CN1352539A - Vascular surgery - Google Patents

Abstract

An anastomotic connector for connecting a graft to a target vessel, comprising a thin collar section ( 104 ) adapted to engage a portion of the graft; and a separate spike section ( 124 ) adapted to mount on said collar section, and comprising a plurality of spikes ( 126 ) each of said spikes ( 126 ) adapted to transfix said graft. Preferably, the connector comprises at least one locking element for interlocking said spike section ( 124 ), and said collar section ( 104 ). Preferably the locking element provides a spring action between the two sections.

Description

Vascular surgery

Related application

The present invention is the continuation application of PCT patent application PCT/IL99/000284 and PCT patent application PCT/IL99/000285, and these two patents are all specified the U.S., and their the open this patent that all is merged in is with as a reference.

Invention field

The present invention relates to the enforcement of angiostomy.

Background of invention

Connect two blood vessels, promptly vascular anastomosis is an important surgical technic in reparation, treatment and the plastic operation.Old identical standard be with the side offside, end-to-end or the end offside two blood vessels of structure manual suture.Although we wish to shorten its persistent period for any operation process usually, but this is a particular importance for the other surgical operation of coronary artery, in this operation, patient is usually with a heart-the lung machine is connected, and patient's heart stops to beat usually.

Except blood vessel is carried out the manual suture, also have some to connect other method of blood vessel at present, comprise staple and anastomosis ring.PCT patent publication No. WO97/40754 and WO97/28749 have described and have been used for the other operating staple of coronary artery, wherein a grafting vessel links to each other with aorta at the one end, and be connected at the coronary artery of its other end with an obturation, link position is positioned at the distally of occlusion locations.In such operation,, simultaneously aorta and grafting vessel are pressed against on the anvil together by the grafting vessel nail is sealed coincideing on aorta.In a kind of announcement scheme, in order to carry out stitching, this anvil is inserted into aorta, may it be removed by the mode that anvil is taken apart then.In another kind announcement scheme, an end of grafting vessel turns up on an annular anvil, thereby makes this anvil be in the outside of blood vessel always.

Recently, adopted in the other surgical operation and minimized intrusion (through hole) operation.In this operation, open an aperture at chest, disconnect rib thereby replace, and arteria mammaria (arteria mammaria (LIMA) in for example left, arteria mammaria (RIMA) in the right side) is used as the shunting grafting vessel.This stitching or stitching are by using instrument as described above to implement.

A kind of invade the littler operation of degree even need be at the chest opening, but by adopting a kind of precut mode that one or more conduits are introduced blood vessels.PCT patent G publication number WO97/27898, WO97/13471 and WO97/13463 and their priority document, it is U.S. Patent application 60/010,614,60/005,164,08/730,327 and 08/730,496 have described arterial occlusion have been carried out the method and apparatus that precut is handled, and these publication applications are merged in this patent with as a reference, and are called as " vascular anastomosis patent application ".These patents mainly comprise two kinds of methods.In one approach, open a pipeline from a side to the opposite side of occlusion locations of occlusion locations in (blood vessel outside) at tissue, and a stretching, extension or or a stretching, extension/grafting vessel can be placed into this pipeline.In another approach, a kind of vascular of being convenient to insert or grafting vessel are connected with inaccessible blood vessel, and set up coincideing of two side offsides between the blood vessel of obturation and shunting are through the vascular of inaccessible part or grafting vessel.The far-end of this vascular and proximal part can seal in several ways.Connection between vascular and the tremulous pulse can be by two blood vessel bondings are realized, perhaps by adopting preferred various adapter to realize.Wherein a kind of disclosed adapter comprises two springs, and these two springs are separated from each other by a bit of of a grafting vessel that may not stretch.This spring is down infundibulate, thereby two blood vessels can be crowded together.When having a determining deviation between two blood vessels, preferably adopt various different technologies and/or the device tissue around stoping to oppress junction between vascular and the tremulous pulse.The purpose that adopts various types of adapters is by making contact or to keep two blood vessels close mutually by oppressing intervascular tissue, thereby guarantees not have blood to ooze out from the junction between adapter and the blood vessel substantially.

In a kind of TIPS process, a stretching, extension part is placed in the passage, and this passage is opened between portal vein and the hepatic vein in advance.As described in some embodiment above, intervascular relative position be by around two blood vessels or between the existence of solid relatively tissue keep.Coupling part itself between each bar blood vessel that like this, just need not require an end of adapter and be attached thereto reaches complete antiseep.

The Internet WWW went up disclosed document " http://me210abc.standford.edu/94-95/projects/Pfizer/Spring/1.ht ml " and described a kind of method that is used to reduce other operating complexity in March, 1998, and the document of the disclosure is merged in this patent with as a reference.In this method, a grafting vessel passes skin and enters aorta, and near the otch the surgical site passes by one is arranged in.Chest has a through hole, is used to introduce an instrument, thus grafting vessel sewed up or stitching on aorta and the coronary artery that will be shunted.

Grafting vessel and the difficulty especially that is connected coronarius, this is because this tremulous pulse is in unsound state usually, and very weak, is damaged easily.

Many people suffer from peripheral vessels and block disease.The typical treatment method of these diseases is to implement abdomen artery bypass grafting, femoral artery bypass or implement a kind of strand of-popliteal artery bypass graftings.

Brief summary of the invention

Some preferred embodiments of the present invention relate in one aspect to a kind of self-locking stapling apparatus, this device comprises an installing ring part and a spike part that comprises several interconnective spikes, preferred these two parts are all processed by a kind of flaky material or tubing, and preferably adopt identical materials.In a preferred embodiment of the invention, this spike partly is locked on the installing ring part, can not open automatically thereby in a single day this stapling apparatus just is mounted.In a preferred embodiment of the invention, this stapling apparatus is made of two assemblies, a spike part and an installing ring part.Perhaps, these two parts can be merged into a monomer spare.In a preferred embodiment of the invention, this lock part has certain elasticity, thereby for example allows two parts to produce axial relative motion.

Some preferred embodiments of the present invention relate in one aspect to a kind of identical adapter, this adapter has a spring element, produces relative motion between two blood vessels that are used to allow to link to each other by this identical adapter.In a preferred embodiment of the invention, provide several spring elements, thereby make the different piece of blood vessel have different relative motion amounts.In a preferred embodiment of the invention, all spring is a pedestal with a monomer installing ring that is connected with blood vessel wherein all.Yet, this not and be unique structure, the blood vessel that different springs can be different and/or the different piece of adapter are pedestal.In a preferred embodiment of the invention, spring allow with a blood vessel mutually interlock spike and with installing ring that another blood vessel is connected between produce relative motion.As producing substituting or additional aspects of relative motion between the major part that allows each bar blood vessel, this relative motion can be limited in this some fraction place that coincide and connect.In an example, by a spring is provided for each spike, the thickness of tissue difference of being pegged by spike just can be compensated by spring.Substitute or additional aspects as a kind of, spring allows intervascular contact area to be pressed against together mutually.This spring part can be an explicit spring element, for example is processed into the part of spike.Perhaps, this spring also can functionally be included in other structure, the locking piece that this structure example locks together as the two parts that are used for a binary spare stapling apparatus.

Relating in one aspect on little blood vessels such as for example coronary artery of some preferred embodiments of the present invention punched.In a preferred embodiment of the invention, downcutting this method of picking up part then by the sub-fraction of at first picking up (for example coronary artery) on the blood vessel punches.This is picked up with stock removal action and can be finished by the independent component on the card punch respectively, also can be finished by same element.In a preferred embodiment of the invention, picked up the twice of the radius of part less than coronary artery thickness.Substitute or additional aspects as a kind of, after coronary artery is picked up, pick up part and be pulled away from blood vessel, thereby make the part of picking up coronarius away from a relative side coronarius.

Relating in one aspect to of some preferred embodiments of the present invention by on coronary artery, cut out the technology in hole along the circumference of a perfect apertures.In a preferred embodiment of the invention, provide a kind of rotary cutting apparatus, this device has a center grasping device and one and preferably is the spike shape and is positioned at cutting edge on its circumference.In a preferred embodiment of the invention, this grasping device is a vacuum tube.Substitute or additional aspects as a kind of, this grasping device is a mechanical type grasping device.In use, grasping device is picked up blood vessel, thereby makes spike piercing blood vessel wall.The spike bearing part rotates then, thereby downcuts the part of blood vessel wall.

The self-retracting end that relates in one aspect to a kind of card punch of some preferred embodiments of the present invention.In a preferred embodiment of the invention, this end was withdrawn before being got the hole on the blood vessel.Preferred punching action is produced by the retraction of this end.Perhaps, this end is withdrawal in a single day, just is difficult to protract once more, thereby an additional protection measure is provided.

Some preferred embodiments of the present invention relate in one aspect to a kind of card punch that is used on blood vessel, beating inclined hole.In a preferred embodiment of the invention, this card punch comprises two mutual uneven oblong surface.Become a for example low-angle of 5 ° between preferred two surfaces.Perhaps, one of them surface is not the plane, for example comprises a bossing, and this is in order to match with the blood vessel that will be perforated better.

Some preferred embodiments of the present invention relate in one aspect to a kind of card punch, wherein the punching action realizes by non axial manipulation card punch.So just reduced because of the danger that other parts or following tissue to blood vessel cause damage of protracting of the accident of card punch sharp tip.Preferred this card punch is used in the piercing operation.Substitute or additional aspects as a kind of, this card punch has an axial handle.Perhaps, this card punch has a rotation grasping piece.In a preferred embodiment of the invention, the punching action realizes by the handle of extruding card punch.

Some preferred embodiments of the present invention relate in one aspect to a series of instruments of coincide connecting of being used for, wherein instrument is around grafting vessel.In case grafting vessel is connected, instrument just can be pulled down from grafting vessel.In certain embodiments of the present invention, a crack is arranged on the sidewall of this instrument, grafting vessel is inserted into and/or is split out by this crack.Substitute or additional aspects as a kind of, this instrument can be opened or be rived.Preferred this instrument comprises a tingle, and when the part of instrument is pulled through this tingle top, this tingle will be rived this instrument.Preprocess has the crack or is punched in advance at least on preferred this instrument, however this and nonessential.As a kind of of tingle substituted or additional aspects, can adopt a blade, this blade is torn this instrument vertically.Preferred this blade and/or tingle transfixion, and tools section their slips relatively.Substitute or additional aspects as a kind of, this this blade or tingle slide.This instrument can optionally comprise a hard part that can prevent that the fissured instrument of preprocessing is separated.Yet this hard part comprises an opening, in case the fissured instrument of this preprocessing by in this opening of retraction, this hard part will allow this instrument to be rived, thus make grafting vessel can by from the sealing instrument taken out.Exemplary tool in this tool kit is turn up one or more in device and the identical installed part of an identical connector, grafting vessel.These instruments can be made of a single instrument that has different adnexaes.Substitute or additional aspects as a kind of, these instruments are suitable for using in piercing operation.Substitute or additional aspects as a kind of, these instruments be suitable for passing blood vessel or in the method for peeping.

Substitute or additional aspects as a kind of, this instrument by one for example the external tool of blade cut.Substitute or additional aspects as a kind of, tear rope this instrument that is used to rive for one.

The method that relates in one aspect to the identical adapter of a kind of cooperation in use of some preferred embodiments of the present invention.In a preferred embodiment of the invention, this adapter comprises at least one (along X direction) thickening, and preferably these thickenings are positioned on the spike.This thickening is optimized for adapter is pulled away from blood vessel, thereby uses the hook solid spike of this adapter opposite side to puncture blood vessel.Substitute or additional aspects as a kind of, this thickening is used to adapter is pushed forward into blood vessel.In a preferred embodiment of the invention, the spike that is processed with thickening be elastic, hyperelastic or when using this stapling apparatus the mode with other shift out the adapter plane.Like this, cooperate, just can make stapling apparatus break away from deployment tool by allowing or making spike bend with the axial of instrument.

A kind of spike of stapling apparatus that will comprise that relates in one aspect to of some preferred embodiments of the present invention is installed in a method on the grafting vessel, does not use independent step that grafting vessel is turned up in this method.In a preferred embodiment of the invention, this grafting vessel is pierced on the spike with first kind of structure, makes grafting vessel keep intermediate structure (for example, not turning up) substantially simultaneously.After grafting vessel was pierced, the structure of spike was changed, and for example to external rotation, thereby made this spike be more conducive to match with the second blood vessel in residing position in implementing the process of coincideing.When grafting vessel stretched out before the second blood vessel, preferably this grafting vessel was turned up because of contact.In a preferred embodiment of the invention, spike, when grafting vessel is left in their rotations, is convenient to match with the second blood vessel so that when they point to grafting vessel adapter is pierced through by hook simultaneously.

The everting method that relates in one aspect to a kind of grafting vessel of some preferred embodiments of the present invention, thus wherein the grafting vessel end has been folded backward on the grafting vessel part that covers contiguous grafting vessel end.In a preferred embodiment of the invention, the grafting vessel end is grasped, and is pulled rearward, thereby covers on the grafting vessel.Preferred this grafting vessel is centered around in the pipe fitting, and is turned up on this pipe fitting in the grafting vessel end.Can free motion mutually between preferred pipe fitting and the grafting vessel.Yet the end of pipe fitting is used as the backfolding axis of grafting vessel.Preferred this place climbs over journey and is finished by machinery, and is not directly finished by manual.

The everting method that relates in one aspect to a kind of grafting vessel end of some preferred embodiments of the present invention, wherein near-end is rolled on grafting vessel forward towards the far-end of grafting vessel.In a preferred embodiment of the invention, this grafting vessel is installed on the pipe fitting or its inside, and the near-end of grafting vessel is pushed with small incremental along the direction towards the grafting vessel far-end.The near-end of preferred migration blood vessel is bitten and is pushed, rather than is grasped.

