Pre-loaded multiport delivery device

A method of placing a stent graft in a body vessel at a treatment site, comprising:

• introducing a proximal end of a stent graft delivery device into a body vessel and advancing the stent graft delivery device to the treatment site, the stent graft delivery device comprising:
• a guide wire catheter having a guide wire lumen therethrough;
• a handle assembly at a distal end of the guide wire catheter, the handle assembly including a manifold;
• a nose cone dilator at a proximal end of the guide wire catheter, the nose cone dilator comprising a distally facing capsule on the distal end of the nose cone dilator;
• a pusher catheter extending from the manifold towards the nose cone dilator, the pusher catheter comprising a longitudinal pusher lumen therethrough and at least two auxiliary lumens having an oblong cross-section, the pusher catheter completely enclosing the at least two auxiliary lumens and the longitudinal pusher lumen radially;
• a sheath disposed coaxially over the pusher catheter and the stent graft;
• the guide wire catheter extending through the longitudinal pusher lumen;
• the stent graft comprising a stent structure, graft material having a side wall, at least one fenestration in the side wall of the graft material, a proximal end, a distal end and a lumen therethrough;
• the manifold comprising at least two side ports and a through bore, the at least side ports extending distally at an angle from the through bore,
• the pusher catheter further comprising at least two apertures near the distal end of the pusher catheter and the at least two apertures opening respectively into the at least two auxiliary lumens, the pusher catheter being in communication with the through bore of the manifold such that the at least two apertures communicate respectively with the at least two side ports;
• at least two non-concentric elongate devices each disposed within a respective auxiliary lumen of the at least two auxiliary lumens, wherein one of the at least two non-concentric elongate devices extends through one of the at least two side ports, into the manifold from external thereof, into the distal end of the stent graft, through the lumen of the stent graft, and out one of the at least one fenestration;
• wherein the at least two longitudinal auxiliary lumens of an oblong cross-section each have a maximum diameter D extending in a generally tangential direction of the pusher catheter and a minimum diameter d, less than the maximum diameter D, extending in a generally radial direction of the pusher catheter;
• wherein the maximum diameter D is greater than the sum of diameters of the at least two non-concentric elongate devices disposed alongside each other within each of the at least two auxiliary lumens, and, to avoid twisting of the at least two non-concentric elongate devices within each of the at least two auxiliary lumens, the minimum diameter d is greater than the largest single diameter of the at least two non-concentric elongate devices disposed in each of the at least two auxiliary lumens, but smaller than the sum of two diameters of the at least two non-concentric elongate devices;
• partially withdrawing the sheath from the stent graft;
• advancing a guide wire through one of the at least two non-concentric elongate devices, out of the at least one fenestrations and into a respective target branch vessel branching from the body vessel;
• advancing at least one of the two non-concentric elongate devices to the target branch vessel;
• advancing a side arm stent through at least one of the two non-concentric elongate devices and at least partially out of one of the at least two fenestrations and into the respective target branch vessel, the side arm stent having a proximal end and a distal end;
• and
• expanding the side arm stent within the target vessel.