FR2869527A1 - A vascular prosthesis for arterial anastomoses comprising two end portions each including an inflatable support (stent) connected to a bypass as a unitary ensemble - Google Patents

Abstract

A vascular prosthesis for bypasses, especially arterial anastomosis comprising at least two end portions having an orifice intended to communicate with an arterial cavity when proceeding to an arteriotomy, each including a dilatable support organ (stent) and connected by a bypass with which the end portions communicate and form a unitary ensemble. At least one of the end portions has a disk fixed at the junction of the end portion and bridge, or close to it and extending in such a way as to be in intimate contact with the artery and covering the arteriotomy. The disk may be square, rectangular, oval, round, a conical section or a cylinder. The support organs, which are 2-8 cm long, may be rigid or flexible. At least one of the internal or external walls of the organ is covered with a synthetic layer in a material identical to that of the bypass either sutured on or fixed with a biological glue. The material is most preferably Dacron (RTM). The flexible organs are folded into a slit cylinder which is withdrawn after placement of the end portion(s) in the artery. The end portions have two orifices communicating with an arterial cavity and a lateral orifice opening into the bypass so as to permit a termino-lateral anastomosis. Alternatively at least one of the end portions extends into the bypass extension so as to permit a terminal-terminal anastomosis. The end portions are covered only in part by an extension of the bypass. The prosthesis comprises for at least one of the end portions a hollow cylinder intended to facilitate the passage of a guide line. In an alternative form, the bypass has two limbs linked by a common end portion, on at least of which has at its end another end portion. One or other limb may be bifurcated and the limb and/or the bifurcation may have an end portion. An independent claim is included for a kit for practising an arterial anastomosis comprising the claimed prosthesis and a system of fixing and/or sealing to be applied at the level of the arteriotomy. The latter comprises one or more sleeves, thread, one or more strips and one or more rings.

Description

An extra-arterial anastomotic prosthesis ready to be placed, and

  together to practice a corresponding anastomosis.

  The field of the invention is that of vascular surgery. More specifically, the invention relates to an intra-extra arterial anastomotic prosthesis.

  Conventionally, in vascular surgery, bridging is performed using a synthetic prosthesis between a donor artery and a recipient artery.

  Generally, these prostheses are made in one of the following materials: dacron (registered trademark), polytetrafluoroethylene (PTFE), or a hybrid dacron / PTFE material.

  The current practice of bridging is to perform an arteriotomy, then to connect on this arteriotomy a bridging prosthesis using a non-resorbable wire to make the anastomosis. Usually, at least two anastomoses are made in this way to connect the bridge to the artery, these anastomoses being made manually using a non-resorbable wire.

  The anastomoses can be performed in termino-lateral or terminoterminal.

  Bridging can be simple or forked (as is the case, for example, for aortoiliac or aorto-iliac bypass grafts).

  The practice of anastomosis is of course a very delicate operation, long and tedious, the quality of execution must be obviously irreproachable given the high risk of intervention for the patient.

  The prior art has proposed several solutions to eliminate the manual manufacture of anastomoses, this by designing prostheses intended to include a prefabricated anastomosis in the laboratory.

  A vascular bridging device such as that described by the international patent application WO-98/311302, in which the prosthesis comprises a tubular section intended to be introduced into an artery via a lateral incision formed in an artery, is known in particular. this is the section with a bifurcated branch intended to emerge through the incision.

  In addition, according to this technique, it is intended to introduce into the section, once it is placed in the artery, an expandable support member (commonly referred to as the stent) in the vicinity of each orifice of the section.

  This technique has several disadvantages.

  The prosthesis described avoids the manual preparation of an anastomosis.

  However, this solution offers only a partial response to the problem of anastomosis to be performed manually.

  Moreover, the described surgical technique is likely to cause possible problems of vascularization because of the two stents spaced apart from each other and between which the section may locally present a narrowing relative to the diameter of the two stents; and especially the diameter of the section is always smaller than the diameter of the chosen artery.

  By using PTFE as a stump material, the stent must be inside the stump.

  This assembly is also in several segments, and not a single body.

  Furthermore, there is the absence of a sealing system to fight against a possible leak between the aortic lumen and the prosthesis, and a possible leak due to the micro vascularization of the aortic wall. There is also no fixation system to prevent dilation of the aorta under the radial force of the stent that is causing secondary leakage.

