Pre-loaded multiport delivery device

A stent graft delivery device having two indwelling access sheaths preloaded with a stent graft on the delivery device, 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 including a multiport manifold;
• a nose cone dilator at the 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 two longitudinal auxiliary lumens, the pusher catheter completely enclosing the two longitudinal auxiliary lumens radially, a sheath disposed coaxially over the pusher catheter and the stent graft, the guide wire catheter extending through the pusher lumen and the guide wire catheter able to move longitudinally and rotationally with respect to the pusher catheter, the pusher catheter comprising a proximal end spaced distally from the nose cone dilator and thereby defining between the proximal end of the pusher catheter and the nose cone dilator a stent graft retention region;
• the stent graft comprising a stent structure, graft material having a side wall, at least two fenestrations in the side wall of the graft material, a proximal end releasably retained within the distally facing capsule, a scallop in the proximal end of the graft, a distal end and a lumen therethrough;
• the manifold comprising two side ports and a through bore, the two side ports extending distally at an angle from the through bore,
• the pusher catheter further comprising two apertures near the distal end of the pusher catheter and the two apertures opening respectively into the two auxiliary lumens, the pusher catheter being in communication with the through bore of the manifold such that the two apertures communicate respectively with the two side ports;
• an indwelling access sheath within each auxiliary lumen, the indwelling access sheaths each configured to receive a guide wire, the indwelling access sheaths extending through respective 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 of respective fenestrations.

A method of placing a fenestrated 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 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 including a multiport manifold;
• a nose cone dilator at the 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 two longitudinal auxiliary lumens, the pusher catheter completely enclosing the two longitudinal auxiliary lumens radially, a sheath disposed coaxially over the pusher catheter and the stent graft, the guide wire catheter extending through the pusher lumen and the guide wire catheter able to move longitudinally and rotationally with respect to the pusher catheter, the pusher catheter comprising a proximal end spaced distally from the nose cone dilator and thereby defining between the proximal end of the pusher catheter and the nose cone dilator a stent graft retention region;
• the stent graft comprising a stent structure, graft material having a side wall, at least two fenestrations in the side wall of the graft material, a proximal end releasably retained within the distally facing capsule, a scallop in the proximal end of the graft, a distal end and a lumen therethrough;
• the manifold comprising two side ports and a through bore, the two side ports extending distally at an angle from the through bore,
• the pusher catheter further comprising two apertures near the distal end of the pusher catheter and the two apertures opening respectively into the two auxiliary lumens, the pusher catheter being in communication with the through bore of the manifold such that the two apertures communicate respectively with the two side ports;
• an indwelling access sheath within each auxiliary lumen, the indwelling access sheaths each configured to receive a guide wire, the indwelling access sheaths extending through respective 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 of respective fenestrations;
• partially withdrawing the sheath from the stent graft to expose the indwelling access sheaths;
• advancing a guide wire through each of the access sheaths, out of the respective fenestration and into a respective target branch vessel branching from the body vessel;
• advancing the at least one access sheath to the target branch vessel;
• releasing the proximal end of the stent graft from the distally facing capsule;
• advancing a side arm stent through each of the indwelling access sheaths and at least partially out of the respective fenestration and into the respective target branch vessel, the side arm stents each having a proximal end and a distal end;
• expanding each of the side arms within the target vessel with a balloon;
• flaring the proximal ends of the side arm stents within the lumen of the stent graft.