The forming method of the part that relates in one aspect to a kind of grafting vessel of some preferred embodiments of the present invention, this part refers in particular to the end, but also may be the mid portion of grafting vessel.Preferred this method is used for thickening by an end that makes grafting vessel to be simulated grafting vessel and turns up, and does not turn up veritably.In a preferred embodiment of the invention, this grafting vessel is an arteria mammaria.In a preferred embodiment of the invention, grafting vessel end thickening under the effect of axial compression.The mould of a grafting vessel inside is adopted in preferred axial compression, is used for setting the internal diameter of (increase, reduce or keep) grafting vessel.This extruding can be used to form an end perpendicular to axis, and perhaps this extruding can be limited to form other shape, for example forms the saddle type of mating with profile phase coronarius, or forms an inclined end portion.In a preferred embodiment of the invention, the grafting vessel thickening is pierced through by identical adapter and helps to keep its shape.Substitute or additional aspects as a kind of, this thickening makes the part inner membrance come out along the end of grafting vessel, is complementary to the connection of the identical connection of inner membrance and/or a kind of adventitia external membrane and/or with other vascular lamina thereby help to implement a kind of inner membrance.In a preferred embodiment of the invention, this thickening is pierced through along the path that is parallel to the grafting vessel axis by the spike of an identical adapter.

The relative grafting vessel axis of a kind of generation that relates in one aspect to of some preferred embodiments of the present invention has the technology of the grafting vessel end of turning up at inclination angle.On an inclination angle, directly turn up and to compare difficulty.In a preferred embodiment of the invention, an identical adapter has the spike that prebends, thereby their tip is in substantially parallel relationship to the surface of another blood vessel.Therefore, when grafting vessel is partly turned up and spike when protruding, these tips can easily puncture a side of grafting vessel and help through turns up.

Some preferred embodiments of the present invention relate in one aspect to a kind of spike tip, this tip is used to prevent that spike from thrusting too far.In a preferred embodiment of the invention, this spike tip is forked, for example is divided into two or three tips (a for example similar tuning fork).In a preferred embodiment of the invention, when grafting vessel was pierced through by spike, spike stopped to pierce through when the bifurcation touches tremulous pulse.Perhaps, be bigger angle between each tip, thereby avoid oppressing the tissue between the tip.

Some preferred embodiments of the present invention relate in one aspect to one and be used for around (non-coronary artery) blood vessel, for example implement other operating tool kit in shank or the abdominal artery.In a preferred embodiment of the invention, such tool kit comprises that two ends are equipped with grafting vessel and a guiding piece that is used for guiding grafting vessel between two identical link positions of an identical adapter.In a preferred embodiment of the invention, this guiding piece is made of a guide line.Perhaps, this guiding piece is a rigidity guiding piece.Perhaps, this guiding piece is a deflective guiding piece.

Some preferred embodiments of the present invention relate in one aspect to a kind of method from elasticity of an intrafascicular approximately release or super-elasticity device, pulling down of its middle and upper part constraint makes this device can produce distortion, and self is pulled down from the bossing that is limited on the lower constraint.

Relating in one aspect to of some preferred embodiments of the present invention is a kind of from the identical adapter that turns up.In a preferred embodiment of the invention, this adapter is compressed and the forward direction spike on it is inserted in the grafting vessel.When spike was released, they rotated in a plane perpendicular to vessels axis, and blood vessel is turned up.Perhaps, in order to be connected with blood vessel by using forward direction spike piercing blood vessel, this adapter can comprise other the fold part part of a flange (for example as), this fold part makes intervenient vessel end produce fold, and the end of pulling blood vessel when they are out of shape, thereby for example form a flanging.In some preferred embodiment of the present invention, it is very important that the necrosis of vessel end is not considered to.

Therefore, according to a preferred embodiment of the present invention, provide one to be used for grafting vessel is connected identical adapter on the target blood, it comprises:

One is suitable for the thin installing ring part that is connected with the part of grafting vessel; With

An independently spike part that is suitable for being installed on the described installing ring part, this spike partly comprises several spikes, each described spike all is suitable for piercing through described grafting vessel.Preferred this adapter comprises that at least one is used to make described spike part and the described installing ring part locking piece of locking mutually.Preferred described locking piece is installed on the described installing ring part.Preferred described locking piece matches with a hole that is limited by described spike part.

In a preferred embodiment of the invention, described locking piece provides a kind of spring motion, this motion can be resisted at least a portion of described spike part and the motion to axial between installing ring at least a portion partly, and this resistance depends on the amplitude of motion.

In a preferred embodiment of the invention, described spike part is made of a kind of elastic material.Substitute or additional aspects as a kind of, described spike quilt is hook in advance, thereby described hook-type is suitable for being connected with target blood.Substitute or additional aspects as a kind of, described installing ring partly comprises several edge of a wing parts near described target blood.Preferred described edge of a wing part limits several holes, so that described spike spare passes.Perhaps, described edge of a wing part comprises at least one opening on its girth, and this opening is enough wide, so that wherein said spike can pass this opening.

In a preferred embodiment of the invention, described installing ring defines a cylindrical space.Substitute or additional aspects as a kind of, described installing ring partly is suitable for constituting a vertical anastomat.Perhaps, described installing ring partly is suitable for constituting an inclination anastomat.

According to a preferred embodiment of the present invention, also provide one to be used for grafting vessel is connected identical adapter on the target blood, it comprises:

A base that is used to connect described grafting vessel;

Several are used to the spike that pierces through described grafting vessel and be connected with described target blood; With

At least one spring part, this spring part is connected with at least one described spike.This spring part is used as the connector between described spike and the described base.Preferred described spike and described base constitute a monomer spare.Perhaps, described spike and described base constitute two split parts.

In a preferred embodiment of the invention, described spring is made of a flat wind spring.As an alternative or additional aspects, described spring is made of a sheet spring.As an alternative or additional aspects, described at least one spring is made of at least two springs that are in series.

In a preferred embodiment of the invention, each described spike have at least with one independently spring be connected.As an alternative or additional aspects, described adapter is designed to implement the inclination anastomosis.As an alternative or additional aspects, described adapter is used for moving described spike by the block that comprises that at least one is connected with one of described spike.Preferred described block is suitable for retracting described spike.As an alternative or additional aspects, described block is suitable for releasing forward described spike.

According to a preferred embodiment of the present invention, also provide an equipment that is used for a grafting vessel is delivered to an identical junction, this equipment comprises:

At least two tubular member, each defines a hole, and this hole is suitable for inserting described grafting vessel, thereby this grafting vessel is passed from first end of described tubular member;

At least one separation member, this separation member are installed at least one described tubular member, and another described tubular member that is used to rive is moved out of thereby described grafting vessel can pass the elongated slot of riving, and this elongated slot is crossed between described first end and described hole.Preferred described at least one separation member is made of a described fissured blade of cutting.As an alternative or additional aspects, described at least one separation member is made of an extension, and this extension is widened the existing crack in the described pipe fitting, thereby forms described elongated slot.

In a preferred embodiment of the invention, this equipment comprises an outer tube member, and this outer tube member prevents described pipe fitting division, unless it fully bounces back.As an alternative or additional aspects, described tubular member is suitable for a stapling apparatus is clipped in wherein.

According to a preferred embodiment of the present invention, also provide one to be used for method that a grafting vessel means of delivery is pulled down from a grafting vessel that is enclosed in wherein, this method comprises:

Use the described pipe fitting of riving, thereby form an elongated slot; With

Described grafting vessel is taken out by described elongated slot.Preferred described groove drip molding is made of the blade of the described pipe fitting of riving.As an alternative or additional aspects, described groove drip molding is made of an extension, and this extension is widened the existing crack in the described pipe fitting.

In a preferred embodiment of the invention, this method comprises and retracts at least one pipe fitting around the described grafting vessel.Preferred describedly retract action described pipe fitting is reclined mutually with a groove drip molding.

In a preferred embodiment of the invention, this method comprises makes described groove drip molding move relative to described pipe fitting, thereby forms described elongated slot.

According to a preferred embodiment of the present invention, also provide an identical adapter, this identical adapter comprises:

Annular element with an axis;

At least one group of spike that is positioned on the described annular element; With

At least one is along the thickening of X direction, and this thickening is positioned at least one described spike, simultaneously away from described annular element.Preferred this adapter comprises second group of spike, and the sensing of this group spike is opposite with the direction of described first group of spike.As an alternative or additional aspects, described thickening comprises a point, and wherein said spike is cleaved into some tips in this some punishment.The length at preferred described tip is less than the thickness of the target blood that this adapter was suitable for.

In a preferred embodiment of the invention, described at least one group of spike in use do not apply inside or outside radial pressure to described annular element.

According to a preferred embodiment of the present invention, also provide a kind of and be used to keep and discharge a method that has the identical adapter of a thickening, this method comprises:

Described adapter is remained between two pipe fittings, and the axially-movable of described thickening is subjected at least one restriction that is limited to the bossing at least one described pipe fitting; With

Pull down one that is positioned at the outside in the described pipe fitting, thereby this adapter produces distortion, and this thickening no longer is subjected to the restriction of described at least one bossing.

According to a preferred embodiment of the present invention, also provide a kind of method of implementing anastomosis between a grafting vessel and target blood, this method comprises:

An identical adapter is inserted target blood;

Discharge at least one forward direction spike of described adapter;

Retract described adapter, thereby described forward direction spike is connected with described target blood; With

Finish described anastomosis procedures.Preferably finish described anastomosis procedures and comprise, discharge described adapter at least one the back to spike, thereby be connected with described target blood.Perhaps, finish described anastomosis procedures and comprise, described spike is locked on the part of the described adapter except that described spike.Perhaps, finish described anastomosis procedures and comprise, discharge described spike, thereby make it part withdrawal towards the described adapter except that described spike.

According to a preferred embodiment of the present invention, also provide a kind of perforating mechanism that is used for punching on blood vessel, this mechanism comprises:

A sharp tip that is suitable for piercing through described blood vessel;

An axle that at one end has described tip;

Widen part away from first of described tip for one; With

Widen second of part away from described first for one and widen part, described first and second widen part defines a narrow path portion between the two at it, and this narrow path portion is suitable for holding the blood vessel wall that is pierced; With

A connector, this connector are used to make the retraction at described tip and described a kind of relative motion of widening part to be coupled.Part is widened in preferred described most advanced and sophisticated retraction described first, pulls to described second and widens part thereby widen part with described first.Substitute or additional aspects as one, described tip is installed on the tip axis, and make most advanced and sophisticated withdrawal by retracting this tip axis, wherein said tip axis is connected with described axle, thereby after described tip axis is fully pulled back, described tip axis contacts with described axle, and it is pulled back.

According to a preferred embodiment of the present invention, also provide a kind of method of the grafting vessel that is used to turn up, this method comprises:

Be held between an internal mandrel and the outer tube member described; With

One end of described grafting vessel is pushed on the described grafting vessel backward.Preferred this method comprises described promotion operation repeated several times, thereby obtains the ideal amount of turning up.As an alternative or additional aspects, the described end that promotes described grafting vessel comprises and will translate on the described outer tube outside the described end.

According to a preferred embodiment of the present invention, also provide a kind of grafting vessel device that turns up, it comprises:

An end, this end is suitable for described grafting vessel mounted thereto;

A grafting vessel retainer, this retainer are used for the protrusive movement of described grafting vessel end on described end limited; With

Several place the expansion finger between described grafting vessel retainer and the described end, described finger has an expansion state, wherein their external diameter is greater than described end and described grafting vessel, described finger also has a unexpanded mode, and wherein its diameter is not enough to match with described grafting vessel.

According to a preferred embodiment of the present invention, also provide a kind of being used for to be installed in a method on the grafting vessel with an identical adapter that has spike is installed, this spike has the tip that goes out a cavity of described adapter to excurvation, and this method comprises:

Make described some described spike at least keep torsion structure, thereby make the tip of described spike bend into this cavity;

Pierce through described grafting vessel with described tip; With

Change the structure at described tip, make it outwardly-bent.Preferred this structure that changes comprises the described spike of release.

According to a preferred embodiment of the present invention, also provide a kind of method that grafting vessel turns up of simulating, this method comprises:

One end of described grafting vessel is pressed into a forming tool, thereby on described end, forms a thickening; With

Use at least one spike of the adapter that coincide to pierce through described thickening.Preferred described grafting vessel is made of an arteria mammaria.As an alternative or additional aspects, the described axis that comprises along described grafting vessel that pierces through pierces through.Perhaps, described piercing through comprises that the direction that tilts along the axis with the institute grafting vessel pierces through.Perhaps, the described direction that comprises along vertical described grafting vessel axis that pierces through pierces through.In a preferred embodiment of invention, described forming tool comprises an interior footstalk.As an alternative or additional aspects, described mould defines the flat end surface of a described thickening on described grafting vessel.Perhaps, described forming tool defines the beveled end surface of a described thickening on described grafting vessel.Perhaps, the described nonplanar end surfaces that defines a described thickening on the described grafting vessel that is formed in.

According to a preferred embodiment of the present invention, also provide a kind of an adapter thorn is through a method on the grafting vessel, this method comprises:

The radius of this grafting vessel one end of broadening;

At least one spike on the described adapter is stretched out forward along the direction that is parallel to described grafting vessel, thereby make it to pierce through described broadening zone; With

Make the end bent of at least one described spike become hook-shaped.

According to a preferred embodiment of the present invention, also provide one to be used for other operating tool kit, this tool kit comprises:

At least one two ends is equipped with the grafting vessel of an identical adapter, and described grafting vessel and described adapter are applicable to the other surgical operation of peripheral vessels; With

The guide line that at least one is connected with an end of described grafting vessel.Preferred described adapter is embedded in the described end of described grafting vessel.

According to a preferred embodiment of the present invention, also provide a kind of inclination card punch, this card punch comprises:

An axle;

A first non-rounded edge that tilts with one the first described relatively axle of angle;

A second non-rounded edge that tilts with one the second described relatively axle of angle; With

Be used to reduce the device in the slit between the described two edges, this is in order to excise vascular tissue between the two.Preferred described two angle differences.Perhaps, described two angles are identical.

According to a preferred embodiment of the present invention, also provide a kind of in the piercing operation process, the card punch that is used on blood vessel, punching, this card punch comprises:

A tip that is used to pierce through described blood vessel;

One is applicable to piercing operation and hard handle that be connected with described tip, and this handle is used for a locus at described tip;

Two surfaces, this surface are used for the blood vessel wall of receiving ring around around described hole; With

Thereby be used to make described surface to lump together the device of getting described hole.Preferred described tip changes.Perhaps, described tip can have groove vertically.

