Externally directed anastomosis systems and externally positioned anastomosis fenestra cutting apparatus

• US 6,551,334 B2
• Filed: 12/14/2000
• Issued: 04/22/2003
• Est. Priority Date: 04/16/1999
• Status: Active Grant

• Current Assignee: Advent Access Pte. Ltd.
• Original Assignee: Integrated Vascular Interventional Technologies LC (Integrated Vascular Interventional Technologies)
• Inventors: Barrus, Mike C., Tullius, Nemo J. Jr., Burnett, Bruce M., Blatter, Duane D., Goodrich, Kenneth C.
• Primary Examiner(s): Woo, Julian W.
• Application Number:
  US09/736,781
• Publication Number:
  US 20010016749A1
• Time in Patent Office: 859 Days
• Field of Search: 606/149, 606/150, 606/151, 606/153, 606/159, 606/167, 606/170, 606/184, 600/566, 600/567, 128/898
• US Class Current: 606/153
• CPC Class Codes: A61B 17/0643 with separate closing member, e.g. for interlocking with staple
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/11 for performing anastomosis; Buttons for anastomosis
• CPC Class Codes: A61B 17/115 Staplers for performing anastomosis in a single operation
• CPC Class Codes: A61B 17/1152 applying the staples on the outside of the lumen
• CPC Class Codes: A61B 17/1155 Circular staplers comprising a plurality of staples
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 2017/0641 having at least three legs as part of one single body
• CPC Class Codes: A61B 2017/1107 for blood vessels
• CPC Class Codes: A61B 2017/1135 End-to-side connections, e.g. T- or Y-connections
• CPC Class Codes: A61B 2017/1157 applying the staples radially

Abstract

Anastomosis procedures and anastomosis cutting procedures are achieved with an anvil apparatus that is externally positioned through the wall of a vessel into the vessel lumen. The externally positioned anvil apparatus has an anvil that engages a cutter to form a vessel opening. The anvil is larger than the cutter to enable the vessel to be cut as it is compressed between the cutter and the anvil. The anvil may have a spherical engaging end for use with a cylindrical cutter for forming circular openings in a manner such that the anvil self centers. The anvil and cutter may also be adapted to form elliptical openings. The balloon may be solid or deployable.

Claims

1. A method for forming an opening in a vessel comprising the steps of

identifying an anastomosis site in a first vessel,

forming an insertion opening in a wall of the first vessel at the anastomosis site,

inserting an anvil means for engaging an interior surface of a wall of a first vessel at the anastomosis site, wherein the anvil means is inserted through the insertion opening into a lumen of the first vessel, wherein the anvil means has an engaging end, and wherein the engaging end is convex,

positioning the engaging end of the anvil means against an interior surface of the wall of the first vessel, wherein the positioning is achieved through the insertion opening, and

creating a first vessel opening in the wall of the fist vessel at the anastomosis site through the interaction of the engaging end of the anvil means with the cutting means for forming a first vessel opening in the wall of the first vessel at the anastomosis site,

wherein the cutting means has a cutting perimeter that defines the shape of the first vessel opening, and

wherein the cross-sectional area defined by the cutting perimeter is smaller than a cross-sectional area of the engaging end of the anvil means such that portions of the engaging end of the anvil means extend beyond the cutting perimeter when the cutting means engages the anvil means and creates the first vessel opening.

2. A method as recited in claim 1, wherein the anvil means is inserted into the lumen of the first vessel simultaneously as the engaging end of the anvil means is positioned against the interior surface of the wall of the first vessel.

3. A method as recited in claim 1, wherein the engaging end of the anvil means is positioned against the interior surface of the wall of the first vessel by manipulating an anvil pull extending from the engaging end of the anvil means through the insertion opening of the first vessel.

4. A method as recited in claim 3, wherein the anvil pull is manipulated via an anvil pull engager holding the anvil pull.

5. A method as recited in claim 1, wherein the cutting means includes a cutting tube that terminates at a cutting knife with a cutting edge and wherein the first vessel opening is created by bringing the cutting edge and the engaging end of the anvil means together with sufficient force to cut through the first vessel.

6. A method as recited in claim 5, wherein the cutting edge and the anvil means are brought together with sufficient force to cut through the first vessel and create a first vessel opening at the anastomosis site by puffing an anvil pull extending from the engaging end of the anvil means through the insertion opening of the first vessel as the cutting edge is pushed against the engaging end of the anvil means.

