main body of the main endoprosthesis; a guide reversing system advanceable from the external access site through the first branch of the main vessel into the first leg of the primary endoprosthesis and configured to guide the guide member back into the second leg of the primary endoprosthesis and into the second branch of the main vessel, an An auxiliary endoprosthesis that can be advanced over the guide member into the second leg of the primary endoprosthesis through the external access site.
  19. 19. The system of claim 18, wherein the primary endoprosthesis is configured to be implanted into the descending aorta through the external access site.
  20. 20. The system of claim 18 or 19, further comprising a steering sheath and/or snare configured to guide the guide member back into the second leg of the primary endoprosthesis and into the second branch of the main vessel.

Description

Single-access delivery method and system for branch vascular treatment Cross Reference to Related Applications The present application claims the benefit of provisional patent application No. 63/543,373 filed 10/2023, which is incorporated herein by reference in its entirety for all purposes. Technical Field The present disclosure relates generally to methods for delivering an endoprosthesis to a treatment site in a body lumen of a patient using a single access site. More particularly, the present disclosure relates to single access site delivery methods for treating branched blood vessels and associated devices and systems. Background Endoluminal devices are used at various locations within the human body to support various anatomical lumens, such as blood vessels, the respiratory tract, and the gastrointestinal tract. These endoluminal devices are typically deployed at a desired treatment site to treat conditions such as the aforementioned diseases or defects that include the anatomical lumen of the patient's vasculature. Treatment of vascular conditions involving bifurcated lumens is more challenging than non-bifurcated treatment sites. For example, the abdominal aorta branches into the common iliac artery at the main branch, which branches again into the external iliac artery and the internal iliac artery (or inferior abdominal artery) at the opposite secondary branch. Such treatment of the primary and secondary branch anatomy adds modular components and associated delivery systems, increasing surgical complexity. For example, to address the more challenging branch anatomy, modular endoprostheses have been developed that include a main body endoprosthesis and one or more branch endoprostheses that can be assembled with the main body in vivo. Where the anatomy to be treated includes additional prongs, an endoprosthesis system including additional modular components may be employed. For example, g. Oderich et al, in support to endo-Today's Supplement, volume 16, 8, 2017, month 8, "Techniques of Endovascular Aortoiliac Repair Using an Iliac Branch Endoprosthesis (endovascular aortic-iliac repair technique using iliac branch endoprosthesis)", describe the use of a bilateral femoral approach in combination with a modular endoprosthesis system (including Gore Excluder iliac branch endoprosthesis) to treat complex multi-branched aneurysms. Disclosure of Invention The present specification relates to endoprosthesis delivery systems and methods for delivering endoprostheses to intravascular treatment sites including branch vessels. These methods can be used to treat a range of diseases in branch vessels, including abdominal aortic aneurysms, common iliac aneurysms, external iliac aneurysms, and/or internal iliac aneurysms. In various embodiments, the delivery systems and methods referred to in this disclosure allow for simplified endoluminal implantation procedures suitable for complex target sites, such as those extending through branched vascular anatomies having multiple branching levels. In various examples, these simplified methods include implantation of an endoprosthesis using a single access site (e.g., a femoral access site). According to a first example ("example 1"), a method of delivering a device to a target vascular site includes advancing a primary endoprosthesis through an external access site in a patient's body to a location adjacent a bifurcation of a primary vessel, the primary endoprosthesis including a body branching into a first leg and a second leg, wherein the primary vessel branches into the first branch and the second branch at the bifurcation, deploying the primary endoprosthesis, advancing a guide reversing system from the external access site through the first branch of the primary vessel into the first leg of the primary endoprosthesis, advancing a guide member through the external access site through the first branch of the primary vessel into the first leg of the primary endoprosthesis and into the body of the primary endoprosthesis, guiding the guide member back into the second leg of the primary endoprosthesis and into the second leg of the primary vessel using the guide reversing system, advancing a secondary endoprosthesis over the guide member through the external access site and into the second leg of the primary endoprosthesis, and deploying the secondary endoprosthesis. According to a further another example ("example 2") with respect to example 1, the main vessel is the descending aorta. According to a further another example ("example 3") relative to examples 1 or 2, guiding the guide member back into the second leg of the main endoprosthesis and into the second branch of the main vessel using the guide reversing system includes guiding the guide member back into the second branch with the steering sheath and/or snare the guide member with the snare and pulling the guide member back into the second branch with the snare. According to a further another example ("example