  An anastomotic prosthesis of the type described in the patent document published under the number US-5 443 497 is also known. According to this technique, the prosthesis is composed of three distinct elements: a proximal stent intended to be placed in the artery through a first incision, the proximal stent bearing a tubular section communicating with the stent and intended to protrude through the first lateral incision, - a distal stent intended to be placed in the artery through a second incision, the distal stent carrying a tubular section communicating with the stent and intended to project through the second lateral incision, a bridge body for connecting the two stents so as to put them in communication.

  This technique is intended to be used in pure endovascular technique and especially for arteries of small and medium sizes. There is also some reassembly, since the stents act as a connection between the artery and the central segment which may be a prosthesis or a segment of a vein or artery; there are always several segments to be connected to each other during the operating time.

  The invention particularly aims to overcome the disadvantages of the prior art.

  More specifically, the invention aims to provide an anastomotic prosthesis that avoids the production of manual anastomoses, this by limiting the number of phases and operative procedures.

  The invention also aims to provide such an anastomotic prosthesis which has great guarantees regarding the safety of the patient.

  The invention also aims to provide such an anastomotic prosthesis which is simple in design and can be manufactured inexpensively.

  Another object of the invention is to provide such an anastomotic prosthesis that can be adapted to perform a termino-terminal anastomosis or a side-end anastomosis.

  Yet another object of the invention is to provide such an anastomotic prosthesis that can be placed according to a surgical technique easily executable, whether in traditional surgery or coelio surgery.

  These objectives, as well as others which will appear later are achieved thanks to the invention which relates to a vascular prosthesis for bypassing, in particular for arterial anastomosis, characterized in that it comprises at least two end portions having a lumen for communicating with an arterial cavity by performing an arteriotomy, said end portions each including an expandable support member and being interconnected by a bridge body with which said end portions communicate and form a unitary set.

  The invention thus proposes an anastomotic prosthesis which is in the form of a single prefabricated element including the two anastomoses and the central body of a bypass.

  The many operative procedures necessary to proceed to all the connections of the elements together according to the prior techniques are thus removed.

  A prosthesis according to the invention makes it possible to envisage shorter intervention times, while at the same time increasing the degree of safety for the patient (by reducing the arterial clamping time).

  According to a preferred solution, the prosthesis has for at least one of said end portions, at least one pellet fixed at the junction of said end portion and said bridge body, or in the vicinity of said junction, said pellet extending to be plated on said artery covering said arteriotomy.

  It is understood that such a pellet has the function of sealing at the level of the arteriotomy, avoiding blood leakage in case of imperfect junction between the outer portion of the stent and the wall of the artery.

  This pellet also has a second function: that of consolidating the fixation of the prosthesis to the artery, preventing the device from migrating.

  In this case, said one or more pellets preferably have a recess whose periphery is secured to said junction or in the vicinity thereof.

  This provides a simple solution to effectively ensure the junction between the bridge body and the artery. In addition, the securing of the pellet to the bridge body is prefabricated under laboratory conditions ensuring the proper implementation of the bonding.

  Advantageously, said one or more pellets are in one of the following forms: - square; rectangle; oval;' round; truncated cone; cylinder.

  According to a first embodiment, said at least one expandable support member is rigid.

  According to a second embodiment, said at least one expandable support member is flexible.

  According to one or other of these embodiments, at least one of the inner and outer walls of said one or more expandable support members is preferably covered by a synthetic layer made of a material identical to that with which said bridging body.

  Thus, the materials used for the production of the synthetic layer and the bridging body can be chosen for their ability to be joined to each other either by means of son or by means of bio-compatible biological glue.

  Preferably, said one or more synthetic layers are made of dacron.

  Of course, other embodiments can be envisaged without departing from the scope of the invention, for example by producing the synthetic layer or layers of polyester or PTFE.

  According to an advantageous solution, said layer or layers are fixed to said expandable support member by at least one suture and / or via a biological glue.

  This provides a reliable maintenance of the layer or layers on the expandable support member, especially since the bonding is performed prior to surgery, under laboratory conditions.

  According to one conceivable variant, said one or more end portions are covered only in part by an extension of said bridge body.

  Advantageously, said at least one expandable support member has a length of between about 2 cm and about 8 cm.

