Arrangement and method for vascular anastomosis

Abstract

A method for implementing vascular anastomosis in the attachment of a graft vessel to a target vessel such as a coronary artery, and subsequently creating a passageway between the vessels in order to establish fluid flow communication therebetween. Further is to the provision of novel devices which are utilized in implementing the steps of attaching a graft vessel to a target vessel such as a coronary artery through vascular anastomosis, and thereafter creating a fluid flow passageway therebetween.

1 . An arrangement for implementing a vascular anastomosis between a graft vessel and a target vessel and subsequently creating a fluid flow passageway between said vessels, the arrangement comprising: 
 a wire having one end inserted into said target vessel by puncturinga wall of said target vessel and exiting said target vessel by puncturing the wall thereof at a spaced location therefrom, thereby defining a region of contact between said target vessel and said graft vessel, the graft vessel being positioned adjacent said target vessel;    an attachment between said target vessel and said graft vessel; and    a fluid flow passageway provided between lumens of said target vessel and said graft vessel through the region of contact.    
   
   
       2 . The arrangement of  claim 1 , wherein the wire is a suture having suture needles attached at opposite ends thereof for puncturing through said vessel walls.  
   
   
       3 . The arrangement of  claim 1 , wherein said target vessel and said graft vessel are in side-to-side contact in at least the region of contact.  
   
   
       4 . The arrangement of  claim 1 , wherein said target vessel and said graft vessel are in end-to-side contact.  
   
   
       5 . The arrangement of  claim 1 , wherein the wire extends interiorly of said graft vessel from said target vessel and exits said graft vessel through opposite sides thereof at a spacing from said target vessel, said wire being manipulable to align and contact said target and graft vessels and to create the fluid flow passageway.  
   
   
       6 . The arrangement of  claim 1 , wherein the wire is an insulated electrically-conductive wire having an uninsulated portion extending within said target vessel in the region of contact such that electrical energy imparted to the wire facilitates creation of the fluid flow passageway.  
   
   
       7 . The arrangement of  claim 1 , wherein the wire is electrically energizable in at least said region of contact to facilitate creation of the fluid flow passageway.  
   
   
       8 . The arrangement of  claim 7 , further comprising a pair of wires, said pair of wires overlapping in said region of contact.  
   
   
       9 . The arrangement of  claim 8 , further comprising forceps having electrically conductive tines that engage said pair of wires to impart an electrical energy thereto to facilitate the creation of the fluid flow passageway.  
   
   
       10 . The arrangement of  claim 1 , wherein the wire is supplied with RF energy to facilitate the creation of the fluid flow passageway.  
   
   
       11 . The arrangement of  claim 1 , wherein the wire further comprises a hook-shaped needle at a leading end of said wire, dimensions of said needle defining a distance between the inserting and exiting punctures in the contact region of the vessels.  
   
   
       12 . The arrangement of  claim 1 , wherein the attachment comprises a curable adhesive applied between said vessels.  
   
   
       13 . The arrangement of  claim 1 , wherein the attachment comprises stitching sutures joining said vessels.  
   
   
       14 . The arrangement of  claim 1 , wherein the attachment comprises a glue-coated suture filament applied in a pattern to join said vessels.  
   
   
       15 . The arrangement of  claim 1 , wherein the glue-coated suture filament comprises a bio-adhesive.  
   
   
       16 . The arrangement of  claim 15 , wherein the bio-adhesive is cyano-acrylate.  
   
   
       17 . The arrangement of  claim 14 , further comprising a cannulated syringe through which the glue-coated suture filament is applied.  
   
   
       18 . The arrangement of  claim 14 , wherein the attachment further comprises a plurality of glue-coated suture filaments successively applied to the vessels to form a fabric of sutures joining said vessels.  
   
   
       19 . A method for implementing a vascular anastomosis between a graft vessel and a target vessel and creating a fluid flow passageway therebetween, said method comprising: 
 inserting a wire with one end into a target vessel by puncturing a wall of said target vessel and exiting said target vessel by puncturing the wall thereof a spaced location therefrom, thereby defining a region of contact between said target vessel and a graft vessel, the graft vessel being positioned adjacent to the target vessel and the wire puncturing walls of the graft vessel;    attaching said target vessel with said graft vessel; and    providing a fluid flow passageway between the lumens of the target vessel and the graft vessel through the region of contact.    
   
   
       20 . The method of  claim 19 , wherein attaching the target vessel with the graft vessel further comprises applying a curable adhesive to the vessels.  
   
   
       21 . The method of  claim 19 , wherein attaching the target vessel with the graft vessel further comprises stitching sutures about a periphery of the region of contact to secure the target vessel with the graft vessel.  
   
   
       22 . The method of  claim 19 , wherein attaching the target vessel with the graft vessel further comprises applying a glue-coated suture whereat the target vessel and the graft vessel are in contact.  
   
   
       23 . The method of  claim 19 , wherein applying the glue-coated suture further comprises applying a bio-adhesive.  
   
   
       24 . The method of  claim 23 , wherein the bio-adhesive is cyano-acrylate.  
   
   
       25 . The method of  claim 22 , wherein applying the glue-coated suture further comprises providing a cannulated syringe whereby a plurality of glue-coated sutures are successively applied to secure the vessels to each other.  
   
   
       26 . The method of  claim 19 , wherein providing the fluid flow passageway comprises reciprocating the wire to cut through the walls of at least one of the target vessel and the graft vessel in the region of contact.  
   
   
       27 . The method of  claim 26 , wherein the wire includes an abrasive surface to assist in cutting through vessel walls.  
   
   
       28 . The method of  claim 19 , wherein providing the fluid flow passageway comprises cutting through the walls in the region of contact of the target vessel and the graft vessel, which are in side-to-side contact with one another.  
   
   
       29 . The method of  claim 19 , wherein providing the fluid flow passageway comprises cutting through the walls in the region of contact of the target vessel and the graft vessel, which are in end-to-side contact with one another.  
   
   
       30 . The method of  claim 19 , wherein providing the fluid flow passageway comprises providing an insulated electrically-conductive wire having an uninsulated portion extending within the target vessel in the region of contact, and imparting electrical energy to the wire.  
   
   
       31 . The method of  claim 19 , wherein providing the fluid flow passageway comprises electrically energizing the wire to cut through walls of the vessels in the region of contact.  
   
   
       32 . The method of  claim 19 , wherein providing the fluid flow passageway comprises supplying the wire with RF energy to cut through walls of the vessels.