Endovascular aneurysm repair system
Method and apparatus for implanting radially expandable prostheses in the body lumens rely on tacking or anchoring of the prostheses with separately introduced fasteners. The prostheses may be self-expanding or balloon expandable. After initial placement, a fastener applier system is introduced within the expanded prostheses to deploy a plurality of fasteners at at least one prosthesis end, usually as each end of the prosthesis. The fasteners are usually helical fasteners which are delivered from a helical track in the fastener applier by rotation with a rotator wire. The fasteners will be applied singly, typically in circumferentially spaced-apart patterns about the interior of each end of the prosthesis.
1. A method for repairing a diseased or damaged section of an aorta comprising:
(i) advancing a guidewire from a remote access site to a target site in the aorta where the diseased or damaged section exists;
(ii) introducing a prosthesis deployment catheter over the guidewire to the target site, the prosthesis deployment catheter carrying a radially expandable prosthesis including at least one scaffold;
(iii) deploying at least one scaffold of the radially expandable prosthesis from the deployment catheter at the target site;
(iv) introducing a directing device from a remote access site to a location within the radially expandable prosthesis, the directing device including an interior lumen and deflectable distal region;
(v) manipulating the directing device including rotating die directing device and/or deflecting the distal region within the radially expandable prosthesis to orient the distal region with respect to a desired fastening site on the radially expandable prosthesis;
(vi) introducing an intraluminal fastener applier through the interior lumen to the desired fastening site, the intraluminal fastener carrying a single tissue-piercing fastener;
(vii) introducing from the intraluminal fastener applier the single tissue-piercing fastener into tissue at the desired fastening site to anchor the prosthesis;
(viii) withdrawing the intraluminal fastener applier through the interior lumen from the desired fastening site to the remote access site;
(ix) loading another single tissue-piercing fastener into the intraluminal fastener applier at a remote access site;
(x) manipulating the directing device including rotating the directing device and/or deflecting the distal region within the radially expandable prosthesis to orient the distal region with respect to another desired fastening site on the radially expandable prosthesis; (xi) reintroducing the intraluminal fastener applier through the interior lumen to the another desired fastening site, the intraluminal fastener carrying the another single tissue-piercing fastener;
(xii) introducing from the intraluminal fastener applier the another single tissue-piercing fastener into tissue at the another desired fastening site to further anchor the prosthesis;
(xiii) repeating steps viii to (xii) until a desired plurality of tissue-piercing fasteners are introduced into tissue to anchor the prosthesis.
2. A method as in claim 1 , wherein all the at least one scaffold of the prosthesis is self-expanding and step (iii) comprises releasing the prosthesis from constraint to permit the at least one scaffold of the prosthesis to self-expand at the target site.
3. A method as in claim 1 , wherein the at least one scaffold of the prosthesis is malleable and step (iii) comprises applying a radially expansive force within the prosthesis to cause expansion of the at least one scaffold.
4. A method as in claim 1 , wherein all the tissue-piercing fasteners comprise helical tissue-piercing fasteners.
5. A method as in claim 1
wherein at least one of the tissue-piercing fasteners comprises a fastener that pierces tissue in response to rotation; and
wherein the intraluminal fastener applier includes a rotary driver for the fastener.
6. A method as in claim 1 , wherein the desired plurality of tissue-piercing fasteners are introduced in a circumferentially spaced-apart pattern to anchor the prosthesis.