Intraluminal grafting of a bifurcated artery

Description: TECHNICAL FIELD [Detailed description of the invention]

Positioning of intracavitary graft using guide wire And the catheter for it Field of invention The present invention presents a method of positioning an intraluminal implant in a bifurcated artery and the odor of this method. With respect to the catheter used. Background technology Human arteries can easily develop an inflatable sac known as an aneurysm after a disease. As is well known, this aneurysm is prone to rupture. Traditionally, aneurysms are basic surgical Treated by treatment. This treatment is risky to the patient and is often , Impractical due to other pre-existing illness conditions in the patient. Recently, arteries Intracavitary placement of intracavitary grafts that bridge the aneurysm, thereby moving the active ductus arteriosus Many proposals have been made to isolate the aneurysm from the sac. One such trick Is disclosed in Australian Patent Application No. 78835/94. If the aneurysm extends from a single artery to one or more bifurcated arteries, such intracavities Difficulties arise in the placement of the graft. In this case, the so-called "trouser transfer" "Plant" must be used. In such a graft, a single tubular body Is bifurcated into two smaller tubular bodies. The intent is that a single tubular body is single Placed in one artery, and two small tubular bodies each in two bifurcated arteries Be arranged (see, eg, U.S. Pat. No. 5,360,443, Barone) That is. In reality, it is very difficult to place the trouser-shaped graft effectively. It turned out that there was. The present invention is a novel method that facilitates the placement of intracavitary grafts in bifurcated arteries. With respect to catheters so designed. Disclosure of invention In the first aspect, the invention includes a delivery catheter having the following: (a) An elongated catheter with a first end and a second end; (b) An intracavitary graft with a body arranged around an elongated catheter (where, said The body is tubular at the first end, adjacent to the first end of the elongated catheter. Has a portion, at the second end, bifurcates into the first and second tubular graft extension The elongated catheter extends to the extension of the first tubular implant and Extends into the tubular part); and (c) Extend in the first direction through the extension of the first tubular implant and the second different Auxiliary guide wire protruding in the direction into the extension of the second tubular implant. In another aspect, the invention positions an intracavitary implant in a bifurcated vessel within the patient's body. The vessel consists of a single pre-branching vessel, which is one. Including (branching into a pair of post-branching vessels), this method includes: Ru: (a) Have a tubular portion at the first end and on the extension of the first and second tubular grafts Post-branched blood vessel of the first intraluminal graft with a body having a second end that is bifurcated Introducing into one of the first tubular implants, where the first tubular Extends in the first direction through the graft extension of the graft and the second tube in the second different direction. The process in which the guide wire protruding into the elongated portion of the shaped implant is positioned; (b) The first end of the first intraluminal implant and the extension of the second tubular implant. Is positioned within the pre-branch vessel and at least the first end of the implant expands. The step of inflating the implant until it engages with the wall surrounding the pre-branch vessel; (c) The graft with the guidewire until it extends into the other post-branch vessel. The second step of extending in different directions; (d) A second intraluminal graft with an upstream end and a downstream end, after the other branch The guide wire or another guide wire that has been introduced into a blood vessel and positioned at that location. A bite with an ear whose upstream end is within the second tubular graft extension Or surround it, and its downstream end is within the other post-branch vessel. Move the second intraluminal implant until it becomes, and with the upstream end of the second intraluminal implant. The step of forming a fluid delivery engagement with the second tubular implant extension. The catheters and methods according to the invention preferably have an Australian patent application. Utilizing a balloon inflatable implant made in accordance with the disclosure of No. 78835/94, The contents of are incorporated herein by reference. Elongated catheter is inflatable Place the balloon on one end and also with the intracavitary graft placed around the balloon. Can have adjacent to this. Other suitable balloons inflatable or self-inflating Noh stents or implants can be used to carry out the present invention. In a preferred embodiment of the invention, at least partially located in the post-branched blood vessel. Intracavitary grafts to be fitted are provided in various diameters. This is the day in implementation Appropriate grafts are available to fit different