According to a preferred embodiment of the present invention, also provide a kind of method that an identical adapter is heat-treated, this method comprises:

A cutting adapter is installed in the mould;

Fixing described mould, thus make the forward direction of described adapter and back all curve ideal form to spike; With

The described device that is fixedly coupled is heat-treated, thereby it is processed into described structure.

To brief description of drawings

Below in conjunction with accompanying drawing preferred embodiment is elaborated, thereby the present invention will more clearly be understood, the same structure, element or the part that wherein appear among a plurality of figure identify with identical numeral in all figure that they occurred, and accompanying drawing comprises:

The isometry survey perspective view and the cutaway view of two parts of binary spare stapling apparatus according to a preferred embodiment of the present invention represented in Figure 1A-1D summary;

The operation to the device according to a preferred embodiment of the present invention shown in Figure 1A-1D represented in Fig. 2 A-2F summary;

Fig. 3 A and 3B are the floor plan designs of two parts of the stapling apparatus according to a preferred embodiment of the present invention shown in Figure 1A-1D;

Fig. 4 A-4D has represented a kind of method of a loop section of the stapling apparatus according to a preferred embodiment of the present invention shown in Figure 1A-1D that is used to withdraw;

Fig. 5 is the floor plan design of a monomer stapling apparatus according to a preferred embodiment of the present invention;

Fig. 6 A and 6B are the regional side sectional views that coincide, and have represented a kind of method of using device shown in Figure 5 to coincide;

Fig. 7 A summary has been represented the cutting-edge structure of an outside open spike according to a preferred embodiment of the present invention;

Fig. 7 B is the side sectional view of an adapter, and this adapter comprises and is arranged in an endarterial structure as shown in Figure 7 according to a preferred embodiment of the present invention;

Fig. 8 A is the floor plan design of an arterial anastomosis adapter according to a preferred embodiment of the present invention;

Fig. 8 B is the vertical view of the adapter shown in Fig. 8 A, and wherein this adapter is in resting state;

Fig. 8 C is a zoomed-in view, has represented the joint of two spikes of the relative both sides of adapter;

Fig. 8 D is the cutaway view along Fig. 8 B center line A-A, has represented to be in the relative position of spike of the anastomosis apparatus both sides of resting state;

Fig. 9 A and 9B have represented a mould, and this mould is suitable for the anastomosis apparatus according to a preferred embodiment of the present invention shown in themanuscript 8A-8D.

Figure 10 is a flow chart, and this figure has represented the other operating process of punching according to a preferred embodiment of the present invention for example;

Figure 11 is the sketch map of a holding frame instrument, and this holding frame instrument is used for clamping various other instruments according to a preferred embodiment of the present invention in other surgical procedures;

Figure 12 A-12D has represented that according to a preferred embodiment of the present invention one is grabbed the use of cutting card punch;

Figure 13 A-13D has represented the use of a rotation spike card punch according to a preferred embodiment of the present invention;

Figure 14 A-14E has represented the use of an anvil card punch according to a preferred embodiment of the present invention;

Figure 15 A-15D has represented card punch and the using method thereof in the holding frame instrument that is inserted in as shown in figure 11 according to a preferred embodiment of the present invention;

Figure 16 A and 16B have represented a tip retraction card punch according to a preferred embodiment of the present invention with perspective view and perspective section view respectively;

Figure 17 is the perspective view of a tip retraction card punch according to a further advantageous embodiment of the invention;

Figure 18 has represented an assembly drawing and broken away view of inclination card punch according to a preferred embodiment of the present invention;

Figure 19 A has schematically shown another inclination card punch according to a further advantageous embodiment of the invention;

Figure 19 B has represented shown in Figure 19 A two views at the tip of card punch;

Figure 20 A-20D has represented a kind of installation method of adapter according to a preferred embodiment of the present invention;

Figure 21 A-21E has represented a grafting vessel according to a preferred embodiment of the present invention device that turns up;

Figure 22 is the turn up generalized section of device of according to a preferred embodiment of the present invention another grafting vessel;

Figure 23 A-23G has represented that a kind of spike that passes through to reverse an adapter according to a preferred embodiment of the present invention pierces through and the fixing method of blood vessel;

Figure 24 A-24E has represented the method that a kind of simulation is according to a preferred embodiment of the present invention turned up, particularly for arteria mammaria;

Figure 25 A is the near-sighted close-up illustration of holding frame instrument according to a preferred embodiment of the present invention shown in Figure 11, wherein is inserted with the molectron of a grafting vessel holder and adapter holder;

Figure 25 B is the perspective view of Figure 25 A;

Figure 26 has represented the position after the tip withdrawal of holding frame shown in Figure 11, has represented and the target blood spike of interlock mutually;

Figure 27 has represented a layer in the molectron shown in Figure 25 A, Special attention will be given in this layer one processing crack, blade and ledge;

Figure 28 is a cutaway view of holding frame shown in Figure 11, represented will be shown in Figure 27 when layer is fully retracted layer tingle or the circular cone of riving;

Figure 29 A-29F has represented another kind of adapter delivery system based on the mechanism of riving of tingle of use according to a preferred embodiment of the present invention;

Figure 30 A-30D and Figure 1A-1D are corresponding, have represented the identical adapter that is applicable to connection according to a preferred embodiment of the present invention;

Figure 31 A is corresponding with Fig. 2 F, has represented the adapter in the work process shown in Figure 30 A-30D according to a preferred embodiment of the present invention;

Figure 31 B is corresponding with Fig. 2 D, has represented the identical state after the finishing according to a preferred embodiment of the present invention;

Figure 32 A and 32B have represented a floor plan design of the adapter shown in Figure 30 A-30D respectively corresponding to Fig. 3 A and 3B;

Figure 33 A and 33B represented a kind of according to a preferred embodiment of the present invention be used for an inclination adapter is installed in method on the grafting vessel;

Figure 34 A-34F has represented turn up certainly an adapter and an a kind of method of using this adapter according to a preferred embodiment of the present invention;

Figure 35 has represented that inside according to a preferred embodiment of the present invention is embedded with the grafting vessel of an identical adapter; With

Figure 36 has represented an other surgical operation of typical strand-popliteal tremulous pulsies according to a preferred embodiment of the present invention.

Detailed description of preferred embodiments

It may be to implement the other operating first step or second step between a tremulous pulse and this blood vessel that a coronary vasodilator is implemented identical connection, perhaps it also may be a single anastomosis procedure in the longer operation process, for example when needs use the method for attachment of a kind of side end to-end anastomosis arteria mammaria (RIMA) is connected to a coronary vasodilator in arteria mammaria (LIMA) or the right side in a left side.In some cases, there are some problems in this identical connection, and for example, these problems come from following one or more reasons:

(a) coronary vasodilator refers in particular to the blood vessel that is damaged by disease and has fragile structure, and is difficult to handle and draw and stretch.

(b) when operation finishes, and for some embodiment almost in the whole surgery process, the instrument that is used to implement anastomosis operation all is in outside grafting vessel and the coronary vasodilator.

(c) we do not wish the adapter very long (vertically) that coincide usually, and this is because we wish to obtain as far as possible little endosome profile.

(d) we wish blood vessel usually, and particularly the manipulation degree of coronary vasodilator is as far as possible little.If therefore can avoid blood vessel is carried out clamping, will be very favourable.The binary spare connecting device that coincide

Figure 1A-1D has schematically shown the isometry of two parts of binary spare stapling apparatus 100 according to a preferred embodiment of the present invention and has surveyed perspective view and cutaway view.Figure 1A and 1B have represented aloop section 102, preferably are made of a pipe fitting 104.Perhaps, several holes 110 are formed on this pipe fitting.Substitute or additional aspects as a kind of, this pipe fitting can be processed by unfolded naturally netted or other structure.Like this, the total amount of intravital other material of this device is just reduced.Perhaps, pipe fitting 104 can radially be expanded or shrink, for example plasticity, elastic, hyperelastic or use the expansion or the contraction of distortion memory characteristic.Using another possible advantage of mesh is that this stapling apparatus has better elasticity, and can adapt to the variation of organizing geometry, and even can be out of shape for a long time, for example when vasodilation.

Preferably the circumference around pipe fitting 104 is provided with several edge of a wing parts 108.On preferred each edge of a wing part perforate is arranged all, and be used to keep a spike spare (as hereinafter stating).Substitute or additional aspects as a kind of, these edge of a wing parts are used as that blood vessel is turned up thereon and/or otherwise connect thereon a flange.Perhaps, the edge of a wing part on this pipe fitting comprises some barbs, is used for fixing the blood vessel that turns up.Substitute or additional aspects as a kind of, this edge of a wing part is used to improve the intensity of pipe fitting, thereby makes the pipe fitting distortion of can radially not collapsing.

Like this, grafting vessel is fixed by pipe fitting 104.In some cases, this secure fit is a contact, in other cases, provides a kind of mechanical connection, for example friction, is using barb on the pipe fitting 104, is using binding agent or realize on this edge of a wing by turning up.

Preferred several lockingpieces 106 are set on the pipe fitting 104, for example are positioned at a side relative with edge of a wing part, thereby in the use of stapling apparatus 100, are used for spike spare is locked in the relevant position.In a preferred embodiment of the invention, this locking piece is elongation shape, thereby locks relatively, and their length makes it to have certain elasticity.Like this, even after locking, spike and pipe fitting also can produce certain elasticity relative motion.Perhaps, the permission that other type can also be set produces the mechanism of axially-movable, for example makes spike have elasticity (for the predictive role power in the connection procedure that coincide) vertically.

Preferably by this locking piece setting or the position that is placed on away from the edge of a wing of pipe fitting 104 are obtained an elastic locking device.Yet in other embodiments, if for example locking piece itself comprises spring or is made of a kind of elastic component, this locking piece also can or even be positioned on the edge of a wing near the edge of a wing.In addition, this locking piece also can or be positioned on the edge of a wing for other reasons near the edge of a wing, for example under the situation of not elasticity of demand motion.

Fig. 1 C and 1D have represented aspike part 120, and preferably thisspike part 120 is made of 122 on a ring that is connected with several spikes 124.In a preferred embodiment of the invention, the diameter of this ring is a bit larger tham pipe fitting 104.Yet need indicatedly to be, in some preferred embodiment of the present invention,loop section 102 and spikepart 120 one of them or all can radially expand.In a preferred embodiment of the invention, be inserted through an edge of awing part 108,ring 122 slided on pipe fitting 104, thereby spikepart 120 is installed on theloop section 102 by making each spike 124.In certain embodiments, the port of edge of awing part 108 opens wide, rather than closed, as shown in the figure.

In a preferred embodiment of the invention, when assembling stapling apparatus 100, spike is pushed through the hole in the part of the closed edge of a wing.Perhaps, this spike can be slipped into by an opening.In another embodiment, this opening is positioned at the side of edge of a wing part, and by rotatingspike part 120 it is installed on thetube portion 102, thereby makes spike enter edge of a wing part by this opening.

Preferably ring 122 is harder relatively.Yet, in certain embodiments, need not to keep its shape when encircling 122, and be mainly used in when helping withdrawal spike 124, this ring can be sent out has higher elasticity.Should be noted thatring 122 can be an opening, yet preferably it is closed.Preferably whenring 122 was retracted on thelocking piece 106, (Figure 1A 1B) locked by matching withring 122locking piece 106.

In an alternate embodiment,ring 122 is sinusoidal, and wherein spike is connected with positive string section away from the edge of a wing.When ring loosens, it will retract spike like this.

Spike 124 can have multiple design.Yet in a preferred embodiment of the invention, spike curves inwardly towards its end, and has acurved end 126 that has a sharp tip 128.In certain embodiments, especially refer to following will stating, spike 124 can comprise one section distortion.The curved portion of preferred spike has super-elasticity, and this is because spike is processed into the shape of prebuckling, and will keep linear structure at least in a part of use.Yet the bending of elasticity, plasticity, distortion memory and other mechanical type also can be adopted in a preferred embodiment of the invention.

Fig. 2 A-2F has schematically shown operating process to stapling apparatus 100 with side view cutaway drawing.Stapling apparatus 100 shown in Fig. 2 A is installed on thegrafting vessel 130, thereby spike 124 has passed a part of the grafting vessel part 134 (for example valgus angle is less than 180 °) of turning up.In this embodiment, spike enters along curve, thereby afterring 128 withdrawals, shown in Fig. 2 B, spike is stretching byloop section 120, and is preferably stretching by edge of a wing part 108.After they are straightened, or in stretching process, apreferred target blood 132 is pierced through by thetip 128 of spike.Perhaps shown in Fig. 2 F, even before spike is not bent, the most advanced and sophisticated just piercingblood vessel 132 of spike.In certain embodiments, spike also can outwards open, for example for enlarged openings and/or in order to form the connection of other geometry between blood vessel.

In certain embodiments, the relative motion of two connector parts can improve the intensity of spike.In certain embodiments, this motion comprises and makes 132 withdrawals of the relative blood vessel of spike.Perhaps, spike is maintained atrelative blood vessel 132 to have on the position of constant spacing, perhaps even forward stretches out.

Fig. 2 C has represented the replacement scheme of Fig. 2 A, and wherein spike is not curved inwardly.In inserting the process of spike, anopening 136 on the target blood may be extended, and perhaps for example under the effect of a sealed tube, spike may curve inwardly.Also can adopt other method that spike is carried out bending, for example use twisting resistance, perhaps carry out Temperature Treatment by spike to the distortion Memorability.Perhaps, when spike stretched out,curved end 126 was enough sharp, thereby pierced through target blood.Perhaps, most advanced and sophisticated 128 are compressed against on thespike 124, thereby makecurved end 126 have smaller profile.

In a preferred embodiment of the invention,blood vessel 132 can by its chamber with andopening 136 be full of by for example blood, saline, thereby the wall ofblood vessel 132 is separated.

