Means and method for performing an anastomosis

Abstract

An anastomosis is performed using a mounting structure mounted on the outside of at least one vessel. The mounting structure includes a flexible mounting structure that is attached to the vessel by a special instrument. A graft vessel is attached to the mounting structure either directly or by means of another mounting structure attached to the graft vessel. Tools for attaching a mounting structure to a vessel are disclosed, and a tool for attaching two mounting structures together is also disclosed. Methods for carrying out the anastomosis according to the invention are also disclosed.

1 . An anastomotic device comprising: 
 A) a first malleable mounting structure mounted on a first vessel;    B) a second malleable mounting structure mounted on a second vessel;    C) fastener means for fastening said first mounting structure to said second mounting structure; and    D) means in each mounting structure for maintaining the mounting structure associated therewith in a selected shape so a desired flow area and shape can be established at the junction of said first and second vessels:    
     
     
         2 . An anastomotic device comprising means for placing an inside edge surface of an incision in a first vessel in abutting contact with an inside edge surface of an incision in a second vessel so the vessels heal together at the inside edge surfaces of the vessels, and a hemostatic medium, a stiffening framework having essentially no material memory, means for attaching said stiffening framework to said body, and means for attaching said body to vessels, said means for attaching said body to vessels including pins.  
     
     
         3 . The anastomotic device defined in  claim 1  wherein each mounting structure further includes means for mounting each mounting structure on the vessel associated therewith adjacent to an incision in the vessel and for placing an inside edge of the first vessel immediately adjacent to the incision in said first vessel in healing contact with an inside edge of the second vessel immediately adjacent to the incision in said second vessel.  
     
     
         4 . The anastomotic device defined in  claim 1  wherein said first and second vessels are in side-to-side contact with each other.  
     
     
         5 . The anastomotic device defined in  claim 1  wherein said first and second vessels are in end-to-side contact with each other.  
     
     
         6 . The anastomotic device defined in  claim 1  wherein each of said first and second mounting structures includes a flexible body, and means for attaching said body to a vessel.  
     
     
         7 . The anastomotic device defined in  claim 6  wherein said means for attaching said body to a vessel includes retention means.  
     
     
         8 . The anastomotic device defined in  claim 7  further including means for placing said retention means in said vessel.  
     
     
         9 . The anastomotic device defined in  claim 8  wherein said means for placing said retention means includes an anvil.  
     
     
         10 . The anastomotic device defined in  claim 9  wherein said anvil includes a curved surface for turning said staples.  
     
     
         11 . The anastomotic device defined in  claim 2  wherein said first and second vessels are in side-to-side contact with each other.  
     
     
         12 . An anastomotic device comprising a mounting structure mounted on the outside of a first vessel adjacent to an incision and on the outside of a second vessel adjacent to an incision in the second vessel.  
     
     
         13 . The anastomotic device defined in  claim 12  further including means connecting said mounting structure to said vessels in position so that an inside edge of said first vessel immediately adjacent to the incision in said first vessel is in healing contact with an inside edge of said second vessel immediately adjacent to the incision in said second vessel.  
     
     
         14 . The anastomotic device defined in  claim 1  wherein said means in each mounting structure for maintaining the mounting structure in a selected shape includes a sinuous stiffening element.  
     
     
         15 . The anastomotic device defined in  claim 1  wherein each mounting structure is mounted adjacent to an incision in the vessel associated therewith and said flow area is larger than the area of one of said vessels whereby said one vessel is enlarged when said mounting structures are fastened together.  
     
     
         16 . The anastomotic device defined in  claim 15  wherein said means in each mounting structure for maintaining the mounting structure in a selected shape enlarges the incision in one vessel and decreases the size of the incision in the other vessel.  
     
     
         17 . The anastomotic device defined in  claim 2  wherein said first and second vessels are in end-to-side contact with each other.  
     
     
         18 . The anastomotic device defined in  claim 1  further including a blood flow passage defining means in one of said vessels for maintaining blood flow while said mounting structures are being mounted to said vessels and fastened to each other.  
     
     
         19 . The anastomotic device defined in  claim 2  further including a blood flow passage defining means in one of said vessels for maintaining blood flow while the inside edge of the one vessel is being placed in abutting contact with the inside edge of the second vessel.  
     
