Medical grafting apparatus and methods

Abstract

Instrumentation for facilitating cutting an opening in a side wall of a body conduit in a patient. A tubular structure defines a lumen and has a sharpened distal end portion configured to cut a section of the body conduit to create the opening. A tissue holding structure is provided which is axially movable within the lumen of the tubular structure. The tissue holding structure includes a piercing portion to permit passage of the tissue holding structure through the body conduit from an entrance side to an exit side thereof. The tissue holding structure also includes a retention member to secure the section of the body conduit to the tissue holding structure during movement of the tissue holding structure to approximate the entrance side of the body conduit with the sharpened distal portion of the tubular structure to enable the sharpened distal structure to cut the body conduit. A connector is also provided for attaching a new length of tubing to the body conduit at the opening made by the cutting.

The invention claimed is  
     
         1 . An anastomosis delivery system for delivering a connector having at least one backwards spike having a bent tip, comprising: 
 a hollow guide sheath; and    a hollow, axially slotted section, fitting within said sheath, said section having a flared configuration and an unflared configuration and wherein said axially slotted section is adapted to contain at least a part of said connector and to limit axial motion of said connector when said section is in its unflared configuration.    
     
     
         2 . A system according to  claim 1 , wherein axially moving said section selectively advances said spike.  
     
     
         3 . A system according to  claim 1 , wherein axially moving said section selectively retracts said spike.  
     
     
         4 . A system according to  claim 1 , wherein said slotted section maintains said bent tip in a bent configuration.  
     
     
         5 . A system according to  claim 1 , wherein said slotted section includes at least one receptacle for engaging said bent tip.  
     
     
         6 . A system according to  claim 5 , wherein said receptacle comprises an inner lip of said section, adapted for catching said tip.  
     
     
         7 . A system according to  claim 5 , wherein said receptacle comprises a hole in said section, for engaging said tip.  
     
     
         8 . A system according to  claim 1 , wherein said section comprises a second, inner tube and wherein said inner tube and said slotted section define between them a receptacle for a bent section of at least one bent spike of connector.  
     
     
         9 . A system according to  claim 8 , wherein said receptacle is a space between tips of said slotted section and said inner tube.  
     
     
         10 . A system according to  claim 7 , wherein said receptacle is an opening in said inner tube.  
     
     
         11 . A system according to  claim 7 , wherein said slotted section and said inner tube grip between them a part of said connector.  
     
     
         12 . A system according to any of claims  1 - 11  wherein said slotted section comprises a capsule closed at one end.  
     
     
         13 . An anastomosis delivery system for delivering a connector having at least one backwards spike having a bent tip, comprising: 
 a hollow guide sheath;    an apertured inner tube fitting within said sheath; and    a plurality of spike locking elements disposed between said guide sheath and said apertured inner tube, wherein said spike locking elements, when extended, are adapted to grip a part of said anastomosis connector between said inner tube and said locking elements and wherein said apertures are each adapted to receive a said bent tip of said anastomosis connector.    
     
     
         14 . A method of mounting an anastomosis connector having a plurality of bent backwards spikes including bent tips, into a delivery tube, comprising: 
 bending back said spikes to point backwards along an axial direction of said connector, away from a graft mounted on said connector;    maintaining said tips in a bent configuration; and    inserting said spikes into a receptacle of said delivery tube by pushing back each spike, using a jig, into said receptacle, and locking said spike tip in said receptacle, which receptacle maintains said tips in a bent configuration.    
     
     
         15 . A rotating punch, comprising: 
 a sharp, central guide wire; and    a rotating outer tube having a vascular cutting edge defined by a lip of said tube, wherein said outer tube has an increasing outer diameter, away from said cutting edge.    
     
     
         16 . Apparatus for anastomosis, comprising: 
 a delivery system includes conical shaped arrangement of puller spikes; and    a cone shaped body defining an opening at either end, a wide opening, at abase thereof, for receiving said conical arrangement and a narrow opening, at an apex thereof, for insertion into a blood vessel.    
     
     
         17 . Apparatus according to  claim 16 , wherein said cone shaped body is pre-split axially.  
     
     
         18 . Apparatus according to  claim 16 , comprising a cutting mechanism adapted to fit in said cone and comprising at least one cutting blade that fits through said narrow opening said cone.  
     
     
         19 . Apparatus according to any of claims  16 - 18 , wherein said cone is at least partially pre-split from an apex thereof.  
     
     
         20 . Apparatus according to  claim 19 , wherein said cone is pre-split on opposite sides.  
     
     
         21 . A removable graft guide for a graft delivery system, comprising: 
 a body removably mounted on said delivery system; and    a guide portion adapted to fit in an aperture in said graft delivery system and prevent contact between a graft inserted through said aperture and damaging parts of said delivery system.    
     
     
         22 . A guide according to  claim 21 , wherein said body is adapted to be mounted on an outside of said delivery system.  
     
     
         23 . A guide according to  claim 21  or  claim 22 , wherein said body comprises a collar for preventing distortion of a delivery end of said delivery system.  
     
     
         24 . A vessel puller, comprising: 
 a shaft adapted to be inserted in a bore of a tubular gaft delivery system having a delivery end;    a vessel engager mounted on one end of the shaft and adapted to engage a tip of a graft; and    a handle attached to another end of said shaft.    
     
     
         25 . A puller according to  claim 24 , wherein the shaft is longer than a distance between an aperture in the side of said bore and said delivery end, such that said handle can be comfortably held by a person while a graft is inserted through said aperture, by said person, to be engaged by said vessel engager.  
     
     
         26 . A puller according to  claim 24 , wherein said vessel engager is adapted to engage a graft end from a side of said engager.  
     
     
         27 . A puller according to any of claims  24 - 26 , wherein said shaft is flexible.  
     
     
         28 . A combined hole punching and graft delivery device, comprising: 
 a body, having therein at least one recess for receiving a spike of a connector; and    a sharp tip retractable relative to said body, wherein said sharp tip and said body define between them a blood vessel wall receiving area.    
     
     
         29 . A device according to  claim 28 , wherein said spike is pre-stressed to self extend out of said recess.  
     
     
         30 . A device according to  claim 28 , wherein said spike radially extends out of said recess when it is retracted.