Preferred in case encircle 122 and fully withdrawn, lockingpiece 106 just matches with ring and/spike, locks it in the relevant position.Fig. 2 D has represented an end-state, and wherein most advanced and sophisticated 128 contacts of spike or lock lean against the bottom or the inside of edge of a wing part.Fig. 2 E has represented an end-state, and wherein most advanced and sophisticated 128 contacts of spike or lock lean against the sidepiece of edge of a wing part.In addition, the spike tip can not contact with edge of a wing part yet or locks and lean on.Should indicatedly be that by the structure of the control stapling apparatus and the part of turning up, thepart 134 of turning up of graftingvessel 130 can be pierced through or do not pierced through in spike tip 128.In a preferred embodiment of the invention, although thesmooth part 134 of turning up can be pierced through intip 128, most advanced and sophisticated 128 are not exposed to the outside, thereby avoid them to stab near other tissue, and it is caused damage.Like this, in some embodiments of the invention, comprise the described embodiment of other parts in the literary composition, when blood vessel was fixed, blood vessel can be stung fully or part pierces through.

Fig. 3 A is the floor plan design ofloop section 102 according to a preferred embodiment of the present invention.

Fig. 3 B is the floor plan design ofspike part 120 according to a preferred embodiment of the present invention.As shown in the figure, in thering 122several selectivity openings 129 are arranged.

Fig. 4 A-4D has represented a kind of method of a loop section of the stapling apparatus according to a preferred embodiment of the present invention shown in Figure 1A-1D that is used to withdraw.Preferred insertion instrument 140 shown in the meaning property as shown comprises aring retractor 142 that has a ring mating part 144.Thisring mating part 144 can match with opening 129.Substitute or additional aspects as a kind of,ring mating part 144 matches withring 122 at its downside.Can carry out multiple change to ringmating part 144, yet in a preferred embodiment of the invention,mating part 144 comprises several fingers, when this finger is withdrawn away fromblood vessel 132, will spurring 122 together.Finger matches withopening 129, and an advantage is that they provide a kind of method of stretching outring 122.

Whenring retractor 142 was contracted, shown in Fig. 4 B,ring 122 and spike 124 also were contracted simultaneously.After abundant withdrawal, encircle 122 locked 106 lockings.Perhaps, an extension 148 ofinsertion instrument 140 will stop the lock fit of lockingpiece 106, be contracted until this extension, thereby allow to correct the mistake that occurs.In a preferred embodiment of the invention, when lockingpiece 106 andring 122 lock fit, will cooperate withmating part 144 disengagings, for example by pushing the finger that is in mated condition vertically open.Perhaps, mating part can be oppressed lockingpiece 106, thereby prevents their work.Pull down this device, can comprise pushinglocking piece 106 and/or stretching out spike forward, thereby spike is curved inwardly.May need to clampblood vessel 132, thereby make spike with respect to vessel retraction.

Shown in Fig. 4 C, in a preferred embodiment of the invention, whenretractor 142 was continued to retract,mating part 144 was ejected cooperation position by a projection (or reinforcement) 146 of instrument 140.Like this,withdrawal ring 122, lock this stapling apparatus and pull down the level and smooth action thatinsertion instrument 140 can be used as an integral body and carry out.Fig. 4 D has represented to pull downinsertion instrument 140 completed identical state afterwards.As shown in the figure, spike 124 is inserted the blood vessel sidewall usually, thereby reduces to be exposed to the area in the blood flow, but also is not this mode of certain employing.

In a preferred embodiment of the invention,instrument 140 be not be centered around fully grafting vessel around, for example have only 270 ° around the angle.Like this, just formed a grooving on the sidewall ofinstrument 140, thereby in case after anastomosis procedures finished, this instrument just can pass this groove and be pulled down from grafting vessel.Locking

In a preferred embodiment of the invention, the lock out action that lockingpiece 106 locks lean against on thering 122 has some elasticity a little, this is in order to adapt to the variation of topography structure, particularly to apply too big pressure in order being avoided on the vasculature part of being oppressed by stapling apparatus.In a preferred embodiment of the invention, this elastic value of setting meets an ideal pressure limit, and for example, this pressure can be too not low to cause blood leakage, can be too not high to cause tissue necrosis yet.Substitute or additional aspects as a kind of, this elasticity can adapt to the variation of blood vessel thickness of the different piece of different blood vessels, different patient and/or same blood vessel.This elasticity can obtain in several ways, for example by following one or more modes, promptly bymake locking piece 106 have elasticity, by make pipe fitting 104 have elasticity, by makingspike 124 have axial elasticity and/or having elasticity by the bendingarea 126 that makes spike.In an exemplary embodiments, spike comprises a spring section, one of its bottom section S curve for example, and the length of this spring section can change, thereby regulates the most advanced and sophisticated and locking piece of spike or encircle distance between 122.

In a preferred embodiment of the invention, spike 124, especially thrust in " sidewall " ofblood vessel 132 inclinodactyly zone 126, contacts thereby in fact spike is not existed with blood flow.Yet, preferably should as indicated above the pressure that is applied on the spike be regulated, thereby avoids producing downright bad.Installing ring length

When this stapling apparatus 100 was installed, pipe fitting 104 was used as an installing ring.In some cases, the length of this installing ring may be a factor that characterizes the suitability of this stapling apparatus.In a preferred embodiment of the invention, this installing ring has been chosen as far as possible little length.Perhaps, for example after this stapling apparatus is mounted, can cut away unnecessary material.

Be to be noted that an inclination adapter (following will stating) relatively blood vessel have a profile that cardinal principle is lower.

In an alternate embodiment of the present invention, pipe fitting 104 is made of two rings that separated by a spring.In case anastomosis procedures finishes, this pipe fitting will be released, and ring contacts simultaneously.Perhaps, thus narrowing of the ring is installed also can be engaged in by a part that makes spike between two rings and makeelement 106 have locking action.Also can adopt other structure of shrinking vertically in addition, for example adopt sinusoidal shape.Monomer spare stapling apparatus

Fig. 5 is the floor plan design of a monomer stapling apparatus 200 according to a preferred embodiment of the present invention.Adopted among this figure and Fig. 3 A and the similar labeling scheme of 3B, be used to express the similarity of these two kinds of stapling apparatus.An advantage of monomer stapling apparatus is to reduce or exempted necessity that the relative position of two parts is controlled.Substitute or additional aspects as a kind of, owing to have only a part, this stapling apparatus is convenient to clamping, has therefore also just reduced to fall into the intravital probability of patient.In addition, owing to have only a part, just can remove the locking edge of a wing from, elastic movement can be provided by special purpose spring 223 and 225 simultaneously.Shown in exemplary embodiments in, spring 225 is used to the main retraction movement of spike, spring 223 then provides some elasticity at accurate withdrawal amount.In the typical use of this stapling apparatus,, spike 224 is stretched out forward by pressing the short column 227 that links to each other with spike 224.When this short column is released, spring will retract spike.Perhaps, be connected at point 229 places with spike by making spring, can force pullback spring, its medi-spring has a thickening at point 229 places.

In an alternate embodiment, have one in two springs 225 and 223 at least and produce plastic deformation, and do not produce strain.

Although in a monomer spare device, do not need locking, locking mechanism can be set yet.Perhaps, a block piece can be set, be used to prevent stretch out too far when spike is pulled.

Fig. 6 A and 6B are the regional side sectional views that coincide, and have represented a kind of method of using stapling apparatus 200 to coincide.As shown in the figure, the process shown in this process and Fig. 4 A-4F is very similar, and difference is, 200 of stapling apparatus are made of a part, and do not have lock operation.

In these figure, the edge of awing 208 folds apart 209 as shown in the figure backward and upwards.This bending is optionally, yet it can improve the intensity of coincideing and connecting, avoid near 228 pairs at the tip of spike body structure to cause damage and/or enter hole in the edge of awing 208, thereby allow the clamp blood vessels tissue by the tissue of forcing to make the spike clamping.

In stapling apparatus 100 and 200, as mentioned above, preferably the relative position according to spike makes it to have certain elasticity.In a typical embodiment, the gap of permission between 0.1 and 2mm between, for example greater than 0.5mm or 1.5mm.The amount in gap depends on the parameter that coincide to connect usually, the geometry that comprises pressure, blood vessel with is connected in the number of spike of use.The variation of stapling apparatus

Fig. 7 A has schematically shown the spike cutting-edge structure 260 of a bifurcated according to a preferred embodiment of the present invention.Preferred this spike structure is used to the aortic type adapter that coincide, and for example as described in the patent PCT/IL99/00284, disclosing of this patent is merged in this patent, with as a reference.Yet such spike structure also can be used to other identical adapter.In a preferred embodiment of the invention, the blood vessel that structure 260 is used to be pierced is clamped together, and for example is used to prevent separately, avoid simultaneously applying towards or away from the pressure of the adapter that coincide.Perhaps, this spike also can apply this radial pressure.

Thickening a little at one, 253, one spikes 252 are divided into two tips 254.Preferably should the tip long enough, thus can thrust aorta (or other " sidewall ") blood vessel, but do not pierce through it.Perhaps, this tip also can piercing blood vessel.In addition, the tip of different numbers can be set also, for example one or three, these tips are coplane not.Thicken a little 253 or crotch be used as a stop point, be used to avoid spike to thrust aorta too far.As an alternative or additional aspects, following will stating, this thickens and a little also is used as an anchor point that is used to handle stapling apparatus in installation process.

In a preferred embodiment of the invention, each tip has different width and/or thickness, thereby stops most advanced and sophisticated withdrawal.The variation of this geometry also can be set on the spike in addition.

Fig. 7 B is the side sectional view of an adapter, and this adapter comprises the structure according to a preferred embodiment of the present invention 250 that is arranged in the tremulous pulse 256.As shown in the figure, the tip 254 that two aorta layers 258 and 260 (the 3rd, intermediate layer) are clamped together is not illustrated.

Substitute or additional aspects as one, an advantage of fork-shaped spike end is to help to make the locking mutually between the spike of relative both sides of adapter that coincide.For this reason, can use the pinprick shape tip that has an aperture, rather than the tip of opening.As an alternative or additional aspects, this tip (or spike itself) has barb, is used to prevent the withdrawal of spike.Perhaps, spike is processed with barb along its length direction, thereby a detent mechanism is provided, and wherein this spike can only march forward along folk prescription.Can provide a self-locking to coincide like this and connect, when particularly being connected with aforesaid spring, wherein these springs allow to produce between spike and the identical adapter certain relative motion.

The cross section of preferred spike is the rectangle that has chamfering.Yet, also can adopt other cross section.For example, this cross section can be triangular in shape (for example, surface towards or deviate from the bending direction of spike), ellipse or rectangle (for example, thick side or thin side are towards bending direction).Perhaps, the cross section of spike does not align with bending direction.In addition, this cross section can change along the length direction of spike.This can or reverse this spike by for example chemical etching, cut, machining at low temperature and obtain.The advantage of some of them spike cross-sectional structure is to provide maximum intensity on required direction, and keeps elasticity on other direction.Substitute or additional aspects as a kind of, this cross section preferably can embed in the blood vessel, does not contact blood flow simultaneously.In addition, some spike shapes are expected at least some layer of blood vessel caused less relatively damage during insertion.Exemplary embodiments

Fig. 8 A is the floor plan design of the identical adapter of an aorta according to a preferred embodiment of the present invention.

Fig. 8 B is the vertical view of the adapter shown in Fig. 8 A, and wherein this adapter is in resting state.

Fig. 8 C is a zoomed-in view, has represented the joint of two spikes of the relative both sides of adapter.

Fig. 8 D is the cutaway view along Fig. 8 B center line A-A, has represented to be in the relative position of spike of the anastomosis apparatus both sides of resting state.

Provide typical embodiment among the figure, but this is not considered to the adapter among other embodiment is construed as limiting.Preferably this adapter employing Nitinol, and the mould shown in use Fig. 9 A and the 9B is bent and is machined to the spare space shown in the figure.

In a kind of typical process method, shown in Fig. 8 A, pipe fitting is processed to adapter through cut (or a flat part is through cutting, and be welded into a pipe after being bent molding on the footstalk).Preferred this tube connector is installed on thefootstalk 262, and preferably this footstalk is one and the close-fitting distensible footstalk of adapter.Subsequently, the spike of adapter is mended curved on aring mould 264, and is centered on by two body spare outer mold that comprisepart 266 and 262.The adapter of this molding is placed into a stove and heat-treats then, and preferred then water quenches.Then, pull down outer mold, and for example by make spike backward bending will encirclemould 264 and pull down.In a preferred embodiment of the invention, have only a heat treatment step to be used to process whole adapter.

In a typical coronary anastomosis device, the metal diameter that spike adopted between 0.07 and 0.1mm between, close with the diameter of the line that is generally used for shunting stitching.Pipe fitting 104 can be thick slightly, 0.3mm for example, however this is not to be essential.Connector material

In a preferred embodiment of the invention, this adapter is processed by Nitinol, yet, also can adopt other material, for example rustless steel or polymer are as plastics or composite.Also can adopt biological decomposable plastics.In some cases, adapter can be made of two or more different materials, and for example, each part adopts different materials, even same part adopts two or more different materials.

Perhaps, adapter at least a portion is made of allograft or xenograft material.For example,ring 122 can be made of tendon.

The preferred migration blood vessel is an allograft, for example an arteria mammaria or a peripheral vessels.Perhaps, also other graft materials be can adopt, the synthetic material in the present technique field or the material of other type comprised.In some cases, this adapter is connected with grafting vessel external, may be in a position far away.The use of identical adapter

Figure 10 is a flow chart, the figure shows the other operatingcanonical process 300 of punching according to a preferred embodiment of the present invention.Can carry out many changes to this program, for example, the introducing of grafting vessel can be by a chest perforate, by a blood vessel or obtain in chest region.In another example, although this shunting needs two connections usually at least, these two one of connect or all can be by endoscope, pass blood vessel or use open surgery to operate.In addition, for the connection of crown far-end, one of them connection can be removed at least, if for example arteria mammaria is used.The change of another kind of type is that grafting vessel is prepared and is used for connecting (for example, when adapter is installed) constantly.For two extreme example, this preparation both can be carried out in vivo, also can carry out in another country.The time limit of this process also is flexibly, depends on the type of material of employing and usedtechnology.Process 300 is described to a universal process, although also need to consider various possible variations.

