Endograft device delivery systems and associated methods

A catheter for delivering an endograft over a guidewire, the catheter comprising:

• an inner tube having a distal end and an inner lumen extending within the inner tube, the inner tube defining a catheter axis and opposing proximal and distal ends of the catheter, the proximal and distal ends of the catheter defining a proximal direction and a distal direction along the catheter axis, the distal end of the inner tube having a transverse slot communicating with the inner lumen, the transverse slot extending in the proximal direction;
• a cylindrical wall engaging the distal end of the inner tube, the cylindrical wall covering at least a portion of the distal end of the inner tube and defining a first internal volume between the cylindrical wall and the covered inner tube, the cylindrical wall extending in the proximal direction to a cylindrical wall edge;
• a pusher tube slidably disposed over the inner tube, the pusher tube having a distal end at least in part disposed within the first internal volume, the distal end of the pusher tube having a transverse opening communicating with the inner tube;
• and
• a sheath slidably disposed over the pusher tube and having a distal end terminating at a sheath edge disposed to face the cylindrical wall edge of the cylindrical wall to define a separation therebetween, the distal end of the sheath and the pusher tube defining a second internal volume therebetween that communicates with the first internal volume to define a delivery chamber,
• wherein the catheter and the endograft together define a guidewire path through the catheter and though the transverse slot of the inner tube and the transverse opening of the pusher tube proximate to the separation.

A method for treating an abdominal aortic aneurysm, the method comprising:

• exposing a portion of an expandable endograft carried within a catheter of an endograft delivery system, wherein the endograft comprises a frame and a cover defining an endograft lumen, the frame having a plurality of frame openings with the cover extending over at least one frame opening;
• cutting the cover extending over the at least one frame opening to form a fenestration through the cover and frame of the endograft, the fenestration communicating with the endograft lumen, the endograft lumen enclosing a pusher tube slidably disposed over an inner tube having an inner tube lumen;
• and
• advancing a guidewire though the fenestration and into the inner tube lumen.

A method of implanting an expandable endograft at an implant target site having a primary blood vessel directing a primary blood flow and communicating with an intersecting secondary blood vessel directing a transverse blood flow relative to the primary blood flow, the method comprising:

• advancing a guidewire through the primary blood vessel to the implant target site and into the secondary blood vessel so that the guidewire bends where the secondary blood vessel intersects the primary blood vessel;
• advancing an endograft delivery system along the guidewire towards the target site, the endograft delivery system including a catheter with a distal end enclosing the endograft in an unexpanded low-profile configuration, the advancing including passing the guidewire through a fenestration of the endograft and into an internal lumen of the catheter;
• and
• positioning the fenestration of the endograft at the bend of the guidewire at the implant target site.

A method of implanting first and second expandable endografts at an implant target site having a main artery communicating with first and second renal arteries, the method comprising:

• disposing a first guidewire within the main artery and the first renal artery;
• disposing a second guidewire within the main artery and the second renal artery;
• advancing the first endograft over the first guidewire;
• advancing the second endograft over the second guidewire;
• aligning a first fenestration of the first endograft with the first renal artery;
• and
• aligning a second fenestration of the second endograft with the second renal artery,
• wherein alignment of the first and second fenestrations of the first and second endografts, respectively, are independent of each other.