  Of course, the length of the expandable support members may vary according to the needs of the intervention.

  According to a particular embodiment, the prosthesis comprises for at least one of said end portions, a hollow cylinder for facilitating the passage of a guidewire.

  In this way, it is easier to perform the installation of the anastomotic prosthesis.

  In the case of flexible expandable support members, these are advantageously folded in a split cylinder intended to be removed after placement in said artery of said end portion or portions.

  It is thus possible to obtain the deployment of the corresponding stent easily and quickly.

  According to a first approach of the invention, at least one of said end portions has two orifices intended to communicate with an artery cavity and a lateral orifice opening into said bridging body so as to allow a terminally-lateral anastomosis. .

  According to a second conceivable approach of the invention, at least one of said end portions extends in the extension of said bridging body to allow a termino-terminal anastomosis.

  According to a particular embodiment of one or other of these approaches, said bridge body has two legs connected by a common end portion, at least one of said legs having at its other end, a portion of 'end.

  According to another particular embodiment of one or other of these approaches, said bridge body has two legs connected by a common end portion, at least one of said legs having a bifurcation, one at at least one of said legs and / or said bifurcation having at its free end an end portion.

  The invention also relates to an assembly for performing an arterial anastomosis, comprising: at least two end portions having a lumen for communicating with an arterial cavity by performing an arteriotomy, said end portions each including an organ of an expandable support and being interconnected by a bridge body with which said end portions communicate and form a unitary assembly.

  a fixing and / or sealing system intended to be attached to said arteriotomy.

  Preferably, said fastening and / or sealing system comprises at least one of the following elements: at least one sleeve; some thread; at least one strip; at least one ring.

  Other characteristics and advantages of the invention will appear more clearly on reading the following description of various preferred embodiments of the invention and some of their variants, given by way of illustrative and non-limiting examples, and attached drawings among which: Figure 1 is a schematic view of a first embodiment of a prosthesis according to the invention, having two end portions each provided to allow a later-end anastomosis; Figures 2 and 3 are each a view of the prosthesis of the type shown in Figure 1, to illustrate different embodiments of the end portions; Figures 4a, 4b and 4c are each a sectional view of an alternative embodiment of an end portion of a prosthesis according to the invention; Figure 5 is a schematic view of the embodiment shown in Figure 1, the prosthesis being associated with a device for placing a guide wire illustrated in isolation in Figure 6; - Figure 7 is a partial view of a prosthesis according to the invention, an end portion comprises a part to be removed to allow the deployment of the stent, this part being shown in isolation by Figures 8a and 8b; Figure 9 is a view of a second embodiment of a prosthesis according to the invention; Figure 10 is a view of a third embodiment of a prosthesis according to the invention; Figure 11 is a view of a fourth embodiment of a prosthesis according to the invention; FIGS. 12a, 12b and 12c are views of a sleeve that can be associated with a prosthesis according to the invention; Figures 13 and 14 are each a view of complementary fastening means may be associated with a prosthesis according to the invention; FIGS. 15 to 21 are views of the various operating phases for setting up a prosthesis according to the invention; Fig. 22 is a view of a fifth embodiment of the invention; Fig. 23 is a view of a sixth embodiment of the invention; FIG. 24 is a view of a seventh embodiment of the invention; Fig. 25 is a view of an eighth embodiment of the invention; FIG. 26 is a view of a ninth embodiment of the invention; Figure 27 is a view of a tenth embodiment of the invention; Fig. 28 is a view of an eleventh embodiment of the invention; Fig. 29 is a view of a twelfth embodiment of the invention; As already indicated above, the principle of the invention lies in the fact of proposing an anastomotic prosthesis in the form of a unitary assembly comprising two (or more) end portions each including a stent, a bridging body connecting the two end portions.

  As will become more clearly apparent later, such a prosthesis can be declined in different embodiments to allow one or more termino-terminal anastomoses, one or more end-to-end anastomoses or a combination of termino-terminal or late-lateral anastomoses. terminal.

  FIG. 1 illustrates an embodiment of a prosthesis according to the invention according to which a bridging body 1 connects two end portions 2, 3 each including a stent.

