Temporary anastomotic seal and method
Forming a proximal anastomosis on an aortic wall includes method and instrumentation and apparatus for forming an aortic puncture and inserting into the vessel through the puncture a fluid-impervious sealing element with a protruding retainer. An anastomosis of a graft vessel over the puncture is partially completed with the retainer of the sealing element protruding through the partial anastomosis. The retainer facilitates removal of the sealing element from the partial anastomosis prior to completion of the procedure.
1. An apparatus for forming a temporary fluid-tight seal on the inner wall of a fluid conduit within a patient's body, the apparatus comprising:
a fluid-impervious mushroom-shaped flange having an outer periphery and a straight, linear stem centrally formed thereon, wherein the mushroom-shaped flange has a concave surface having a radius and the stem extends within the outer periphery and beyond the radius of the concave surface, the flange including a continuous region of diminished shear strength extending from the stem along a continuous path to the periphery for selectively reconfiguring the flange in response to tension applied to the stem to disassemble the flange along the continuous region into a continuous strand, wherein the mushroom-shaped flange has a first deployed configuration and a confined configuration, wherein in the first deployed configuration the mushroom-shaped flange has a first dome configuration and in the confined configuration the mushroom-shaped flange has a configuration that is different from the first dome configuration.
2. The apparatus according to claim 1 including:
an elongated hollow sheath having an open distal end, the sheath being positioned about the stem and about the flange disposed therein in confined configuration near the distal end of the sheath.
3. The apparatus according to claim 2 including:
a plunger slidably disposed within the sheath near a proximal end thereof for selectively ejecting the fluid-impervious flange from the distal end of the sheath in response to sliding movement of the plunger within the sheath toward the distal end thereof.
4. The apparatus according to claim 2 including:
a resilient member that extends laterally and includes a pair of mating ends disposed to traverse the periphery of the flange;
a strand of flexible material attached to the mating ends and to one of the stem and flange for supporting the stem and flange intermediate the mating ends of the resilient member; and
said sheath being positioned about the flange and about the stem and the resilient member that are confined within the sheath at locations therein proximal the distal end.
5. The apparatus according to claim 4 including:
a plunger disposed within the sheath near a proximal end thereof and including a lumen therethrough;
a length of line attached to the resilient member and passing through the lumen in the plunger;
wherein the plunger is slidably disposed within the sheath to selectively eject the flange, the stem, the resilient member, and the strand of flexible material from the distal end in response to sliding movement of the plunger within the sheath toward the distal end thereof.
6. The apparatus according to claim 1 , wherein the continuous region of diminished shear strength comprises a joint formed between adjacent convolutes of a wound tube or string.
7. The apparatus according to claim 1 , wherein the straight, linear stem is flexible.
8. The apparatus according to claim 1 , wherein the mushroom-shaped flange is configured to maintain the first dome configuration against tension applied to the stem that is less than the tension applied to the stem to disassemble the flange.
9. The apparatus according to claim 8 , wherein the confined configuration constitutes a second dome configuration that is different from the first dome configuration.
10. The apparatus according to claim 9 , wherein the second dome configuration is a compressed version of the first dome configuration.
11. An apparatus for forming a temporary fluid-tight seal on the inner wall of a fluid conduit within a patient's body, the apparatus comprising:
a fluid-impervious mushroom-shaped flange having an outer periphery and a straight locator thereon disposed to protrude through an aperture in a wall of the fluid conduit for positioning the flange against an inner wall over the aperture; and wherein the flange is selectively reconfigurable for removal from the aperture, the flange including a continuous region of diminished shear strength extending from the locator along a continuous path to the outer periphery for selectively reconfiguring the flange response to tension applied to the locator to disassemble the flange along the continuous region into a continuous stand, wherein the mushroom-shaped flange has a concave surface having a radius and the locator extends within the outer periphery and beyond the radius of the concave surface so as to protrude through the aperture in the wall of the fluid conduit, wherein the mushroom-shaped flange has a first deployed configuration and a confined configuration, wherein in the first deployed configuration the mushroom-shaped flange has a first dome configuration and in the confined configuration the mushroom-shaped flange has a configuration that is different from the first dome configuration.
12. The apparatus according to claim 11 in which the locator on the flange is configured to extend to a conduit outer wall beyond the aperture for providing force on the flange against the inner wall of the conduit.
13. The apparatus according to claim 11 , wherein the straight locator is flexible.
14. The apparatus according to claim 11 , wherein the mushroom-shaped flange is configured to maintain the first dome configuration against tension applied to the stem that is less than the tension applied to the stem to disassemble the flange.
15. The apparatus according to claim 14 , wherein the confined configuration constitutes a second dome configuration that is different from the first dome configuration.
16. The apparatus according to claim 15 , wherein the second dome configuration is a compressed version of the first dome configuration.