At first, this shunting process begins (302).This is usually included in chest and opens one or more holes and/or open other hole on health.Heart can stop or not stopping to beat, and the blood vessel that will be shunted can be blocked or not blocked.

Prepare a grafting vessel (304).This grafting vessel can be gathered (for example, the one leg vein) in the patient body, or is provided by the operation case.This work can be carried out before or after whole process begins.In certain embodiments, this grafting vessel is one and half arteria mammarias that connect or do not connect, and this tremulous pulse can be by an obtained and/or preparation of through hole.

Adapter (for example 100 or 200) is installed on the grafting vessel (308).According to the method that is used to install and coincide, this blood vessel can be before the adapter that install to coincide, in the process or turned up afterwards (306).

According to the difference of other type of surgical procedure, need one, two or more connection between grafting vessel and the patient's blood vessel system.Step 310-316 has described this type of connection.

In step (310), a hole is bored on the target blood.Preferred this card punch is mended and is retained in the hole, thereby prevents that blood from flowing out from the hole.

Then, the grafting vessel that has an adapter is inserted into hole (312).In certain embodiments, local deformation took place in this adapter before or after being inserted into, or was allowed to be deformed into a local installation site.

Connect (314) then, preferably realize, but in certain embodiments, can realize by drawing or pushing away this device by the distortion of finishing this equipment.In addition, can optionally adopt an additional step, promptly the new construction to this device locks, and perhaps excises the unnecessary part (these steps are all not shown) in this device.

Then, instrument is removed (316).In certain embodiments, this instrument is centered around around the grafting vessel.This instrument can be removed from the other end of grafting vessel.Perhaps, this instrument is removed.Perhaps, this instrument is separated.Perhaps, this instrument is excised from blood vessel.Perhaps, this instrument in use not exclusively is centered around around the grafting vessel.

Carrying out step of connecting number of times as required is repeated.In some cases, step 304,306 and/or 308 also is repeated.

After one or two connection is finished, preferably implement a quality assurance (QA) 318 steps, wherein check to connect to have or not leakage and/or guarantee that adapter is correctly installed.Typical inspection can be whether to detect all spikes all to be disposed proper and thrust in the target blood.For example, this inspection can be undertaken by vision or radiograph.

This process promptly comes to an end (320) then, for example seals through hole.

The various different instruments according to a preferred embodiment of the invention that use in below will each step to said process are introduced.Exemplary tool

Figure 11 is the sketch map of a holdingframe instrument 400, and this holding frame instrument is used for clamping various other instruments according to a preferred embodiment of the present invention in other surgical procedures.

Preferred kit 400 comprises that a handle 402 and one are from the extended axle 401 of this handle.The specific characteristic of this embodiment is an elongated slot 404 that extends generally alongwhole holding frame 400, and this elongated slot 404 allows freeing in and out of grafting vessels, although following will stating, it is just enough that this elongated slot only is present in the far-end of this instrument.Preferably on this instrument, process anend 408, thereby it can be matched with an inside that penetrates the hole on blood vessel in the connection procedure that coincide.A zone 406 atpreferred kit 400 ends places has higher side (for example, except a grafting vessel dismounting elongated slot, it has the almost circumference of sealing), is used to help to keep be inserted in the structure of the instrument of holdingframe 400 inside, as hereinafter stating.In addition, zone 406 is used as a block piece, is used to prevent thatinstrument 400 from ad infinitum inserting a blood vessel.Zone 410 has the sides lower than zone 406, is used to allow the instrument of this insertion to separate and makes the grafting vessel that is trapped among wherein can freely-movable, as hereinafter stating.Also can adopt other structure.

Preferred terminal 408 are installed on the extension, and this extension and holdingframe 400 are separated, and when needs when grafting vessel is pulled down instrument, or in the process of the identical adapter of installation, will withdraw from holding frame in this extension.Yetpreferred end 408 just is in the operating position before in punch operation (this moment, this end was pushed into the hole of putting on), all is removed until some or all other instrument, and finishes until anastomosis procedures.

Preferred holdingframe instrument 400 comprises benchmark elongated slot (not shown), and insertion instrument wherein is used for aliging suitably.

Preferred terminal 408 adopt plastics, yet also can adopt metal.The other parts ofpreferred kit 400 are selected known rigid plastics in the present technique field foruse.Instrument 400 can use up promptly to be lost.Perhaps, it can be sterilized and re-use, and for example uses known sterilization method in the present technique field.

In a preferred embodiment of the invention, if the instrument that is inserted in the holdingframe 400 surrounds grafting vessel, when they are contracted, will mechanically be separated so.Therefore, grafting vessel just can be taken out from instrument.Substitute or additional aspects as a kind of, in order to carry out mechanical separation, may need to cut off these instruments with blade, cut instrument may be a component part of the holdingframe 400 or the instrument of insertion.Preprocess has (or two a) crack on the preferred insertion instrument, so that remove.Perhaps, most of instruments are openings, for example are strip, only have one to be used for around the ring of living blood vessel at its end.This instrument may be damaged in demolishing process, so it can only be used once.Perhaps, it only produces plasticity or strain, thereby it can be curved original-shape, be sterilized and re-use.Card punch

When on blood vessel, punching, some problems will appear, some of them or all will by the invention preferred embodiment describe:

(a) avoid the doubles hole, the opposite side of its medium vessels is also penetrated.

(b) avoid blood vessel being caused accidental injury because of the motion of card punch.

(c) avoid blood to lose by the orifice flow that passes.

(d) remove the part of downcutting exactly.

In a preferred embodiment of the invention, a punch operation generally includes two steps:

(i) tool using is worn a hole on target blood; With

(ii) tool using takes out the part of blood vessel wall.

In a preferred embodiment of the invention, drilling tool is not have axially-movable in completing steps (i) and/or the motion (ii) carried out.The danger of doubles holes (a) and/or the danger of accidental injury (b) have so just been minimized.Grab and cut card punch

Figure 12 A-12D has represented first kind of card punch, and promptly card punch 420.The same with other instrument described herein, card punch 420 can be designed to use with holdingframe instrument 400, also can be used as an independent instrument and uses.In some embodiment of invention, after the hole is got,instrument 400 will be placed in (usually by applying the mode of power) on the part of this card punch, and this part remains in the hole of getting, thereby prevent to reveal and/orimport terminal 408.

Card punch 420 comprises a pipe fitting 423 that is split into two (or a plurality of) outside open tongues 424.Perhaps, whole pipe fitting can be split by branch.A sleeve 426 is used to when pipe fitting 423 withdrawals tongue be closed up together.

In Figure 12 A,, the part ofblood vessel 422 is bitten by tongue by tongue is pressed against on the blood vessel.

In Figure 12 B, this pipe fitting produces a spot of withdrawal, and tongue picks up the part 428 of blood vessel 422.As shown in the figure, have one on the inner surface of preferred tongue 424 and be installed in a cutting edge on the vertical component.

In Figure 12 C, pipe fitting 423 is further withdrawn, thereby downcuts part 428.

Figure 12 D has represented through theresidue blood vessel 422 after the punching.

The advantage of some embodiment of this card punch is that by the hole that is limited by tongue 424 is set rightly, this card punch can avoid biting simultaneously the both sides of blood vessel.Perhaps, for the clamping device of cutting blood vessel, also can adopt an independent cutting members (not shown) to cut and bite part 428.The rotation card punch

Figure 13 A-13D has represented the use of a rotationspike card punch 430 according to a preferred embodiment of the present invention.Preferred card punch 430 comprises an interior grasping piece 432 and anouter cutter 434, and preferred interior grasping piece 432 is vacuum tubes, and simultaneously preferredouter cutter 434 comprises that at least onespike 436 Figure 13 B is perspective views ofouter cutter 434.

As shown in FIG. 13A, grasping piece 432 contacts withblood vessel 422, and it is bitten, and for example by the use vacuum, or uses an interior grasping device (not shown).In case it is past that preferredblood vessel 422 is snapped, grasping piece 432 is just slightly withdrawn, thereby avoids that the opposite side toblood vessel 422 causes accidental injury in the punching process.

In Figure 13 C, cuttingmembers 434 is stretched out forward towardsblood vessel 422, thereby makesspike 436 piercing blood vessels.By rotary cutting spare 434, spike 436 cuts out a circular hole on blood vessel 422.Preferred spike 436 is shape linearly, and its length is a bit larger tham the wall thickness of blood vessel 422.Perhaps, spike also can adopt other length or geometry.In a specific embodiments, spike 436 is sickleshaped, and thrustsblood vessel 422 by rotatablely moving.

Figure 13 D has represented through theblood vessel 422 after the punching.The anvil card punch

Figure 14 A-14E has represented the use of ananvil card punch 440 according to a preferred embodiment of the present invention.

Shown in Figure 14 A and 14B, acutting edge 422 is used to cut out aslit 444 onblood vessel 422.

Shown in Figure 14 C,anvil card punch 446 comprises that an end is processed with theinternals 446 of ananvil 452 and theouter part 448 that end is processed with cutting edge 450.Substitute or additional aspects as a kind of, cutting edge and anvil or with switch perhaps only use cuttingedge.Anvil 452passes hole 444 and is inserted into blood vessel 422.Then, shown in Figure 14 D, after being cut betweenanvil 452 and thecutting edge 450, anvil is just withdrawn until blood vessel 422.Figure 14 E has represented the hole of getting.Avoid loss of blood and other change

For fear of loss of blood, a preferred sealed tube (not shown, but can be terminal 408) is inserted into the hole of getting.Preferred this sealed tube has a valve, and card punch can pass that this valve is inserted into and when card punch is moved out of, valve closing, thus there is not the blood outflow.

This sealed tube can be pushed into this hole.Substitute or additional aspects as a kind of, this pipe fitting can be rotated and be screwed into this hole, for example by processing screw thread in the pipe outside.

Substitute or additional aspects as a kind of, by replacing blood with saline or, just can avoiding the loss of blood as replenishing of blood made it to be full of blood vessel.This method has prevented advantageously thatfragile blood vessel 422 from producing and has subsided, perhaps helped to remove blood.In addition, also can make this brine stream through card punch itself.Another advantage that is full ofblood vessel 422 is just to make and be operated a side of (punching, equipment connect) and the opposite side of blood vessel to be kept apart, thereby reduces the probability of injured blood vessel opposite side.The single punch device

Figure 15 A-15D has represented acard punch 460 that is inserted in the holdingframe instrument 400 according to a preferred embodiment of the presentinvention.Card punch 460 comprises anaxle 462, and this far-end has ahandle 464 that is used to handle this card punch, and the other end has a sharpdistal tip 466 that is used for piercing blood vessel.An end of 466 endways, this axle has formed anarrow path portion 468, and the blood vessel that is pierced continues to push along withterminal 466, perhaps is directed intonarrow path portion 468 places under the effect of a relief angle (not shown) on 466 endways.One end ofnarrow path portion 468 has an anvil 470.Perhaps,anvil 470 has an exterior angle, and the blood vessel that is used to help to downcut moves to (holding frame 400) terminal 408 from punching.

When punching, shown in Figure 15 B, terminal 466relative anvils 470 are contracted, thereby get a hole on blood vessel.

Figure 15 C has represented to be inserted in thecard punch 460 in the holdingframe 400.

Figure 15 D is the zoomed-in view of the near-end ofcard punch 460, and when punching, it is inserted in the holding frame 400.In a preferred embodiment of the invention, there is one to decidediameter region 467 between theanvil 470 and terminal 466, is used to prevent the landing from the card punch of cut vasculature part.Preferred anvil 470 has certain gradient, so that the blood vessel that is perforated is shifted onto on theend 408 of holdingframe 400.

Figure 16 A and 16B have represented a tip retraction card punch 480 according to a preferred embodiment of the present invention with perspective view and perspective section view respectively.Card punch 480 comprise a sharp withdrawal end 486, anvil 490, one be limited to terminal 486 and anvil 490 between narrow path portion 488 and one terminal 486 and narrow path portion 488 between column part 487.

Shown in Figure 16 A, the punching action produces by the end 486 of withdrawing, and preferably uses axle or hawser 492 pullings terminal 486 of a processing in column part 487.When terminal 486 were further retracted, column part 487 was pulled and leans against on the anvil 490, the vasculature part that uses a ridge part 496 that is limited by column part 487 and/or anvil 490 to downcut in the narrow path portion 488 between the two.

In a preferred embodiment of the invention, holdingframe 400 and/orterminal 408 comprises a sealing member, and for example iris or loose-leaf sealing member, card punch can pass the sealing part and be inserted into and withdraw, as long asend 408 is positioned within the hole of getting, just can prevent blood leakage simultaneously.Other tail house that bounces back

Figure 17 is the perspective view of a tip retraction card punch 500 according to a further advantageous embodiment of the invention.In this embodiment, the retracting motion ofend 506 under the effect of axle 502 do not retract a column part 507, thereby do not have to downcut theblood vessel 422 on the cutting edge 512 that leans against anvil 510.Terminal 506 and the motion of column part 507 can be separated from each other and independently.Perhaps, these two motions also can be subjected to same control.Perhaps, use nail or other mechanism that is positioned at axle 502 far-ends that the motion of axle 502 and the motion of column part 507 and/or anvil 510 are coupled.The inclination card punch

Figure 18 has represented an assembly drawing and broken away view of inclination card punch 520 according to a preferred embodiment of the present invention, and the hole that this card punch is got can have the cavity that is not orthogonal to blood vessel.According to the difference of punching part shape, the shape in hole can rounded, oval or other shape, even polygon.Card punch 520 generally comprises an outer tube member with preceding cutting edge 528, internals 524, match with the inboard of internals 524 and the terminal 522 and cutting members 526 of retractible as mentioned above retraction, this cutting members is retracted by internals 524, and is close on the pro-cutting edge.Thereby on blood vessel 422, get a hole.In other embodiments, the position of cutting edge and anvil can be changed.In addition, retraction terminal 522 is selectable.In a preferred embodiment of the invention, the plane that is limited by cutting members 526 also is not parallel to preceding cutting edge, although also can make it parallel.On the contrary, one 5 ° to 15 ° differential seat angle is arranged therebetween, preferably adopt 5 °.For example, for one 45 ° card punch, preceding cutting edge is 45 ° (being positioned at the rear side of internals 524), and cutting members 526 has 50 ° angle.Cutting members 526 obtains lower machining cost with making cutting edge and punching end separating of internals 524.Substitute or additional aspects as a kind of, just can punch along different angles by replacing cutting members 526.Other inclination card punch

Figure 19 A has schematically shown anotherinclination card punch 530 according to a further advantageous embodiment of theinvention.Card punch 530 has used asolid tip member 532, and this end piece has afront tip 536 and cuttingface 538, back.One cooperates the preceding cuttingface 534 of (selecting uneven usually) to be used for the blood vessel between the two is cut with it.