  It is recalled that the function of such a covered stent (stent) is to line the inner wall of the vessel concerned. Thus, the stent comes to replace the walls of the vessel at this point and prevents the blood from circulating between the inner wall of the vessel and the outer wall of the stent (which prevents blood leakage). Such a stent covered, by the radial forces it exerts, fixed the entire device to the inner wall of the vessel.

  Stents currently available for other applications may be used within the scope of the invention. These are generally formed of a mechanical tubular member in the form of a mesh whose mesh has a helical, and / or circular, and / or oblique, and / or vertical, and / or longitudinal.

  The dilation of the stents may be due to an elastic memory (their expansion being most often obtained using balloons) or to thermal phenomena (their expansion being controlled either by the application of a thermal control flow, or by the temperature of the body).

  In the context of the invention, the stents may have a length identical to that of the end portion or slightly exceed it for better fixation.

  According to the present embodiment, the end portions are connected to the bridging body so as to allow a lateroterminal anastomosis. To do this, each end portion has three orifices: an orifice at each of its ends 21, 22 (said upper and lower orifices) and a lateral orifice 23 (shown in dashed lines).

  The stents of the end portions are provided with or without a fixing hook.

  As illustrated, the stents used are rigid (and made of a metallic material, for example steel) and provide the corresponding end portion with a predetermined cylindrical shape. According to another conceivable embodiment, they may be flexible (using a material such as nitinol or the like).

  Note that: the diameter of the stent is chosen to be equal to or greater than the diameter of the artery concerned; the diameter of the lower orifice of the stent is equal to or greater than the diameter of the upper orifice of the stent; the stent diameter of one of the end portions may be different from the diameter of the stent of another end portion; the length of a stent is between 2 cm and 8 cm (as needed).

  With reference to FIGS. 2 and 3, the stent of each of the end portions is coated with a layer of a synthetic material, this material being preferably the same as that used for the bridging body, in this case dacron .

  According to an alternative embodiment illustrated in Figure 2, the stent is completely coated.

  According to other possible variants, the stent 20 is only partially coated, the coating being able to assume a semi-cylindrical shape (as it appears on the right end portion in FIG. 3) or a parachute shape ( as it appears on the left end portion in Figure 3).

  As shown in Figure 4c, the stent 20 is coated with a synthetic double layer: the first layer 24 covers the outer surface of the stent, and the second layer 25 covers the inner surface of the stent.

  These two layers 24, 25 are bonded to one another, and to the stent 20, by a suture (or a biological glue according to an alternative embodiment possible).

  It is understood that the layers 24, 25 have the same shape as that of the corresponding end portion and therefore have, according to the present embodiment, each three orifices (one orifice at each end and one lateral orifice, this lateral orifice being in continuity with the bridge body).

  According to two possible variants, the stent may be coated only by an outer layer 24 (Figure 4b), or only by an inner layer 25 (Figure 4c).

  With reference to FIG. 5, each stent 20 can be folded on a plastic cylinder 4 with two extreme orifices, such as that illustrated in FIG. 6, this cylinder being provided to facilitate the passage of guidewires during the operating phase. These cylinders 4 are removed immediately after the introduction of a guide wire in the stent lumen.

  Such plastic cylinders facilitate the introduction of dilation balloons in the stents, these balloons being slid with a guide wire and for deploying the stents against the arterial wall.

  When using a flexible stent (self-expanding nitinol or other similar material), the stent may be folded and / or wound into a split (or multiple) cylinder as shown in FIG. 7. Such a split cylinder is shown in Figures 8a and 8b.

  Furthermore, the bridging body 1 is preferably monolayer and has a generally elongated cylindrical shape whose length and diameter are adapted according to the needs.

  As already indicated, the bridging body is preferably made of the same material as that of the stent coating of the end portions, and preferably in dacron.

  According to another characteristic of the invention, the anastomotic prosthesis has, for each of its end portions, a pellet 11 as illustrated in particular in FIGS. 1 to 3.

  Such a pellet 11 is secured to the bridge body 1 at the interface between the bridge body and the corresponding end portion. It has a recess that surrounds the bridge body at the interface mentioned above.

  This pellet 11 acts as a seal once plated on the artery, thus covering the arteriotomy performed for the establishment of the corresponding end portion.

  In addition, the pellet contributes to the fixation of the prosthesis on the artery, to prevent it from migrating.