diameters of routinely operated post-branch vessels Ensure that it is possible. In some embodiments, the variety of intracavitary graft diameters Is an inward or outward tape of the outer diameter along at least a portion of the shaft length. Achieved by par. Alternatively, the change in diameter is a difference in the diameter at which the implant is constructed. A shorter step-down or step between two substantially cylindrical parts Provided by the pu-up taper. Preferably, the upstream end of the intracavitary implant is That of the tubular graft extension of the intracavitary graft fully positioned within the pre-branch vessel It has a standard diameter to provide a secure connection with each. With reference to the typical application, placement of a trouser-shaped implant in the bifurcated artery, this Ming is disclosed herein below. But the present invention is other such as veins or bile ducts. Can be used for human blood vessels. Intracavitary grafts, the extension of each tubular graft terminates upstream of the bifurcation in the artery It is preferable to have such a length. In this arrangement, a separate tubular graft Is used to connect each tubular extension to its associated distal artery .. In another arrangement, the intraluminal graft is long enough to project into the first distal artery. Includes one tubular extension. In this case, the other tubular extension is the above bifurcation And the second tubular implant connects its extension to the second distal artery To do. Upstream through the first tubular graft extension and the second tubular graft extension The guide wire extending downstream through is preferably very fine and substantially. Kink resistant. In certain embodiments, the auxiliary guide wire is a graft. It can extend through grooves throughout the body. In another embodiment, the auxiliary catheter is the first Upstream through the tubular graft extension and into the second tubular graft extension Can extend downstream, this auxiliary catheter contains a guide wire. 3 French assistance Catheter is particularly preferred. Auxiliary catheter and guide wire are thin Can be loosely placed in the graft before being packaged around a long catheter .. Alternatively, the auxiliary catheter is coupled to the graft body over a portion of its length. It can be. In another alternative, part of the catheter is interwoven with part of the implant. Can be forced or otherwise combined. For further alternatives, auxiliary cutters The tell can be incorporated into a groove in the fabric of the graft wall. These various technologies Auxiliary guide wire and its associated force while inserting the implant into the arterial system Designed to better secure the tatel in the proper position. In a further aspect, the present invention describes both iliac movements from the aorta in the patient's body. It consists of a method of positioning an intracavitary graft across an aneurysm that extends into the pulse. The method includes the following steps: (a) The step of incising or puncturing to expose one of the patient's femoral arteries; (b) The first guide wire is exposed so that it crosses the aneurysm. The step of inserting through the femoral artery, the corresponding iliac artery, and the aorta; (c) The first catheter sheath, the first guy, until it crosses the aneurysm. The process of guiding on the wire; (d) Step of retracting the first guide wire; (e) A second relatively rigid guide wire, said until it crosses the aneurysm. The process of insertion through the first catheter sheath; (f) The step of retracting the first catheter sheath; (g) A second relatively large diameter catheter sheath that crosses the aneurysm Until, the process of guiding on the second guide wire; (h) First delivery catheter, which has a non-inflated balloon at one end (Contains a first intraluminal implant that is adjacent and is placed around the balloon). On the guide wire of 2 and of the second larger diameter catheter sheath Internally guided step (where the first intraluminal implant has a tubular portion at the first end And a second end bifurcated into a first and second tubular graft extension (Having a portion), where the first tubular implant extends within the first implant. A second variant through the portion in the first direction and during the second tubular graft extension. Position a third catheter containing a third guide wire that extends in the same direction Process; (i) The first delivery catheter, the first end of the first implant of the aneurysm The process of positioning to be upstream; (j) The second larger diameter catheter sheath is partially retracted to the second. Step of releasing 1 intracavitary graft; (k) Inflate the balloon, thereby the first end of the first intraluminal implant. Inflate the portion until it engages the wall of the aorta over the aneurysm Process to make; (l) The balloon is contracted and the first and second tubular grafts are elongated by blood. A step that allows the first implant to flow downstream; (m) Place the third guide wire in the second direction to the other iliac artery. And the process of guiding