Figure 19 B has represented two views of tip member 532.Embodiment shown here comprises the groove 542 of several processing in most advanced and sophisticated.These grooves are also inessential, yet they look and can reduce to rotate most advanced and sophisticated necessity in the punching process.Preferably process a pin-and-hole 540 in addition, so that the tip is connected on theaxle.Cutting face 538, preferred back comprises the relative more flat part 546 with of a sloping portion 544, to help blood vessel is carried out clamping.

Perhaps, the rotation at card punch tip can obtain by the remainder of vibrating tip and/or card punch.Perhaps, this rotation also can be by manually realizing.Connector is installed on the grafting vessel

There is several different methods to can be used for stapling apparatus is installed on the grafting vessel.Among described herein a plurality of embodiment, this device is positioned at the grafting vessel outside, and has inner membrance being connected inner membrance between this grafting vessel and the blood vessel.Perhaps, in some other embodiment, most of devices are positioned at the grafting vessel and the outside that coincide and be connected.

In a preferred embodiment of the invention, this grafting vessel is turned up on adapter, thus make the other parts of the spike that stretches out from grafting vessel and adapter be positioned at grafting vessel the part of turning up below or far-end.This part of turning up can be partial (for example about 90 °) or whole (for example about 180 °).Yet, also can adopt other valgus angle.The process of turning up itself is also remarkable usually, and this is because grafting vessel is not only sliding but also little, and is difficult to handle.Another problem is that it is hook-shaped that spike may be, and is difficult under the situation that does not cause huge damage and passes grafting vessel.

To the different solutions of turning up be described below.Particularly, this solution mainly contains three major types:

(a) craft of grafting vessel (or machine is auxiliary) is turned up.Before adapter can turn up, in the process or pierce through grafting vessel afterwards.

(b) pierce through grafting vessel with adapter, the generation of wherein turning up is actual in handling this device and/or realizing by implementing to coincide.

(c) avoid all implementing turning up, may be by simulating this operation of turning up.Monomer adapter installed part

Figure 20 A-20D represented a kind of according to a preferred embodiment of the present invention based on the everting method that pierces through (b).An advantage of 20A-20D specific embodiment as shown in the figure is that this outer turning-up devices almost all is in the grafting vessel outside, thereby an end of this grafting vessel can be connected with patient in advance.

In Figure 20 A, a graftingvessel 551 is inserted into blood vessel holding frame 552inside.An adapter 554 that has several forward direction spikes 556 is installed on the adapter holding frame 564.Preferably provide one ormore keepers 562 to be used to prevent that thespike 556 on theadapter 554 from bending rearwards to slack position (for example, in super-elasticity or elastic device).Match with several lip shape spares 560 in the end of graftingvessel 551, wherein lip shape spare 560 is connected with adilator 558.

In Figure 20 B,dilator 558 is strutted, thereby radius increases, and the opening of 560 pairs of graftingvessels 551 of lip shape spare is stretched.Should be noted that the internal diameter of preferred lip shape spare 560 is equal to or greater than the external diameter of spike 556.In addition, the mechanism that also can adopt other internal diameter that can make lip shape spare 560 to increase.

In Figure 20 C,adapter 554 stretches out forward, thereby makesspike 556 pierce through the end of graftingvessel 551.

Figure 20 D has represented final state, has wherein obtained partly to turn up.Should be noted that in asingle day spike 556 is discharged fromterminal keeper 562, will bend.Perhaps, lip shape spare 560 has stopedspike 556 to bend intografting vessel 551 backward.Now just can pull down various dilators and terminal keeper.

In an alternate embodiment, spike inserts graft vessel wall with the generaI investigation of certain angle, thereby grafting vessel generating unit branch is turned up and/or grafting vessel is kept by the formed shape of opening of grafting vessel end.The binary spare grafting vessel device that turns up

Figure 21 A-21E has represented a grafting vessel according to a preferred embodiment of thepresent invention device 570 that turnsup.Grafting vessel 551 is inserted in the grafting vessel holding frame 564 (possible its on an identical adapter has been installed), and has only its endprotruding.Holding frame 564 can be held by one, and turns updevice 570 in the another hands.Perhaps, the two one of or all can be installed on the workbench and/or interconnect.Adapter 554 (not shown) can be installed on the holdingframe 564.

Thedevice 570 that turns up comprises amain body 571, and this main body comprises aswitch 580 and ahead 572 again.

Figure 21 B has representedhead 572 in detail.A preferredrounded end 574 is wherein arranged, be used for the end of graftingvessel 551 is adornedthereon.Dilator 579 withseveral fingers 578 is used to open the grafting vessel end, as hereinafter stating.Several stopfingers 576 preferably are provided, be used to controlgrafting vessel 551 endways 574 andfinger 578 on move forward.Perhaps, can control the relative position ofstop finger 576 and terminal 574, this is for for example control amount of turning up or in order to allow grafting vessel to be carried out clamping more stably, but this is also nonessential.

Figure 21 C has representeddilator 579 in detail.

Figure 21 D is a sectional side view that passesdilator 579, has representeddress grafting vessel 551 thereon.

In Figure 21 E, apin 582 stretches out forward, anddilator 579 is opened.Bygrafting vessel holder 564 is moved forward together with graftingvessel 551, thereby make it to enter the inside offinger 578, this blood vessel is turned up.Moving forward of graftingvessel 551 can also comprise the reach of adapter that coincide, thereby pierces through this grafting vessel.When needed, can utilize that for example the resistance or the stop finger of grafting vessel are controlled the amount that moves forward.Whenpin 582 was contracted,finger 578 moved inward, and the process of turning up simultaneously finishes.Perhaps, pin 582 also promotes to surround the pipe fitting ofdilator 579 forward.This pipe fitting also is used as a block piece, prevents thatfinger 578 from further opening, and grafting vessel is absorbed between finger and this pipe fitting.When this pipe fitting moves forward, it will make grafting vessel to turning up fromfinger 578.

In an alternate embodiment, stopfinger 579 comprises some little spikes at its end, and is also opened under the effect ofpin 582, thereby matches with grafting vessel internally.The continuing to protract and make grafting vessel to turning up driving stop finger 582 (being used as the finger that turns up now) ofpin 582 from finger 578.This motion is with to use tweezers to carry out manual process of turning up similar, and difference is that this grafting vessel has only inside to be touched.Perhaps, this grafting vessel can produce inside and outside contact simultaneously.The another kind of binary spare grafting vessel device that turns up

Figure 22 is the turn up generalized section ofdevice 590 of according to a preferred embodiment of the present invention another grafting vessel.In thedevice 590 that turns up, grafting vessel matches with the device that turns up, and as additional or alternate scheme, also can only match with the grafting vessel end (shown in the embodiment among Figure 21 A-21E).Anexpansion end 594 that is preferably mounted onbody 592 ends preferably clamps graftingvessel 551internally.Grafting vessel 551 can be mounted or not be installed in graftingvessel keeper 564 inside.Preferred terminal 594 is expansion silicones ends, and it will expand under the effect of a pressure source 596.A typical pressure source comprises a rod member, when rod member is pressed in the silicones end 594, will make this end produce distortion.Perhaps, also can adopt other expansion or clamping device.

Several fingers (or a domain) 598 are provided, and it has matched edges 591.Whenfinger 598 stretched out forward, matchededges 591 promoted the edge of graftingvessel 551 backward, thereby grafting vessel is turned up.This turning up can be only by due to the step reach of finger.Perhaps, each this reach makes grafting vessel produce the little amount of turning up backward.The terminal control of spike

In certain embodiments of the present invention, be used for piercing through the spike that turns up on the adapter of blood vessel and be in case of bending in penetration process.Yet in some preferred embodiment of the present invention, spike just is bent after penetration process.

Since grafting vessel when being pierced fixedly also nonessential employing active material or even carry out (perhaps not contacting at least) in vivo with body structure, so can adopt the distortion memorizing material, flexible material when for example heating.The thermal source of this heating can be from the surrounding air in for example room or by leading to an electric current at adapter.The preferred only end of spike has the distortion Memorability, thereby makes the other parts of spike enough hard so that can insert grafting vessel.

Perhaps, when adapter moves forward, a block piece is set thereon, is used to make the terminal linear structure that keeps of spike, for example adopt a pipe fitting, wherein each spike has a tool finger.

As an alternative or additional aspects, spike can be bent under the effect of for example plastic deformation after the penetration process.After piercing through grafting vessel, can heat-treat the bending point of spike, thereby make it " acquisition " new shape.Based on piercing through of reversing

Figure 23 A-23G has represented that a kind of spike that passes through to reverse an adapter according to a preferred embodiment of the present invention pierces through and the fixing method of blood vessel.Figure 23 A represented one with thesimilar adapter 600 of adapter shown in Figure 2, difference is that spike 602 (only illustrating) is bent rear tip 604 (only illustrating) and points to inner, rather than outside.Preferred adapter 600 comprises aspike part 601 and a tube portion 603.

The grafting vessel 551 (Figure 23 B) that preferably provides asleeve 608 to be used to protect to be inserted into prevents that it from being pierced through by most advanced and sophisticated 604 accidents.In a preferred embodiment of the invention, other structure of most advanced and sophisticated 604 is in the outside, and they under an effect of reversingkeeper 606 to intort, and maintain this position.Yet this is also inessential.For example, spike 602 can be pierced the generation Plastic Torsion at grafting vessel 551.Should be noted that, also can produce plastic deformation in the super-elasticity device, for example pass through inordinate rotation.

In Figure 23 B, graftingvessel 551 is inserted into the grafting vessel keeper, is under thesleeve 608.

In Figure 23 C,sleeve 608 is removed, thereby graftingvessel 551 and most advanced and sophisticated 604 is contacted.

In Figure 23 D, graftingvessel 551 is pierced through by most advanced and sophisticated 604.In one approach, graftingvessel 551 is drawn forward out the grafting vessel keeper and/or is stretched, for example by using device as shown in figure 21.In another example, canadapter 600 be contracted by a balloon of graftingvessel 551 inside or other inflatable are inflated, thereby stop its motion and/or control penetration process.

Figure 23 E has represented a selectivity step of turning up and partly moving forward that makes therelative grafting vessel 551 of spike.This step also can be carried out after a while, perhaps is omitted.

In Figure 23 F,reverse keeper 606 and be removed (perhaps spike is reversed), thereby being produced, spike reverses and most advanced and sophisticated 604 directed outwards.

After Figure 23 G has represented that the selectivity step of the grafting vessel on retracting spike is finished, the done state of penetration process.

Should be noted that, spike is for ease of piercing through and/or turning up and reversing of producing also can be adopted in staple embodiment, wherein anastomosis procedures by use several independently staple implement, each staple can be around the rotation of its major axis, reversing ofspike 602 to that indicated in the drawings is similar.Simulation is turned up

In general, arteria mammaria is thicker relatively, is difficult for turning up.The applicant is surprised to find, and arteria mammaria can be handled produces the zone of effectively turning up, and need not reality tremulous pulse is turned up, and only needs to apply less pressure simultaneously on tremulous pulse.

Figure 24 A-24D has represented the method that a kind of simulation is according to a preferred embodiment of the present invention turned up, particularly for arteria mammaria.

Figure 24 A has represented a wall of an arteria mammaria 620.Should be noted that, also can adopt the blood vessel and the grafting vessel material of other type.

In Figure 24 B, an inner mold 622 and an outside framework that cooperates with blood vessel 621 are provided, be used to clamp tremulous pulse 620.This clamp method can be selected any known method in the present technique field for use, for example a friction surface or little barb.

In Figure 24 C, framework 621 stretches out forward, thereby the end of tremulous pulse 620 is compressed against on the moulding section 623 of mould 622, and is widened.By selecting the geometry of mould 622, moulding section 623 and outside framework 621 rightly, with regard to the size and the type of may command distortion.Perhaps, be processed with ridge on framework 621 and/or the mould 622, thereby on tremulous pulse 620, produce wrinkle.Although there is shown a vertical mold, also can adopt an inclined mould, perhaps end that makes tremulous pulse 620 produces the mould of other shape, for example makes it to form saddle type.

In Figure 24 D, the spike 228 that a reinforcement of tremulous pulse 620 is connected on the device 626 pierces through, and for example uses method described herein.Mould 622 can comprise a plurality of perforates, in order to avoid damage spike 228.

In an exemplary embodiments, arteria mammaria (LIMA) has been compressed 1cm in the left side.Should be noted that the inner membrance of tremulous pulse 620 and the end position of adventitia also can be controlled by mould 622 and framework 621.

Figure 24 E has represented an alternate embodiment, one of them adapter 632, and for example tremulous pulse adapter has pierced through a reinforcement 630 of tremulous pulse 620.A loop section 634 is positioned at the outside of processing part.By making mould 622 have suitable shape, also can make a part of inner membrance be in 640 places, a position in reinforcement 630 outsides, thereby allow the connection of inner membrance inner membrance.The maintenance of the cutting of tremulous pulse 620 and reinforcement 630 can be pierced through by a forward direction spike 638 that is connected device 632 and be realized.