  The pellet is attached to the outer wall of the artery using a biological glue (or an external fixation system (ring, wire, strip) according to a possible variant) and fixed by a biological glue, to the lower wall of a sleeve which will be described in more detail later.

  Different shapes can be envisaged for the pellet (square, rectangle, oval, round, frustoconical ...). In case of end-terminal anastomosis, the pellet preferably has the shape of a cylinder whose diameter is slightly greater than the diameter of the corresponding end portion.

  Moreover, it may be provided to add on the outer wall of the artery a sleeve which also covers the pellet 11.

  Such a sleeve 6 is illustrated in Figures 12a, 12b and 12c.

  As already mentioned, the holding in position of the sleeve 6 is ensured by means of a complementary fastening system comprising strips 61 and / or non-resorbable wire 62 (FIG. 13) and / or one or more rings 63 (FIG. 14).

  More specifically, the complementary fastening system may consist of: one or more articulated rings, metal or plastic of diameter equal to or smaller than the diameter of the vessel plus the thickness of the pellet and the thickness of the sleeve; strips that are integral with the sleeve (or pellet), or independent and added to the outer face of the sleeve.

  Such a fastening system also contributes to the seal. It is applied on the outer surface of the sleeve and makes it possible to fix the end portion to prevent it from moving through the arteriotomy, upstream or downstream of the selected vessel.

  Note that in the case of bifurcated bridging, the sleeve is adapted to have an orifice for each arm of the bifurcated bridge (Figure 12e).

  The shape of this sleeve may be square, rectangular, oval (Figure 12b), round or cylindrical (Figure 12a, in case of end-terminal anastomosis), with or without side strips.

  The dimensions of such a sleeve can vary as much as necessary, it may be provided to cover only part of the artery, or to cover the entire end portion. It is attached to the outer wall of the artery and to the pellet by biological glue and possibly by a complementary external fixation system such as that mentioned above.

  It is understood that such a sleeve forms additional sealing means, and a complementary attachment means for preventing the corresponding end portion from migrating. It also prevents any increase in the diameter of the artery that could be driven by the radial force acting on the corresponding end portion.

  An operative technique for fitting an anastomotic prosthesis according to the invention will now be described with reference to FIGS. 15 to 21.

  The technique described hereinafter is intended to perform a bridging between a donor artery (stenosed or thrombosed) and a recipient artery, with placement of the anastomotic prosthesis intra / extra arterial, termino-terminal and termino position. -terminal, with a rigid steel stent.

  After dissecting the recipient artery and the donor artery, a percutaneous puncture of the artery is performed downstream of the lesion area 7 (stenosed or trombosed).

  Then, a percutaneous guide wire 8 is mounted in the internal lumen of the artery, up to the level of the distal arteriotomy 9, on the recipient artery. The guidewire 8 has emerged through the distal arteriotomy 9.

  At this stage, the guidewire is introduced into the lumen of one of the end portions of the prosthesis, then it is reintroduced into the arteriotomy so as to cross the stenotic zone until it reaches the level of the Proximal arteriotomy 10.

  Again, the guidewire is removed from the artery, this time through the proximal arteriotomy to be introduced into the second end portion of the prosthesis, the guide wire being then reintroduced into the arteriotomy.

  At this stage, a configuration such as that illustrated in FIG. 15 is obtained.

  Note that in the case of use of guiding rolls guide wire, they are removed at this time of the operation.

  A second phase of the operation consists in introducing the end portions, one after the other, into the artery lumen through the arteriotomies, as illustrated by FIGS. 16 and 17.

  If it is impossible to cross the thrombotic zone by the guide wire (FIG. 18), a second puncture of the artery is performed just downstream of the proximal arteriotomy (upstream of the arterial thrombosis) in order to be able to pass a second guide wire.

  In a third phase of the operation, the stents are deployed in the lumen of the artery using a dilatation balloon catheter (for a rigid stent). In the case of using a flexible stent, this phase consists of removing the split cylinder 5 described above.

  At the end of this phase, the stent is pressed against the inner wall of the artery, as shown in Figure 19.

  Then, a biological glue is applied to the outer wall of the artery in order to adhere thereto the pellet 11 (FIG. 20). This last is fixed definitively on the wall of the artery using threads or strips or by the combined action of a sleeve and son and / or strips and / or articulated rings (Figure 21).