downstream into the femoral artery; (n) Incision or puncture, and the third guide wire to the other femoral movement The process of pulling back from the pulse; (o) The step of retracting the third catheter through the one femoral artery; (p) Place the fourth catheter sheath on the third guide wire and the other Through the femoral artery and the iliac artery of the side, it is inside the first graft , And guide until at least the top of the second tubular graft extension Process to do; (q) The step of retracting the third guide wire through the one femoral artery; (r) A fourth relatively large diameter guide wire, the fourth catheter sheath Through the guide wire is at least the top of the second tubular implant extension The process of guiding until you reach; (s) Retracting the fourth catheter sheath through the other femoral artery About; (t) A fifth relatively large diameter catheter sheath, the fourth guide wire Above, the fifth catheter sheath is at least the extension of the second tubular implant. The process of guiding until you reach the top; (u) Second delivery catheter, which has a non-inflated balloon at one end A second that is adjacent, has an upstream end and a downstream end, and is arranged around the balloon. On the fourth guide wire and the fifth larger Inside the caliber catheter sheath, the upstream end of the second implant is the second tube. The process of guiding until it is inside the elongated part of the graft; (v) Partially retract the fifth catheter sheath to remove the second intraluminal implant. Release process; (w) Inflate the balloon in the second delivery catheter, thereby The upstream end of the second intraluminal implant, which is relative to the extension of the second tubular implant. Inflate until engaged; (x) Withdrawing the first delivery catheter from the one femoral artery, the val The process of maintaining the expansion of the (y) The baru as soon as the first delivery catheter is removed from the one femoral artery. The process of shrinking. (z) Completely pull the fifth catheter sheath through the other femoral artery. Putting process; (aa) Third delivery catheter, which has a non-inflated balloon at one end Adjacent to the balloon, having an upstream end and a downstream end, and arranged around the balloon. 3 Intracavitary implants) on the second guide wire and in the second catheter -Inside the tel sheath, the upstream end of the third graft extends the first tubular graft. The process of guiding until it is inside the part; (bb) The second catheter sheath is partially retracted and the third intraluminal implant The process of releasing; (cc) Inflate the balloon in the third delivery catheter, thereby , The upstream end of the third intraluminal graft, which is paired with the extension of the first tubular graft. And inflate until engaged; (dd) The step of contracting the balloon in the third delivery catheter; (ee) The second delivery catheter is passed through the other femoral artery and the second. Step of retracting the delivery catheter of 3 through the one femoral artery; (ff) The fourth guide wire and the fifth catheter sheath are attached to the one thigh. The step of retracting through an artery and suturing an incision or puncture in that artery; (gg) The second guide wire and the second catheter sheath are attached to the one thigh. The step of retracting through an artery and suturing an incision or puncture in the artery. A brief description of the drawing FIG. 1 has an aortic aneurysm bridged by an intraluminal implant according to the invention. Partially clipped central view of the patient; FIG. 2 is a tubular intraluminal implant used by the method described with reference to FIG. It is a front view of an embodiment of FIG. 3 is a cross-sectional view of the intracavitary graft of FIG. 2 opposite to the longitudinal direction; FIG. 4 is a detailed elevation view of one end of the intracavitary graft of FIG. 2; FIG. 5 is a detailed perspective view of the first end of the intracavitary implant of FIG. 4, the end of the implant. How the alternating crests of wire radiate outward while inserting the implant Indicates whether it is pushed in the direction; 6 and 6a are placed on the delivery catheter used in the practice of the method of the invention. It is a vertical cross-sectional view of two possible embodiments of a bifurcated implant to be made; Figure 6b shows a bulge adjacent to the free end of the catheter and guide wire, respectively. An enlarged view of a stretchable balloon, the balloon is inflated; FIG. 6c is a longitudinal sectional view of the device of FIG. 6b, with the balloon not inflated. I; Figure 6d shows a guide wai with an inflatable umbrella adjacent to its free end. Simplified cross section of Yar; Figures 7a-7i show the steps in which the method according to the invention is practiced; 8a-8f show a simplification of yet another intraluminal implant used in the method according to the invention. It is a side elevation FIG. 9 shows a tube placed on a delivery catheter that can be used to carry out the methods of the invention. FIG. 5 is a vertical cross-sectional view of