In an alternate embodiment of the present invention, blood vessel or grafting vessel form thickening shape (just in its end) and pass one or more spikes or an adapter on reinforcements by oppressed, thus the anamorphic effect of keeping.The insertion of adapter

In case after grafting vessel is turned up and is connected device and pierces through, this adapter and grafting vessel just will be connected on the hole of target blood 422.In case connection procedure finishes, instrument must be pulled down from grafting vessel.

Figure 25 A is the near-sighted close-up cross-sectional view of holdingframe instrument 400, wherein is inserted with the molectron of a grafting vessel holder and adapter holder 640, has schematically shown graftingvessel 551, but does not represent an adapter.Figure 25 B is the perspective view of Figure 25 A.Preferred holder 640 comprises two layers; one preferably is clamped in an adapter (not shown) its lip-deepinternal layer 642 and the skin 644 that assistance is inserted this device tremulous pulse (or other target blood) and the part of turning up of graftingvessel 551 is protected.Substitute or additional aspects as a kind of, outer 644 make spike keep linear structure.Preferredmigration blood vessel 551 turn up part between layer 644 and terminal 408, yet big, it also can be betweenlayer 642 and 644.

Preferred layer 642 comprises several bossings, is used for clamping this adapter by the reinforcement on the adapter (Fig. 7).For example, the tip of spike shown in Figure 7 can be positioned at a zone 650 of this layer, and the main body of adapter is positioned at a zone 640 of this layer.A ring-type projection 646 stops the motion of adapter.Similarly structure also can be used to clamping binary spare device as shown in Figure 2.At this moment,layer 642 can comprise some notches at its end, thereby allows crooked spike to curve inwardly.

Blade 654 of preferred use is scratched layer 644, hereinafter will describe in detail.

In operating process, terminal 408 are contracted, and perhaps layer 642 and 644 stretches out forward, thereby target blood is contacted with a zone 652 on layer 644 outside.

Layer 644 is contracted, thereby makes the forward direction spike of adapter can be crooked.Preferred then holding frame 400 (or layer 642) is contracted, thereby crooked spike is matched with target blood 422 (not shown).

Figure 26 has represented the position after most advanced and sophisticated 408 withdrawals, has represented andtarget blood 422spike 124 of interlock mutually.

Layer 644 further withdrawal, with discharge to behind the adapter to the radial constraint of spike, thereby allow spike to bend zone 650 (Figure 25 A) and be enclosed on the blood vessel 422.At this moment,layer 642 also can be withdrawn from the anastomosis.

In a preferred embodiment of the invention, the relative motion between different layers and the pipe fitting is operated by a mechanism in the handle for tool, preferably only uses a controller, and for example actuator 653.Adapter is carried on the delivery system

Adapter can be installed between thelayer 642 and 644, for example, by lax grafting vessel is placed on thelayer 642, uses the back crooked backward to spike then, thereby they can be covered by tegillum 644.This bending backward can be finished by for example using tweezers or specific purpose tool.

Substitute or additional aspects as one, freezing by for example using liquid nitrogen that this adapter is carried out, thus make it be easy to bending.

Perhaps, this adapter also can be mounted in the following manner:

(a) adapter that is in relaxed state is installed on the footstalk.

(b) pipe fitting that has V font indenture is enclosed on this footstalk, thereby makes the back to the interlock mutually of one of spike of indenture and adapter.

(c) pipe fitting that has an indenture is rotated, and the spike that makes cooperation is stuck between overcoat pipe fitting and the footstalk with linearly structure substantially.

(d) all spikes are respectively repeated steps (c).

(e) layer 644 is coated over footstalk and has on the pipe fitting of indenture.

(f) adapter and footstalk are pulled through a circular cone that has indenture.These indentures are aligned, thereby make the forward direction spike avoid the influence of circular cone.On the other hand, the main body of adapter is subjected to the compressing of circular cone, thereby this main body is engaged in outer 644 inboard, wherein should stretch out forward by skin, thereby covers connector body.

(g) pull down footstalk and replace the layer 642.Perhaps, this footstalk promptly is a layer 642.The dismounting of instrument

Whenend 408 and layer 644 withdrawal, preferably the blade 654 on theirtegillums 642 is scratched.Like this, they just can be removed by withdrawal, do not damage graftingvessel 551 simultaneously.Perhaps, these layers can have the preprocessing crack, and by use one withterminal 408 and/or layer 644 tingle of riving or circular cone be removed.

Figure 27 has shown alayer 642, Special attention will be given to a preprocessing crack in this layer, blade 654 and ledge 646.

Figure 28 is a cutaway view ofinstrument 400 and 640, has represented the tingle oflayer 642 being rived when fully being retracted whenlayer 642 or circular cone 656 and is removed.In other embodiments, tingle 656 can approach to the terminal of holdingframe 400 and/or it can be moved to the relevant position when needed more.Other cleaving method

Figure 29 A-29F has represented the another kind of adapter delivery system 700 with an outside 703 and a far-end 711 according to a preferred embodiment of the present invention.System 700 also comprises a main body 701 and a handle 702.

Figure 29 B has represented amagazine 705, anadapter holder 706 and asplitting pin 708 that is connected with rod like parts 707.When rod likeparts 707 is pulled, pin 708 will split contacted with it layer, forexample holder 706 and magazine 705.Substitute or additional aspects as a kind of, also can use a retraction blade.

Figure 29 C has represented amagazine 705, and one of them adapter 709 stretches out from its end.Also expressed the crack 716 that a cavity 715 and will be rived bytingle 708 simultaneously.

Figure 29 D has represented a covering pipe fitting 704, and this pipe fitting is used to sealing through the hole on the target blood after the punching.Equally also show the crack that a slotted hole and will be rived by tingle 708.The preferred outside 703 closely cooperates with covering pipe fitting 704, thereby prevents that blood from oozing out from the crack.Substitute or additional aspects as a kind of, crack area can comprise the material that promotes blood coagulation.Substitute or additional aspects as a kind of, this crack area can be capped last layer elastomeric material, for example rubber.

Figure 29 E representeddevice holder 706 and device 709, represented a slotted hole and theadapter co-operating member 718 based on projection in a crack and theholder 706 simultaneously.

Figure 29 F is a cutaway view of the handle area of system 100, has represented one by a pair of handle 702 of extruding, and has made some partially retracted mechanism in the system.A this extruded lever 714 is passed to a pair of slide bar 717 places.When slide bar 717 is fully withdrawn, they will retractholder 706 andmagazine 705 by a pair of connecting pin 710.This forward direction spike and target blood interlock mutually of pulling back and making device 709.In case this target blood is bitten, just onlysurplus magazine 705 continues its retraction movement.Whenmagazine 705 withdrawals, device 709 is released, and uses and match with target blood to spike thereafter.

When handle 702 continued to be extruded, rod likeparts 707 was pulled, andholder 706 is rived, thereby rived skin and allow grafting vessel to be removed.Adapter tilts to coincide

Figure 30 A-30D corresponding to Figure 1A-1D has represented theidentical adapter 800 that is applicable to connection according to a preferred embodiment of the present invention.Wherein element numbers and Figure 1A-1D are corresponding, and difference is, has replaced " 100 " label with all " 800 " labels.Use an inclination adapter can obtain the connection shape more useful than geometry connected vertically, for example, for adapt to grafting vessel send into angle, near the structure adapting to and/or for blood is circulated better.This connection axis or X direction of target blood is relatively tilted.Typical angle of inclination preferably between 30 ° and 70 °, approximately is taken as 45 ° in an exemplary embodiments between 10 ° and 80 °.

Represented theadapter 800 in the work process with the corresponding Figure 31 A of Fig. 2 F.Inclination after having represented to finish with the corresponding Figure 31 B of Fig. 2 D state that coincide.

A floor plan design having represented theadapter 800 shown in Figure 30 A-30D corresponding to Figure 32 A and the 32B of Fig. 3 A and 3B respectively.In Figure 32 and Fig. 3, actual device may be shorter than the device shown in the figure, for example has only 5 spikes.

Although usually is the pipe adapter, yet in other preferred embodiment of the present invention, also can adopt elliptic geometry shape or other shape.

It is difficult that the turning up of the common comparison rules grafting vessel of operation of turning up of inclination grafting vessel operated.Generally speaking, the grafting vessel that is in broad angle one side of adapter is easy to turn up, and the grafting vessel part relative difficult that is in narrower angle one side is turned up.

Figure 33 A and 33B have represented to help in the turning-up devices change addressing this is that outside this.On thegrafting vessel 551 onedevice 800 has acrotch 839 in the narrow angle of grafting vessel side.Shown in Figure 33 B, aholder 840 that is preferred for clampingconnector 800 also uses aprojection 842 thatcrotch 839 is curved inwardly, thereby by using above-mentioned any method, it can pierce throughgrafting vessel 551 more simply.Preference is as whenholder 840 is pulled, andprojection 842 is bent distortion under the effect of adapter 800.From the adapter that turns up

Figure 34 A-34F has represented turn up certainly anadapter 850 and an a kind of method of using this adapter according to a preferred embodiment of the present invention.Figure 34 A has represented a section ofadapter 850, comprisinghandling block 858 to spike 854, forward direction spike 856 and one after theindividual part 852, one.

Shown in Figure 34 B,adapter 850 is inserted in theblood vessel 422 and is installed on thegrafting vessel 551, thereby forward direction spike 856 is rotated into the grafting vessel intracavity.862 pairs of this non-natures of piece holder (in a super-elasticity, elasticity or distortion Memorability adapter) position that one of preferred use is pressed against on theblock 858 keeps.Perhaps, also can adopt plastic deformation method.Preferred spike 854 curves inwardly, thereby helps to insertblood vessel 422, yet this is also nonessential.Preferably arrange a covering pipe fitting 860 in the outside ofholder 862.

In Figure 34 C, preferably cover pipe fitting 860 and stretch out forward, thereby makeblood vessel 422, and reserve the space of turning up away from this device.Under the situation of space permission, this operation of turning up also can be carried out in the more depths ofblood vessel 422.

In Figure 34 D,holder 862 is pulled, and block 858 is discharged, and subsidizes allowingspike 856 to reverse to its slack position, thereby graftingvessel 551 is turned up.

In Figure 34 E, cover pipe fitting 860 and be pulled, thereby allowblood vessel 422 to contact with adapter 850.The withdrawal ofadapter 850 makesblood vessel 422 be pierced through by spike 856.Then, cover pipe fitting 860 and further retracted,discharge spike 854 simultaneously and make it to liveblood vessel 422 from the opposite side thorn.As shown in the figure, the withdrawal that covers pipe fitting 860 can be implemented by spike 854.In one embodiment, between covering pipe fitting 860 and the holder 862 a little space that is used to holdspike 854 is arranged.Perhaps, can in covering pipe fitting 860, limit axial long hole, thereby allowspike 854 to be released by covering pipe fitting 860fetters adapters 850 are rotated vertically.

Figure 34 F has represented the completion status of identical connection procedure.The peripheral tools bag

Said process and device mainly are at the other surgical operation of coronary artery.Yet other surgical operation also can be implemented in the other parts of health.For example, head, brain, abdominal part or limbs are for example implemented surgical operation by the master-femoral artery or other and are used for other surgical operation to the blood vessel of lower limb blood supply.Above-mentioned identical adapter can be changed according to concrete position.Preferably on girth, a spike is set every 1mm.Therefore, a personal share arterial set may have 7 spikes.

In many patents, all provide a tool kit, comprising a grafting vessel.Preferred adapter is installed on the one or both ends (if this grafting vessel has other opening or crack, may be multiterminal) of grafting vessel in advance.Figure 35 has represented a kind of method for optimizing, and this method is used for adapter 874 is installed in grafting vessel 872, thereby prepares what a standby grafting vessel molectron 870.Preferred adapter is embedded in the wall of grafting vessel, inserts this device after for example finishing in the course of processing or by transplanting.Have at least on the preferred migration blood vessel one can be bonding well with the eclipsed part of adapter with the blood vessel that will be attached thereto.The end of grafting vessel can be handled by selectivity, condenses thereby avoid producing when touching blood.And the processing that can improve coagulability to the part of far-end.Although shown in the figure is end connector, equally also can carry out similar embedding operation to a sidepiece adapter.

United States Patent (USP) 5,641,373,5,843,173,5,415,619,4,883,453,4,552,707,4,096,227,5,861,033,5,628,789,4,957,669,4,909,979 and 3,945,052, the grafting vessel and the processing method thereof that can be used in some preferred embodiments of the present invention have been described, these patents separately be merged in this patent herein as a reference.

In an exemplary embodiments, be used to implement other operating tool kit and comprise that a grafting vessel and guide line or other are used to guide grafting vessel to be in and coincide the guiding piece of position.

Figure 36 has represented an other surgical operation of typical strand-popliteal tremulous pulsies according to a preferred embodiment of the present invention.The other surgical operation that uses grafting vessel 870 to carry out will be implemented between 1: 888 on 1: 886 and the popliteal tremulous pulse 878 on the surperficial femoral artery 876.Preferably on point 886 and 888, open two holes 882 and 884.Device 874 at grafting vessel 870 1 ends is connected a little 886 places, for example as mentioned above.Use a guide line 880 pulling grafting vessels 870 to pass the zone that health arrives perforate 884 places.In according to a preferred embodiment of the present invention, guide line 880 is inflexible, perhaps comprises a rigidity guiding piece, and this is for the ease of channeling conduct between two perforates.Preferred guide line 880 is connected with grafting vessel 870 by sewing up.In another embodiment, the identical and guiding of point-to-point transmission is implemented by interior method of peeping or passing blood vessel (grafting vessel is provided at least).

We should be understood that said method and device are adapted at using in the multiple operation, through hole operation and the perforate operation peeping operation in for example, pass blood vessel.Specifically, should be noted that, can carry out fully in vivo, for example by the through hole arteria mammaria (LIMA) in the left side that turns up for the operation of blood vessel and grafting vessel.