     
         20 . A device for performing an anastomosis comprising: 
 A) a body having a channel defined therein;    B) a linkage attached at one end thereof to said body; and    C) a driver means attached to another end of said linkage to be operated by said linkage for fastening a mounting structure to a vessel.    
     
     
         21 . The device defined in  claim 20  further including an anvil having a body sized to be received in said channel and a head which is inserted into a vessel.  
     
     
         22 . The device defined in  claim 21  wherein said head includes a means for defining a blood flow passage.  
     
     
         23 . The device defined in  claim 22  wherein said head further includes means for turning staples.  
     
     
         24 . The device defined in  claim 23  wherein said driver means includes a staple engaging surface.  
     
     
         25 . The device defined in  claim 24  wherein said mounting structure engaging surface is V-shaped in cross sectional shape.  
     
     
         26 . The device defined in  claim 23  wherein said driver means includes an arcuate vessel engaging surface.  
     
     
         27 . The device defined in  claim 21  further including a second anvil.  
     
     
         28 . The device defined in  claim 27  wherein said second anvil includes a portion which is received inside a vessel via an end of said vessel.  
     
     
         29 . The device defined in  claim 1  wherein said mounting structures are hourglass-shaped.  
     
     
         30 . The device defined in  claim 29  further including staples in each of said mounting structures and a retention band in one of said mounting structures.  
     
     
         31 . The device defined in  claim 30  wherein said retention band has virtually no material memory.  
     
     
         32 . The device defined in  claim 2  wherein said means for attaching said hemostatic medium to vessels includes means for moving the vessels towards each other.  
     
     
         33 . The device defined in  claim 32  wherein said means for moving the vessels toward each other includes a malleable bridge.  
     
     
         34 . A method of performing an anastomosis comprising: 
 A) defining an incision in a first vessel;    B) defining an incision in a second vessel;    C) positioning a first mounting structure on the first vessel adjacent to the incision in the first vessel so that the inner edge of the first vessel adjacent to the incision therein is spaced from an inner edge of the first mounting structure;    D) fastening the first mounting structure to the first vessel;    E) positioning a second mounting structure on the second vessel adjacent to the incision in the second vessel so that the inner edge of the second vessel adjacent to the incision therein is spaced from an inner edge of the second mounting structure;    F) fastening the second mounting structure to the second vessel; and    G) attaching the first and second mounting structures together.    
     
     
         35 . The method defined in  claim 34  wherein the step of attaching the first and second mounting structures together includes positioning the inner edges of the vessels in abutting contact with each other after said attaching steps.  
     
     
         36 . An anastomotic device comprising: 
 A) a stent located on a vessel to be joined to another vessel;    B) means for shaping said stent; and    C) vessel attaching means on said stent for attaching said stent to the vessel.    
     
     
         37 . The method defined in  claim 34  wherein the step of shaping the fastened mounting structures includes defining a flow area which exceeds a cross sectional area defined by one of the vessels prior to said attaching step.  
     
     
         38 . The method defined in  claim 34  further including a step of positioning the vessels in side-to-side orientation prior to said attaching step.  
     
     
         39 . The method defined in  claim 34  further including a step of positioning the vessels in end-to-side orientation prior to said attaching step.  
     
     
         40 . The anastomotic device defined in  claim 2  wherein each of said first and second mounting structures includes a flexible body, and means for attaching said body to a vessel.  
     
     
         41 . The method defined in  claim 34  further including a step of maintaining blood flow through one of the vessels.  
     
     
         42 . The method defined in  claim 36  further including a step of maintaining blood flow through one of the vessels.  
     
     
         43 . A method of performing an anastomosis comprising: 
 A) defining an incision in a first vessel;    B) defining an incision in a second vessel;    C) positioning a mounting structure on the first vessel adjacent to the incision in the first vessel so that the inner edge of the first vessel adjacent to the incision therein is spaced from an inner edge of the mounting structure;    D) fastening the mounting structure to the first vessel;    E) positioning the second vessel adjacent to the mounting structure so that an inner edge of the second vessel adjacent to the incision therein is spaced from an inner edge of the mounting structure;    F) fastening the mounting structure to the second vessel; and    G) shaping the fastened mounting structure to define a desired flow area between the first and second vessels.    
     