an embodiment with a shaped implant. Preferred aspects for carrying out the present invention Bifurcated or trouser-shaped graft containing three intracavitary grafts 10, 10a, and 10b Because the piece can bridge and occlude an aortic aneurysm that extends into the left iliac artery Is adapted to be transfemorally inserted into the patient. In Figure 1 As shown, the aorta 11 is connected to the left and right iliac arteries 13 and 12. Aortic aneurysm Placed between the renal arteries 14 and 15 and the iliac arteries 12 and 13, the aneurysm is in the left intestine It extends below the bone artery 13. Each intracavitary implant (as shown in Figures 2-5) is a pleated tube of polyester fabric. Can include 16. Polytetrafluoroethylene, polyurethane, and combinations thereof Other materials, including mixes, may be used. Tube 16 is separated by a plurality of pipes along its length. Reinforced by spaced stainless steel wires 17 (each of these) Each can have a generally closed sinusoidal shape depicted). Wire 17 is preferred Or as thin as possible, and typically 0.3-0.4 mm in diameter. Wire 17 Are malleable and can be bent into any desired shape, i.e. they are any parenchyma Since they do not have elasticity in a certain range, they are more likely to expand due to their own elasticity. Rather, it should be physically inflated into contact with the aorta. wire 17 is each woven into the fabric of tube 16, with alternating crests of each wire 17 of tube 16. On the outside, the rest of the wire 17 is on the inside of the tube 16 (below in the specification). Except for wire 17 at the end as described). The end of each wire 17 is the tube 16 Arranged on the outside of the and twisted together to form the tail 18. The ends together Depicted to be squeezed to form tail 18, but the ends are also folds together Can be done. The tail 18 of the alternating wire 17 is opposite long axis along the outer surface of the tube 16. It is bent so as to extend in the direction. The wire 17a at the end protrudes from each end of the tube 16 and thus theirs. Alternating crests of wire 17a extend longitudinally beyond the end of tube 16. End Wire 17a preferably has an amplitude of about 6 mm and 6 around a 22 mm diameter implant. It has a wavelength such that ~ 8 crests are arranged. The next two adjacent wai The yar 17 is preferably located as close as possible to the wire 17a at the end. And have amplitudes of 4 mm and 5 mm, respectively. These wires are typically It initially has the same wavelength as the terminal wire 17a. Then across the entire graft Wires 17 are spaced 15 mm apart, have an amplitude of 6 mm, and end wires. It has a first wavelength that is substantially the same as Yar 17a. Single because the aneurysm extends from the aorta 11 beyond the bifurcation of the iliac arteries 12 and 13. Tubular grafts move while maintaining blood flowing into each of the iliac arteries 12 and 13. Not enough to bridge the aneurysm. Rather than using a single tubular graft In the method of the invention, three separate tubular implants 10, 10a, and 10b are used. .. A pair of short tubular grafts with bifurcations at the downstream end of the first one of graft 10. Form 10 graft extension portions 19a, 19b. Short tubular graft extension 19a, 19b Can be passively inflated by blood flow, or by inflating a balloon , Or it may be actively inflatable by the self-expansion of the spring. As best illustrated in FIGS. 8 (a)-(f), they extend into the iliac arteries 12 and 13, respectively. Graft portions 10a and 10b adapted to do so have a common diameter upstream Each has an end. The upstream end is adapted to be located inside the aorta 11. It is interlocked at each of the elongated portions 19a.19b of the graft 10. Preferably , This interlock is the friction between the upstream end and the extension 19a, 19b respectively Inflating or splicing the balloon at the upstream end so that there is engagement caused by Achieved by the self-expansion of the In addition to having a straight cylindrical tube, the downstream ends of graft portions 10a and 10b The diameter of 35 is the iliac artery (graft parts 10a and 10b are implanted inside it) It may have a variable diameter to match the diameter of the). Diameter changes can be seen in short step-down sections 31 (see Figure 8c) or steps. By puup part 32 (see Figure 8d) or by graft part 10a or 1 Regions of tapers 33 and 34 extending along the length of 0b (see Figures 8e and 8f) Can be given by. Next, a method of positioning the intracavitary implant will be described with reference to FIGS. 7a-7i. In performing this method, one that is incised or punctured and flows from the corresponding iliac artery. Exposing the femoral artery (eg, ipsilateral) and using Seidinger needle technique, 0.035 Floppy tipped flexible guide wire at the tip of an inch diameter, femoral movement Ilial movement that inserts into the pulse and then enters the aorta 11 so that it crosses the aneurysm Insert it into pulse 12 and pass it through. Then 8French hemostatic sheath to control bleeding Introduce on this wire. Introducing an angiographic catheter to build the patient's blood