7. A method as recited in claim 5, wherein the engaging end of the anvil means is spherical, and wherein the cutting edge is circular such that the first vessel opening is formed as the circular cutting edge and the spherical engaging end are brought together.

8. A method as recited in claim 5, wherein the cutting edge is noncircular, and wherein the engaging end of the anvil means has a shape corresponding to that of the cutting;

edge such that the fist vessel opening is formed as the noncircular cutting edge and the engaging end are brought together.

9. A method as recited in claim 1, wherein the anvil means is an expandable anvil such that the anvil has an initial collapsed position for insertion into the insertion opening and an expanded position, wherein the engaging end has a greater cross-sectional area than the cross-sectional area defined by cutting perimeter of the cutting means when in the expanded position.

10. A method as recited in claim 1, wherein the anvil means is rigid.

11. A method as recited in claim 1, wherein the anvil means is solid.

12. A method as recited in claim 1, further comprising the step of providing spring tension against the cutting means as the cutting means engages the anvil.

13. A method as recited in claim 1, wherein the engaging end of the anvil mean is adapted to engage an area of the interior surface of the wall of the first vessel which is greater than the cross-sectional area defined by the cutting means.

14. A method as recited in claim 1, wherein the cross-sectional area of the engaging end of the anvil means combined with the shape of the engaging end enables the first vessel opening to be created at any position in which the cutting means is initially set against the engaging end.

15. A method for forming an opening in a vessel comprising the steps of

identifying an anastomosis site in a first vessel,

forming an insertion opening in a wall of the first vessel at the anastomosis site,

inserting an anvil having an engaging end though the insertion opening into a lumen of the first vessel, wherein the engaging end is convex,

positioning the engaging end of the anvil against an interior surface of the wall of the first vessel via an anvil pull extending from the engaging end of the anvil, wherein the positioning is achieved through the insertion opening, and

creating a first vessel opening in the wall of the first vessel at the anastomosis site by bringing the engaging end of the anvil and a cutting edge of a cutting knife together with sufficient force to cut through the first vessel,

wherein the cutting edge has a cutting perimeter that defines the shape of the first vessel opening, and

wherein the cross-sectional area defined by the cutting perimeter is smaller than a cross-sectional area of the engaging end of the anvil such that portions of the engaging end of the anvil extend beyond the cutting perimeter when the cutting edge and the engaging end are brought together to create the first vessel opening.

16. A method as recited in claim 15, wherein the anvil is inserted into the lumen of the first vessel simultaneously as the engaging end of the anvil is positioned against the interior surface of the wall of the first vessel.

17. A method as recited in claim 15, wherein the anvil pull is manipulated via an anvil pull engager holding the anvil pull.

18. A method as recited in claim 15, wherein the cutting edge and the anvil are brought together with sufficient force to cut through the first vessel and create a first vessel opening at the anastomosis site by pulling the anvil pull extending from the engaging end of the anvil through the insertion opening of the first vessel as the cutting edge is pushed against the engaging end of tube anvil.

19. A method as recited in claim 15, wherein the cutting knife is at an end of a cutting tube.

20. A method as recited in claim 15, wherein the engaging end of the anvil is spherical, and wherein the cutting edge is circular such that the first vessel opening is formed as the circular cutting edge and the spherical engaging end are brought together.

21. A method as recited in claim 15, wherein the cutting edge is noncircular, and wherein the engaging end of the anvil has a shape corresponding to that of the cutting edge such that the first vessel opening is formed as the noncircular cutting edge and the engaging end are brought together.

22. A method as recited in claim 15, wherein the anvil is an expandable anvil such that the anvil has an initial collapsed position for insertion into the insertion opening and an expanded position, wherein the engaging end has a greater cross-sectional area than the cross-sectional area defined by cutting perimeter of the cutting edge when in the expanded position.

23. A method as recited in claim 15, wherein the anvil is rigid.

24. A method as recited in claim 15, wherein the anvil is solid.

25. A method as recited in claim 15, wherein the cutting knife is at an end of a cutting tube, and further comprising the step of providing spring tension against the cutting tube as the cutting edge and the engaging end of the anvil are brought together.

26. A method as recited in claim 15, wherein the engaging end of the anvil is adapted to engage an area of the interior surface of the wall of the first vessel which is greater than the cross-sectional area defined by the cutting edge.

