Device to aid in arterial microvascular anastomosis

Abstract

An everter device to facilitate preparation of ends of arterial segments for end-to-end microvascular anastomosis. The device includes structure that provides sufficient support to prevent unwanted buckling of arterial tissue. The everter device offsets the tendency of the arterial tissue wall to recover its natural shape and fall off securement posts or pins of a coupler ring. The structure may be in the form of an intraluminal catheter balloon. Alternately, the structure may be in the form of a plunger. Alternately, the structure may be in the form of a radially expanding member provided on a shaft. The device further has a contoured surface on an everter end to evert a free end of arterial tissue over a coupler ring, and to cause the posts or pins of the coupler ring to pierce through the everted arterial tissue. The everter end is provided with one or more openings therein, such as a circumferential slot, to receive the posts or pins of the coupler ring.

What is claimed is: 
     
         1 . An everter device comprising:
 an everting member having an everter end;   an inflation shaft extending distally of the everter end; and   an intralumenal catheter balloon in fluid communication with the inflation shaft.   
     
     
         2 . The everter device of  claim 1 , the everter end having a curved surface. 
     
     
         3 . The everter device of  claim 1 , the everter end having one or more openings therein to accommodate posts or pins of a coupler ring of a microanastomosis clamp system. 
     
     
         4 . The everter device of  claim 3 , the one or more openings including a circumferential slot. 
     
     
         5 . The everter device of  claim 3 , at least one of the one or more openings having a material therein that is piercable, deformable, or axially recedes, when the everter device is advanced into contact with posts or pins of a coupler ring. 
     
     
         6 . A method for preparing arterial tissue for microanastomosis, comprising:
 providing a coupler ring on an arterial segment, the coupler ring having a plurality of securement pins projecting therefrom, such that the securement pins are directed toward a free end region of the arterial segment;   advancing an everting member of an everter device toward the coupler ring and the free end region of the arterial segment until an intraluminal catheter balloon provided along an inflation shaft of the everter device is received in the free end region of the arterial segment and advanced past the coupler ring;   inflating the intraluminal catheter balloon via the inflation shaft until the intraluminal catheter balloon is secured within the arterial segment;   continuing to advance the everting member toward the coupler ring, the everting member being axially slidable relative to the inflation shaft, until the free end region of the arteral segment is everted over the coupler ring;   applying sufficient force to the everting member to cause the pins of the coupler ring to pierce through the everted free end region of the arterial segment;   deflating the intraluminal catheter balloon; and   removing the everter device from the arterial segment.   
     
     
         7 . An everter device comprising:
 an everting member having an everter end; and   a plunger telescopically-mounted in the everting member and having a distal end that extends distally of the everter end.   
     
     
         8 . The everter device of  claim 7 , the everter end having a curved surface. 
     
     
         9 . The everter device of  claim 7 , the everter end having one or more openings therein to accommodate posts or pins of a coupler ring of a microanastomosis clamp system. 
     
     
         10 . The everter device of  claim 9 , at least one of the one or more openings having a material therein that is piercable, deformable, or axially recedes, when the everter device is advanced into contact with posts or pins of a coupler ring 
     
     
         11 . A method for preparing arterial tissue for microanastomosis, comprising:
 providing a coupler ring on an arterial segment, the coupler ring having a plurality of securement pins projecting therefrom, such that the securement pins are directed toward a free end region of the arterial segment;   securing a vessel clamp to the arterial segment adjacent an end of the coupler ring opposite the free end region of the arterial segment;   advancing an everting member of an everter device toward the coupler ring and the free end region of the arterial segment until a telescopically-mounted plunger of the everter device is received in the free end region of the arterial segment, advanced one of up to or past the coupler ring, and into contact with arterial tissue abutting the vessel clamp;   continuing to advance the everting member toward the coupler ring, the plunger remaining stationary relative to the vessel clamp, the everting member being axially slidable relative to the plunger, until the free end region of the arteral segment is everted over the coupler ring;   applying sufficient force to the everting member to cause the pins of the coupler ring to pierce through the everted free end region of the arterial segment; and   removing the everter device from the arterial segment.   
     
     
         12 . An everter device comprising:
 an everting member having an everter end; and   a shaft projecting distally of the everter end, the shaft including
 a radially expanding member that is selectably expandable from a first diameter to a second diameter larger than a nominal diameter of the shaft. 
   
     
     
         13 . The everter device of  claim 12 , wherein the shaft includes
 an outer shaft;   an inner shaft disposed within and slidable axially relative to the outer shaft;   an end cap secured to a distal end of the inner shaft; and wherein the radially expanding member is disposed about the inner shaft between a proximal end of the end cap and a distal end of the outer shaft.   
     
     
         14 . The everter device of  claim 12 , the radially expanding member made of at least one of a flexible material or a rigid material. 
     
     
         15 . The everter device of  claim 13 , the radially expanding member made of a flexible material selected from the group of a thermoplastic elastomer and a silicone rubber. 
     
     
         16 . The everter device of  claim 13 , the radially expanding member made of a rigid material selected from the group of a thermoplastic and a stainless steel. 
     
     
         17 . A method for preparing arterial tissue for microanastomosis, comprising:
 providing a coupler ring on an arterial segment, the coupler ring having a plurality of securement pins projecting therefrom, such that the securement pins are directed toward a free end region of the arterial segment;   advancing an everting member of an everter device toward the coupler ring and the free end region of the arterial segment until a shaft of the everter device is received within an opening of the coupler ring, the shaft including a radially expanding member that is selectably expandable from a first diameter to a second diameter sufficient to create an interference fit with arterial tissue received in an inner opening of the coupler ring   
       is received in the free end region of the arterial segment and the radially expanding member is disposed within the coupler ring;
 expanding the radially expanding member to the second diameter; 
 continuing to advance the everting member toward the coupler ring, the radially expanding member remaining stationary relative to the coupler ring, the everting member being axially slidable relative to the shaft, until the free end region of the arteral segment is everted over the coupler ring; 
 applying sufficient force to the everting member to cause the pins of the coupler ring to pierce through the everted free end region of the arterial segment; 
 moving the inner shaft distally relative to the outer shaft, thereby causing the radially expanding member to radially contract away from the arterial tissue within the coupler ring; and 
 removing the everter device from the arterial segment. 
 
     
     
         18 . The method of  claim 16 , and in advancing the everting member toward the coupler ring and the free end region of the arterial segment, the shaft includes
 an outer shaft;   an inner shaft disposed within and slidable axially relative to the outer shaft;   an end cap secured to a distal end of the inner shaft;   the radially expanding member being disposed about the inner shaft between a proximal end of the end cap and a distal end of the outer shaft, and   in expanding the radially expanding member to the second diameter, pulling the inner shaft proximally relative to the outer shaft such that an axial distance between the proximal end of the end cap and the distal end of the outer shaft is reduced, thereby causing the radially expanding member to expand radially outwardly until it abuts arterial tissue within the coupler ring.