vessels Take a shadow map to show the location of renal arteries 14, 15 and other relevant anatomical structures of the patient Allows you to Then retract the flexible flexible guide wire at the tip, and then Amplatz Angiographic catheter with a very rigid (AES) guide wire 23 (0.035 inch diameter) Through the aorta 11 (see Figure 7a). Withdraw angiographic catheter After that, leave the rigid guide wire 23 in situ. Then preferably 24 French Introduce the catheter sheath 21 and mantle needle into the aorta 11 over the rigid wire 23 ( See Figure 7a). The balloon catheter 24 is then introduced into the sheath 21. As illustrated in more detail in FIG. 6, the balloon catheter 24 is a delivery catheter. This is the extension of the first and second tubular grafts separated at bifurcation point 40. Through the bifurcated graft 10 with minutes 19a, 19b, as well as the first tubular extension 19a In the first direction, then in the second different direction into the second graft extension 19b Prepackaged with a thin catheter 25 containing an extending guide wire 26. Catheter 24 and thin catheter 25 when placing implant 10 in a blood vessel The role of ensuring accurate positioning of the wheel 25 and guide wire 26 In a common catheter sheath 56 that plays, it can bind together under graft 10. Tubular In addition to being slidable through the graft extension 19a, 19b Le 25 was anchored in place at graft 10 prior to insertion of graft 10 into the blood vessel. obtain. Catheter 26 can be sutured, glued, or woven into the body of implant 10. .. Although the guide wire 26 is shown inside the catheter 25 in FIG. 6, the guide wire 26 is shown inside the catheter 25. Only -26 can be placed in the first and second tubular graft extension 19a, 19b. Can be easily predicted. In another configuration illustrated in Figure 6a, the guide wire 26 is positioned within a tubular channel 22 formed within the body of implant 10. To. After packaging the implant 10 around the balloon 20, the balloon is placed in the aorta 11. Before placing the Tether 24, the groove 22 has the guide wire 26 in the first and second tubular. The role of ensuring that the graft remains in the desired position in the elongated portions 19a, 19b Fulfill. If the balloon catheter 24 is positioned at the desired location inside the aorta 11, Sheath 21 is partially retracted, releasing graft 10 and inflating balloon 20 (See Figure 7b). Inflatation of balloon 20 of catheter 24 is the first transplant Inflate the upstream end of piece 10 and above the aneurysm but downstream of renal arteries 14 and 15. , It causes an engagement with the aortic wall at its upstream end. The first graft 10 is A short tubular graft extension 19a, 19b is located completely inside the aorta 11. Has a length. The balloon 20 is then contracted, but the balloon catheter 24 Is left in place for some time (time being) (see Figure 7c). Ba Due to the contraction of rune 20, blood elongates each of the tubular graft extension parts 19a and 19b. Allows the graft 10 to flow downwards. The thin catheter 25 is preferably 3 French and the guide wire 26 is kin. It is a substance that does not squeeze, so the guide wire 26 is downstream of the catheter 25. Can stretch in the direction (see Figure 7c). The guide wire 26 is small at the tip. Inflatable balloon 55, or other device that obstructs flow as illustrated in Figure 6. You can have a chair. The balloon 55 can be inflated and the guide wire 26 can be stretched As a result, the guide wire 26 is guided by the blood flow to the opposite iliac artery 13. Kake. Is the guide wire 26 preferably a nitinol core with a hydrophilic coating? It consists of. The balloon 50 may also be at the free end of the catheter 25. like that Details of the examples of balloons 50, 55 are illustrated in more detail in FIGS. 6b and 6c. Bar The catheters 25 and 55 are inflated, and the catheter 25 and the guide wire 26 are respectively. Helps to be transported and guided by the bloodstream to the opposite iliac artery 13. Catheter 25 and guide wire 26 provided by FIGS. 6b and 6c The enlarged view of balloons 50 and 55 adjacent to the free end shows two catheters 25, respectively. Represents having cavities 52 and 53. The guide wire 26 passes through the first lumen 52 To. The end of the second lumen 53 is sealed and the small hole 51 is shaped on the outer surface of the catheter 25. It is made. Latex balloon 50 is annular at 50a on the outer surface of catheter 25 Is glued to. When the balloon 50 is inflated, a liquid or gas, it is a hole Injected downward into the second lumen 53 to inflate the balloon 50 through 51 .. Similarly, the guide wire 26 has a lumen 54, which descends and guide wire Air can be infused to inflate the balloon 55 located at the free end of 26. Inflatable balloons are preferred, but other inflatable devices may be recognized. For example, in another embodiment, the catheter 25 and the guide wire 26 Runes 50, 55 can be replaced by inflatable umbrellas. Ann available An example of a Brera type is illustrated in Figure 6d. Arranged at the free end of the guide wire 26 It is Umbrella 70. Umbrella 70 (This is