27. A method as recited in claim 15, wherein the cross-sectional area of the engaging end of the anvil combined with the shape of the engaging end enables the first vessel opening to be created at any position in which the cutting edge is initially set against the engaging end.

28. A method for forming an opening in a vessel comprising the steps of

identifying an anastomosis site in a first vessel,

forming an insertion opening in a wall of the first vessel at the anastomosis site,

inserting an anvil having an engaging end through the insertion opening into a lumen of the first vessel, wherein the engaging end is convex,

positioning the engaging end of the anvil against an interior surface of the wall of the first vessel via an anvil pull extending form the engaging end of the anvil, wherein the positioning is achieved through the insertion opening, and

creating a first vessel opening in the wall of the first vessel at the anastomosis site by bringing the engaging end of the anvil and a cutting edge of a cutting knife at an end of a cutting tube together with sufficient force to cut through the first vessel,

wherein the cutting edge has a cutting perimeter that defines the shape of the first vessel opening,

wherein the cross-sectional area defined by the cutting perimeter is smaller than a cross-sectional area of the engaging engaging of the anvil such that portions of the engaging end of the anvil extend beyond the cutting perimeter when the cutting edge and the engaging end are brought together to create the first vessel opening, and

wherein the engaging end of the anvil is adapted to engage an area of the interior surface of the wall of the first vessel which is greater than the cross-sectional area defined by the cutting edge.

29. A method as recited in claim 28, wherein the anvil pull is manipulated via an anvil pull engager holding the anvil pull.

30. A method as recited in claim 28, wherein the engaging end of the anvil is spherical, and wherein the cutting edge is circular such that the first vessel opening is formed as the circular cutting edge and me spherical engaging end are brought together.

31. A method as recited in claim 28, wherein the cutting edge is noncircular, and wherein the engaging end of the anvil has a shape corresponding to that of the cutting edge such that the first vessel opening is formed as the noncircular cutting edge and the engaging end are brought together.

32. A method as recited in claim 28, wherein the anvil is an expandable anvil such that the anvil has an initial collapsed position for insertion into the insertion opening and an expanded position, wherein the engaging end has a greater cross-sectional area than the cross-sectional area defined by cutting perimeter of the cutting edge when in the expanded position.

33. A method as recited in claim 28, wherein the anvil is rigid.

34. A method as recited in claim 28, wherein the cross-sectional area of the engaging end of the anvil combined with the shape of the engaging end enables the first vessel opening to be created at any position in which the cutting edge is initially set against the engaging end.

35. A method for forming an opening in a vessel comprising the steps of

identifying an anastomosis site in a first vessel;

forming an insertion opening in a wall of the first vessel at the anastomosis site,

inserting an anvil having an engaging end through the insertion opening into a lumen of the first vessel, wherein the engaging end is convex and spherical,

positioning the engaging end of the anvil against an interior surface of the wall of the first vessel via an anvil pull extending from the engaging end of the anvil, wherein the positioning is achieved through the insertion opening, and

creating a first vessel opening in the wall of the first vessel at the anastomosis site by bringing the engaging end of the anvil and a circular cutting edge of a cutting knife at an end of a cutting tube together with sufficient force to cut through the first vessel,

wherein the cutting edge has a cutting perimeter that defines the shape of the first vessel opening, and

wherein the cross-sectional area defined by the cutting perimeter is smaller than a cross-sectional area of the engaging end of the anvil such that portions of the engaging end of the anvil extend beyond the cutting perimeter when the cutting edge and the engaging end are brought together to create the fist vessel opening.

36. A method as recited in claim 35, wherein the anvil pull is manipulated via an anvil pull engager holding the anvil pull.

37. A method as recited in claim 35, wherein the anvil is an expandable anvil such that the anvil has an initial collapsed position for insertion into the insertion opening and an expanded position, wherein the engaging end has a greater cross-sectional area than the cross-sectional area defined by cutting perimeter of the cutting edge when in the expanded position.

38. A method as recited in claim 35, wherein the anvil is rigid.

39. A method as recited in claim 35, wherein the cross-sectional area of the engaging end of the anvil combined with the shape of the engaging end enables the first vessel opening to be created at any position in which the cutting edge is initially set against the engaging end.

40. A method as recited in claim 35, wherein the engaging end of the anvil is adapted to engage an area of the interior surface of the wall of the first vessel which is greater than the cross-sectional area defined by the cutting edge.