     
         44 . The method defined in  claim 43  further including positioning the inner edges of the vessels in abutting contact with each other prior to said shaping step.  
     
     
         45 . A method of performing an anastomosis comprising: 
 A) defining an incision in a first vessel;    B) defining an incision in a second vessel;    C) fastening a mounting structure to each vessel adjacent to each incision; and    D) shaping said mounting structure to define a desired flow area and shape for the junction of the two vessels.    
     
     
         46 . A method of performing an anastomosis comprising: maintaining blood flow in a vessel; defining an incision in the vessel; fastening a stent on the outside of the vessel; and shaping the stent.  
     
     
         47 . The method defined in  claim 46  further including stabilizing the vessel during the step of fastening the stent.  
     
     
         48 . The method defined in  claim 42  further including a step of drawing the vessels together.  
     
     
         49 . The method defined in  claim 42  further including a step of stabilizing the first vessel.  
     
     
         50 . The method defined in  claim 42  further including a step of positioning the inside edges of each vessel in abutting contact with each other.  
     
     
         51 . The method defined in  claim 34  further including shaping the fastened mounting structures to define a desired flow area between the first and second vessels.  
     
     
         52 . An anastomotic device comprising: 
 A) a hemostatic medium;    B) a stent located on the outside of one vessel which is to be joined to another vessel; and    C) means for bringing vessel walls of said one vessel into intimate approximation with other vessel walls of said another vessel.    
     
     
         53 . The anastomotic device defined in  claim 40  wherein said means for attaching said body to a vessel includes retention means.  
     
     
         54 . The anastomotic device defined in  claim 36  further including a hemostatic medium.  
     
     
         55 . The anastomotic device defined in  claim 36  wherein said stent is located on the outside of the vessel.  
     
     
         56 . The anastomotic device defined in  claim 36  wherein said vessel attaching means includes staples.  
     
     
         57 . An anastomotic device comprising: 
 A) a first malleable frame mounted on a first vessel;    B) a second malleable frame mounted on a second vessel;    C) fastener means for fastening said first malleable frame to said second malleable frame; and    D) means in each malleable frame for maintaining the malleable frame associated therewith in a selected shape so a desired flow area and shape can be established at the junction of said first and second vessels.    
     
     
         58 . The anastomotic device defined in  claim 57  further including a living hinge located at a junction formed between the first and second vessels.  
     
     
         59 . The anastomotic device defined in  claim 57  wherein said fastener means include tissue retention pins that are staggered with respect to each other.  
     
     
         60 . The anastomotic device defined in  claim 57  wherein the junction formed between the two vessels is sinuous in shape.  
     
     
         61 . The anastomotic device defined in  claim 53  further including means for placing said retention means in said vessel.  
     
     
         62 . The anastomotic device defined in  claim 62  wherein said means for placing said retention means includes an anvil.  
     
     
         63 . The anastomotic device defined in  claim 62  wherein said anvil includes a curved surface for turning said staples.  
     
     
         64 . The anastomotic device defined in  claim 2  wherein said means in each mounting structure for maintaining the mounting structure in a selected shape includes a sinuous stiffening element.  
     
     
         65 . The anastomotic device defined in  claim 2  wherein each mounting structure is mounted adjacent to an incision in the vessel associated therewith and said flow area is larger than the area of one of said vessels whereby said one vessel is enlarged when said mounting structures are fastened together.  
     
     
         66 . The anastomotic device defined in  claim 2  further including a blood flow passage defining means in one of said vessels for maintaining blood flow while said mounting structures are being mounted to said vessels and fastened to each other.  
     
     
         67 . A device for performing an anastomosis comprising: 
 A) a member for supporting a malleable stent;    B) an anvil for controlling tissue fastening elements and for controlling vessel tissue during fastening; and    C) means for shaping said stent in situ on the vessel.    
     
     
         68 . The anastomotic device defined in  claim 36  wherein said vessel attaching means includes means for bringing vessel walls into approximation.  
     
     
         69 . The method defined in  claim 46  further including steps of performing multiple grafts.  
     
     
         70 . The anastomosis device defined in  claim 36  further including a second stent located on the first-mentioned vessel and spaced from said first-mentioned stent whereby multiple grafts can be effected.