the inflated shape shown in Figure 6d The wire 71 extending through the lumen 72 in the guide wire 26) Inflated by. Joint stay 72 when retracting wire 71 The wire 71 is stung so that it articulates and inflates the umbrella 70. It is attached to -72. Umbrella 70 is on guide wire 26, but catheter 25 It can be easily recognized that a similar configuration can be used for. Further alternative In, the balloon 55 on the guide wire 26 is an epo, as illustrated in FIG. 6e. It can be replaced with small solid beads 80 of a substance such as xy resin or titanium. The beads 80 preferably have a larger profile than the guide wire 26. To. As soon as the catheter 25 is placed in the desired position in the blood vessel in a particular application At the free end of the catheter 25, the balloon 50 engages with the wall of the blood vessel. Then inflate the catheter 25 further until it is fixed in the desired position within the blood vessel. Hope to provide additional fixation while the guide wire 26 passes through the blood vessel Good. Once the guide wire 26 is correctly placed in the contralateral femoral artery, its thigh movement A cut is made in the pulse (which is fastened at the intersection) and an arteriotomy is made. guide Guide wire 26 if wire 26 is completely guided to the opposite femoral artery By retracting the guide wire through an incision or puncture in the artery It is easily collected. Guide wire 26 is completely guided to the opposite femoral artery If not, a snare or similar device passes through the opposite femoral artery. Can be introduced, grab the guide wire 26 and make an incision to retrieve it Pull back to the puncture site. Once the guide wire 26 is recovered, a thin catheter Le 25 is then retracted via the same side, and the other catheter 27 goes up the guide wire 26 through the opposite femoral artery, which is the first graft 10. Go inside and reach at least the top of the second tubular extension 19b (See Figure 7d). The thin guide wire 26 is then pulled Catete through the opposite femoral artery with a squeezed and thinner guide wire 30 It is inserted in Le 27. Catheter 27 is then removed and catheterized. The machine 21a preferably has 24 French, and the mantle needle is a rigid guide wire. Introduced on -30 (see Figure 7e). Prior to extension of the guide wire 26 to the opposite iliac and femoral arteries, the catheter -Tel sheath (which can be similar to catheter sheath 21) is the opposite femoral movement Any that can extend upstream through the veins and iliac arteries and can be present in these arteries The twists and turns can be reduced, thus facilitating the guidance of the guide wire 26 through it. Second balloon catheter 24a (second tubular implant 10a) as illustrated in FIG. (Packaged on this) then passes through the catheter sheath 21a, well that The upper end goes inside the second tubular extension 19b, and at its lower end the intestine It is introduced until it is inside the bone artery. Catheter sheath 24 The rune 20a has the upper end of the implant 10a engaged by friction with the second tubular extension 19b. It is inflated to fit (see Figure 7f). Catheter 24a The swelling of rune 20a is pulled through the ipsilateral artery 12 of the first balloon catheter 24. Support graft 10a while populated. Then the balloon on catheter 24a 20a is contracted, and catheter 24a is positioned with a third implant 10b. Maintained in place to continue to support grafts 10, 10a in artery 11 during Is done. The catheter sheath 21a is then removed (see Figures 7f and 7g). ), And a third balloon catheter (tubular graft 10b packaged on top) (The third balloon catheter and implant 10b are identical to those illustrated in FIG. (Possible) is introduced into the sheath 21 of the guide wire 23. Sheath 21 After partial withdrawal, its upstream end is inside the first tubular graft extension 19a This is advanced until it is then placed. Third balloon category The third implant, 10b, positioned at the cell, is therefore the second at its upstream end. Contact with 1 tubular extension 19a, and at its downstream end the right iliac artery 1 The contact with 2 is pushed forward (see Figure 7h). Here, the rigid guide wires 23 and 30 are retracted, and the opposite incision is made. Or the puncture is sutured. A second angiography test is then performed, and the graft The hemostatic sheath 21 pulls when 10, 10a, and 10b are properly positioned and functioning. It is tucked in and the right thigh incision or puncture is sutured. As a result, Figure 7i As illustrated in, a trouser-shaped implant that bridges the aneurysm functions. This surgery is general anesthesia, epidural anesthesia, or, where appropriate, local anesthesia. Can be carried out using only. A number of changes and / or modifications have been extensively described in the spirit or scope of the invention. What can be done in the present invention as shown in a particular embodiment without departing from , Can be understood by those skilled in the art. Therefore, all of these embodiments are considered exemplary and limited. It should be considered that it should not be regarded as a target.