We will know, the method of above-mentioned vascular surgery can change with multiple mode, comprising the order that changes each step, which in step carry out in vivo with which step externally carry out, which bar blood vessel is that " side " side and which bar blood vessel or grafting vessel are " end " sides during order, concrete material that the adapter that coincide adopts and/or the end of each step is connected side-to-side anastomosis in each anastomosis procedures.In addition, in this mechanical embodiments, the position of different elements can be changed, and does not exceed thought of the present invention simultaneously, for example exchanges the position of anvil and cutting edge and replace static element in the place that needs relative motion with movement parts in perforating device.In addition, the invention describes a plurality of different characteristics of described method and apparatus.Be noted that different features can be combined by different modes.Particularly, be not that all features described in the specific embodiment all must be included in all similar the preferred embodiments of the present invention.In addition, above-mentioned combination of features also is considered to be within the scope of some preferred embodiment of the present invention.In addition, according to other preferred embodiment of the present invention, some feature of the present invention described herein also is applicable to device of the prior art.Be used to explain concrete geometry of the present invention and should be considered to limitation of the present invention, for example, the circular cavity shown in the figure can be substituted by elliptic cavity in other embodiments.

In addition, scope of the present invention also comprises the operation tool bag, and these tool kits comprise the various armarium of implementing single or a small amount of connection operation that coincide that are applicable to.The preamble of this description just for the ease of the guiding explanation, should not be considered to the content described in any specific part all is limited in this part.The measure that proposes under concrete condition is exemplary, and concrete measure should be decided on practical situation." the comprising " that occurs in the claims, " comprising " or similar word all are meant " including but are not limited to this ".

The one of ordinary skilled in the art should be understood that the present invention is not limited by foregoing.Scope of the present invention only is subjected to the restriction of appended claim.

Claims (73)

1. one is used for grafting vessel is connected identical adapter on the target blood, comprising:

A thin installing ring part that is suitable for being connected with the part of grafting vessel; With

An independently spike part that is suitable for being installed on the described installing ring part, this spike partly comprises several spikes, each described spike all is suitable for piercing through described grafting vessel.

2. adapter as claimed in claim 1 is characterized in that, comprises that at least one is used to make described spike part and the described installing ring part locking piece of locking mutually.

3. adapter as claimed in claim 2 is characterized in that, wherein said locking piece is formed on the described installing ring part.

4. adapter as claimed in claim 3 is characterized in that, wherein said locking piece matches with a hole that is limited by described spike part.

5. as the described adapter of one of claim 2-4, it is characterized in that, wherein said locking piece provides a kind of spring motion, this motion can be resisted at least a portion of described spike part and the motion to axial between installing ring at least a portion partly, and this resistance depends on the amplitude of motion.

6. adapter as claimed in claim 1 is characterized in that, wherein said spike part is made of a kind of elastic material.

7. adapter as claimed in claim 1 is characterized in that, wherein said spike quilt is hook in advance, thereby described hook-type is suitable for being connected with target blood.

8. adapter as claimed in claim 1 is characterized in that, wherein said installing ring partly comprises several edge of a wing parts near described target blood.

9. adapter as claimed in claim 8 is characterized in that, wherein said edge of a wing part limits several holes, so that described spike spare passes.

10. adapter as claimed in claim 9 is characterized in that, wherein said edge of a wing part comprises at least one opening on its girth, and this opening is enough wide, so that wherein said spike can pass this opening.

11. adapter as claimed in claim 1 is characterized in that, wherein said installing ring defines a cylindrical space.

12. adapter as claimed in claim 1 is characterized in that, wherein said installing ring partly is suitable for constituting a vertical anastomat.

13. adapter as claimed in claim 1 is characterized in that, wherein said installing ring partly is suitable for constituting an inclination anastomat.

14. one kind is used for grafting vessel is connected identical adapter on the target blood, comprises:

A base that is used to connect described grafting vessel;

Several are used to the spike that pierces through described grafting vessel and be connected with described target blood; With

At least one spring part, this spring part is connected with at least one described spike.This spring part is used as the connector between described spike and the described base.

15. adapter as claimed in claim 14 is characterized in that, wherein said spike and described base constitute a monomer spare.

16. adapter as claimed in claim 14 is characterized in that, wherein said spike and described base constitute two split parts.

17. adapter as claimed in claim 14 is characterized in that, wherein said spring is made of a flat wind spring.

18. adapter as claimed in claim 14 is characterized in that, wherein said spring is made of a sheet spring.

19. adapter as claimed in claim 14 is characterized in that, wherein said at least one spring is made of at least two springs that are in series.

20. as the described adapter of one of claim 14-19, it is characterized in that, wherein each described spike have at least with one independently spring be connected.

21. adapter as claimed in claim 14 is characterized in that, wherein said adapter is designed to implement and tilts to coincide.

22. adapter as claimed in claim 14 is characterized in that, wherein said adapter is used for moving described spike by the block that comprises that at least one is connected with one of described spike.

23. adapter as claimed in claim 22 is characterized in that, wherein said block is suitable for retracting described spike.

24. adapter as claimed in claim 22 is characterized in that, wherein said block is suitable for releasing forward described spike.

25. an equipment that is used for a grafting vessel is delivered to an identical connector comprises:

At least two tubular member, each defines a hole, and this hole is suitable for inserting described grafting vessel, thereby this grafting vessel is passed from first end of described tubular member;

At least one separation member, this separation member are installed at least one described tubular member, and another described tubular member that is used to rive is moved out of thereby described grafting vessel can pass the elongated slot of riving, and this elongated slot is crossed between described first end and described hole.

26. equipment as claimed in claim 25 is characterized in that, wherein said at least one separation member is made of a described fissured blade of cutting.

27. equipment as claimed in claim 25 is characterized in that, wherein said at least one separation member is made of an extension, and this extension is widened the existing crack in the described pipe fitting, thereby forms described elongated slot.

28. equipment as claimed in claim 25 is characterized in that, comprises an outer tube member, this outer tube member prevents described pipe fitting division, unless it fully bounces back.

29. equipment as claimed in claim 25 is characterized in that, wherein said tubular member is suitable for a stapling apparatus is clipped in wherein.

30. one is used for method that a grafting vessel means of delivery is pulled down from a grafting vessel that is enclosed in wherein, comprises:

The described pipe fitting of riving, thus an elongated slot formed; With

Described grafting vessel is taken out by described elongated slot.

31. method as claimed in claim 30 is characterized in that, wherein said groove drip molding is made of the blade of the described pipe fitting of riving.

32. method as claimed in claim 30 is characterized in that, wherein said groove drip molding is made of an extension, and this extension is widened the existing crack in the described pipe fitting.

33. method as claimed in claim 30 is characterized in that, comprising:

Retract at least one around described grafting vessel pipe fitting on every side.

34. method as claimed in claim 33 is characterized in that, wherein saidly retracts action described pipe fitting is reclined mutually with a groove drip molding.

35. method as claimed in claim 30 is characterized in that, comprises described groove drip molding is moved relative to described pipe fitting, thereby forms described elongated slot.

36. an identical adapter comprises:

Annular element with an axis;

At least one group of spike that is positioned on the described annular element; With

At least one is along the thickening of X direction, and this thickening is positioned at least one described spike, simultaneously away from described annular element.

37. adapter as claimed in claim 36 is characterized in that, comprises second group of spike, the sensing of this group spike is opposite with the direction of described first group of spike.

38. adapter as claimed in claim 36 is characterized in that, wherein said thickening comprises a point, and wherein said spike is cleaved into some tips in this some punishment.

39. adapter as claimed in claim 38 is characterized in that, the length at wherein said tip is less than the thickness of the target blood that this adapter was suitable for.

40. adapter as claimed in claim 36 is characterized in that, wherein said at least one group of spike in use do not apply inside or outside radial pressure to described annular element.

41. one kind is used to keep and discharges a method that has the identical adapter of a thickening, comprising:

Described adapter is remained between two pipe fittings, and the axially-movable of described thickening is subjected at least one restriction that is limited to the bossing at least one described pipe fitting; With

Pull down one that is positioned at the outside in the described pipe fitting, thereby this adapter produces distortion, and this thickening no longer is subjected to the restriction of described at least one bossing.

42. between a grafting vessel and a target blood, implement the method for coincideing, comprising for one kind:

An identical adapter is inserted target blood;

Discharge at least one forward direction spike of described adapter;

Retract described adapter, thereby described forward direction spike is connected with described target blood; With

Finish described anastomosis procedures.

43. method as claimed in claim 42 is characterized in that, wherein finishes described anastomosis procedures and comprises, discharge described adapter at least one the back to spike, thereby be connected with described target blood.

44. method as claimed in claim 42 is characterized in that, wherein finishes described anastomosis procedures and comprises, described spike is locked on the part of the described adapter except that described spike.

45. method as claimed in claim 42 is characterized in that, wherein finishes described anastomosis procedures and comprises, discharges described spike, thereby makes it the part withdrawal towards the described adapter except that described spike.

46. a perforating mechanism that is used for punching on blood vessel comprises:

A sharp tip that is suitable for piercing through described blood vessel;

An axle that at one end has described tip;

Widen part away from first of described tip for one; With

Widen second of part away from described first for one and widen part, described first and second widen part defines a narrow path portion between the two at it, and this narrow path portion is suitable for holding the blood vessel wall that is pierced; With

A connector, this connector are used to make the retraction at described tip and described a kind of relative motion of widening part to be coupled, and this relative motion is shunk described narrow path portion.

47. perforating mechanism as claimed in claim 46 is characterized in that, part is widened in wherein said most advanced and sophisticated retraction described first, pulls to described second and widens part thereby widen part with described first.

48. perforating mechanism as claimed in claim 46, it is characterized in that, wherein said tip is installed on the tip axis, and make most advanced and sophisticated withdrawal by retracting this tip axis, wherein said tip axis is connected with described axle, thereby after described tip axis was fully pulled back, described tip axis contacted with described axle, and it is pulled back.

49. the method for the grafting vessel that is used to turn up is characterized in that, comprising:

Described grafting vessel is grabbed between an internal mandrel and outer tube member; With

One end of described grafting vessel is pushed on the described grafting vessel backward.

50. method as claimed in claim 49 is characterized in that, comprises described promotion operation repeated several times, thereby obtains the ideal amount of turning up.

51. method as claimed in claim 49 is characterized in that, the described end that wherein promotes described grafting vessel comprises and will translate on the described outer tube outside the described end.

A device 52. grafting vessel turns up comprises:

An end, this end is suitable for described grafting vessel mounted thereto;

A grafting vessel retainer, this retainer are used for the protrusive movement of described grafting vessel end on described end limited; With

Several place the expansion finger between described grafting vessel retainer and the described end, described finger has an expansion state, wherein their external diameter is greater than described end and described grafting vessel, described finger also has a unexpanded mode, and wherein its diameter is not enough to match with described grafting vessel.

53. one kind is used for being installed in a method on the grafting vessel with an identical adapter that has spike is installed, this spike has the tip that goes out a cavity of described adapter to excurvation, comprising:

Make described some described spike at least keep torsion structure, thereby make the tip of described spike bend into this cavity;

Pierce through described grafting vessel with described tip; With

Change the structure at described tip, make it outwardly-bent.

54. method as claimed in claim 53 wherein changes this structure and comprises the described spike of release.

55. simulate the method that grafting vessel turns up, comprising for one kind:

One end of described grafting vessel is pressed in the forming tool, thereby on described end, forms a thickening; With

Use at least one spike of the adapter that coincide to pierce through described thickening.

56. method as claimed in claim 55 is characterized in that, wherein said grafting vessel is made of an arteria mammaria.

57. method as claimed in claim 55 is characterized in that, the wherein said axis that comprises along described grafting vessel that pierces through pierces through.

58. method as claimed in claim 55 is characterized in that, wherein said piercing through comprises that the direction that tilts along the axis with the institute grafting vessel pierces through.

59. method as claimed in claim 55 is characterized in that, the wherein said direction that comprises along vertical described grafting vessel axis that pierces through pierces through.

60. method as claimed in claim 55 is characterized in that, wherein said forming tool comprises an interior footstalk.

61. method as claimed in claim 55 is characterized in that, wherein said forming tool defines the flat end surface of a described thickening on described grafting vessel.

62. method as claimed in claim 55 is characterized in that, wherein said forming tool defines the beveled end surface of a described thickening on described grafting vessel.

63. method as claimed in claim 55 is characterized in that, wherein said forming tool defines nonplanar end surfaces of a described thickening on described grafting vessel.

64. one kind is through a method on the grafting vessel with adapter thorn, comprising:

The radius of this grafting vessel one end of broadening;

At least one spike on the described adapter is stretched out forward along the direction that is parallel to described grafting vessel, thereby make it to pierce through described broadening zone; With

Make the end bent of at least one described spike become hook-shaped.

65. one is used for other operating tool kit, comprises:

At least one two ends is equipped with the grafting vessel of an identical adapter, and described grafting vessel and described adapter are applicable to the other surgical operation of peripheral vessels; With

The guide line that at least one is connected with an end of described grafting vessel.

66., it is characterized in that wherein said adapter is embedded in the described end of described grafting vessel as the described tool kit of claim 65.

67. an inclination card punch comprises:

An axle;

A first non-rounded edge that tilts with one the first described relatively axle of angle;

A second non-rounded edge that tilts with one the second described relatively axle of angle; With

Be used to reduce the device in the slit between the described two edges, this is in order to excise vascular tissue between the two.

68., it is characterized in that wherein said two angle differences as the described card punch of claim 67.

69., it is characterized in that wherein said two angles are identical as the described card punch of claim 67.

70. a card punch that is used for punching on blood vessel in the piercing operation process comprises:

A tip that is used to pierce through described blood vessel;

One is applicable to piercing operation and hard handle that be connected with described tip, and this handle is used for a locus at described tip;

Two surfaces, this surface are used for the blood vessel wall of receiving ring around around described hole; With

Thereby be used to make described surface to lump together the device of getting described hole.

71., it is characterized in that wherein said tip changes as the described card punch of claim 70.

72., it is characterized in that wherein said tip can have groove vertically as the described card punch of claim 70.

73. the method that an identical adapter is heat-treated comprises:

A cutting adapter is installed in the mould;

Fixing described mould, thus make the forward direction of described adapter and back all curve ideal form to spike; With

The described device that is fixedly coupled is heat-treated, thereby it is processed into described structure.

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