External tubular stapling device for anastomosing a vascular graft to an anastomosing sheath

摘要

An external tubular vascular stapling device is provided for anastomosing a vascular graft to an anastomosis sheath, the latter being initially attached to an arterial or aortic wall, followed by a secondary anastomosis of the sheath to the vascular graft. The procedure enables the device and method to obviate the need for arterial occluding clamps, and produces a stable anastomosis connection. A suitable anastomosing device for this procedure comprises a stapler housing and a separate, multi-grooved anvil which when assembled, form double aligned tubes. The stapling housing includes staple wires and staple pushers mounted within slots oriented orthogonally to the anvil grooves, the vascular graft, and the anastomosis sheath. The distal end of the vascular graft is passed through the tubular portion of the anvil and everted over the end of the anvil. The proximal end of the graft is either tied off or temporarily cross-clamped with vascular clamps. The staple wires are then bent over the anvil by the staple pushers to effect anastomosis of the graft and the sheath, followed by withdrawing the device. This new method and apparatus facilitates an endoscopic vascular anastomosis by eliminating the need for vascular clamps that obstruct endoscopic viewing, interfere with endoscopic maneuvering in a limited area, and whose use may cause tissue injury downstream of the anastomosis site due to lack of an adequate blood supply.