Bloused stent-graft and fenestration method

Abstract

A method includes deploying a bloused stent-graft into a main vessel such that a bloused section of the bloused stent-graft covers a branch vessel emanating from the main vessel. The bloused section includes loose graft cloth. A pressure differential between the main vessel and the branch vessel causes the bloused section to be forced into an ostium of the branch vessel creating a pocket aligned with the branch vessel. A distal tip of a puncture device is located in the pocket and thus aligned with the branch vessel. An outward force is applied to the puncture device to cause the distal tip of the puncture device to fenestrate the bloused section thus creating a collateral opening in the bloused section precisely aligned with the branch vessel.

1 - 15 . (canceled) 
     
     
         16 . A method comprising:
 deploying a bloused stein-graft into a main vessel such that a bloused section of said bloused stent-graft covers a first branch vessel emanating from said main vessel, said bloused stent-graft comprising:   a proximal section comprising a first cylindrical piece of graft material having a first diameter;   a first stent ring attached to said proximal section;   a distal section comprising a second cylindrical piece of graft material having a second diameter;   a second stent ring attached to said distal section; and   said bloused section attached to and between said proximal section and said distal section, said bloused section comprising loose graft cloth, wherein said bloused section comprises a third cylindrical piece of graft material having a third diameter greater than said first diameter and said second diameter, said bloused section comprising v-shaped pleats to cause said third diameter to be narrowed to said first diameter and said second diameter at ends of said third cylindrical piece of graft material, wherein said ends of said third cylindrical piece of graft material are attached to said proximal section and said distal section to form said bloused section,   wherein a pressure differential between said main vessel and said first branch vessel causes said bloused section to be forced into an ostium of said first branch vessel creating a pocket aligned with said first branch vessel; and   locating a distal tip of a puncture device in said pocket.   
     
     
         17 . The method of  claim 16  wherein said pocket is defined by a portion of said bloused section extending into said first branch vessel. 
     
     
         18 . The method of  claim 16  wherein said pocket comprises an apex, said bloused section tapering radially outward from a vessel wall of said main vessel to said apex. 
     
     
         19 . The method of  claim 16  wherein said puncture device is oriented radially relative to a longitudinal axis of said bloused stent-graft within said pocket. 
     
     
         20 . The method of  claim 16  wherein said distal tip of said puncture device contacts an apex of said pocket. 
     
     
         21 . The method of  claim 16  wherein said puncture device comprises a radiopaque marker and wherein said bloused section comprises radiopaque ink facilitating visualization of alignment of said puncture device within said pocket. 
     
     
         22 . The method of  claim 16  wherein said puncture device comprises a guide catheter being fluoroscopically visible and wherein said bloused section comprises radiopaque ink facilitating visualization of alignment of said guide catheter within said pocket. 
     
     
         23 . The method of  claim 22 , wherein said guide catheter is a steerable guide catheter. 
     
     
         24 . The method of  claim 16  wherein said locating a distal tip of a puncture device in said pocket comprises applying an outward radial force on said puncture device to cause said puncture device to slide down a taper of said pocket to an apex of said pocket. 
     
     
         25 . The method of  claim 22  wherein said locating a distal tip of a puncture device in said pocket comprises applying an outward radial force on said guide catheter to cause said guide catheter to slide down a taper of said pocket to an apex of said pocket. 
     
     
         26 . The method of  claim 16  further comprising applying outward force on said puncture device to cause said distal tip of said puncture device to fenestrate said bloused section in alignment with said first branch vessel. 
     
     
         27 . The method of  claim 22 , wherein a puncture device catheter is contained within said guide catheter and further comprising applying outward force on said puncture device catheter to cause said distal tip of said puncture device to fenestrate said bloused section in alignment with said first branch vessel. 
     
     
         28 . The method of  claim 26  wherein said fenestration of said bloused section comprises creating a collateral opening in said bloused section, said collateral opening being aligned with said first branch vessel. 
     
     
         29 . The method of  claim 28  wherein said first branch vessel is perfused through said collateral opening. 
     
     
         30 . The method of  claim 28  wherein said bloused section follows a contour of an ostium of said first branch vessel forming a branch graft extending into said first branch vessel. 
     
     
         31 . (canceled)