  It is recalled that a prosthesis according to the invention can be provided in different configurations.

  Thus, the bridging body 1 may be monolateral as shown in FIG. 9 which shows a termino-lateral and termino-terminal prosthesis, or in FIG. 10 which shows a termino-terminal and terminoterminal prosthesis.

  According to another embodiment illustrated in FIG. 11, the bridging body 1 can be bifurcated for carrying out a bi-lateral bridging to two receiving arteries, this providing two legs 12 connected by a common end portion 2 As illustrated, the prosthesis is intended to allow end-to-end anastomosis on the donor artery, and a terminally-lateral anastomosis on each of the recipient arteries.

  FIGS. 22 and 23 each illustrate an anastomotic prosthesis according to another embodiment of the invention, provided for a termino-terminal anastomosis, one being an extra-arterial bifurcated prosthesis (FIG. 22) and the other being a prosthesis extra-arterial simple (Figure 23).

  FIG. 24 represents yet another embodiment of the invention according to which the prosthesis is a simple extra-arterial prosthesis, for a termino-lateral and termino-terminal anastomosis.

  FIG. 25 represents yet another embodiment of the invention according to which the prosthesis is a bifurcated extra-arterial prosthesis, for a termino-lateral (donor artery) and terminally-terminal (recipient arteries) anastomosis.

  FIG. 26 represents yet another embodiment of the invention according to which the prosthesis is a bifurcated extra-arterial prosthesis, for a termino-lateral and termino-lateral anastomosis.

  FIG. 27 represents yet another embodiment of the invention according to which the prosthesis is a bifurcated extra-arterial prosthesis, for a termino-lateral anastomosis (donor artery and one of the recipient arteries) and termino-terminus (the other of the arteries). recipient).

  FIGS. 28 and 29 each represent another embodiment of the invention according to which the prosthesis for end-to-end anastomosis is bifurcated and has two legs 12 each carrying a bifurcation 121, each leg 12 and each bifurcation 121 presenting a portion of end according to the invention (Figure 29), or only the legs (Figure 28).

  Other embodiments may still be envisaged without departing from the scope of the invention, in particular by combining together the embodiments described above.

Claims (1)

17 CLAIMS   1. Vascular prosthesis for bypass, especially for arterial anastomosis, characterized in that it comprises at least two end portions (2), (3) having a light intended to communicate with an artery cavity by performing an arteriotomy said end portions each including an expandable support member (20) and being interconnected by a bridge body (1) with which said end portions (2), (3) communicate and form a unitary assembly.   2. Vascular prosthesis according to claim 1, characterized in that it has, for at least one of said end portions (2), (3), at least one pellet (11) attached to the junction of said portion end portion (2), (3) and said bridge body (1), or in the vicinity of said junction, said wafer extending to be plated on said artery covering said arteriotomy.   3. Vascular prosthesis according to claim 2, characterized in that said pellets or (11) have a recess whose periphery is secured to said junction or in the vicinity thereof.   4. Vascular prosthesis according to one of claims 2 and 3, characterized in that said or said pellets (11) are in one of the following forms: square; rectangle; - oval; ' round; truncated cone; cylinder.   5. Vascular prosthesis according to any one of claims 1 to 4, characterized in that said one or more expandable support members (20) are rigid.   6. Vascular prosthesis according to any one of claims 1 to 4, characterized in that said one or more expandable support members (20) are flexible.   7. Vascular prosthesis according to any one of claims 1 to 6, characterized in that at least one of the inner and outer walls of said one or more expandable support members (20) is covered by a synthetic layer (24), ( 25) made of a material identical to that with which said bridging body (1) is made.   8. Vascular prosthesis according to claim 7, characterized in that said one or more synthetic layers (24), (25) are made of dacron.   9. A vascular prosthesis according to one of claims 7 and 8, characterized in that said layer or layers (24), (25) are fixed to said expandable support member (20) by at least one suture and / or by the intermediate of a biological glue.   10. Vascular prosthesis according to any one of claims 1 to 9, characterized in that said one or more end portions (2), (3) are covered only in part by an extension of said bridging body (1).   11. Vascular prosthesis according to any one of claims 1 to 10, characterized in that said one or more expandable support members (20) have a length of between about 2 cm and about 8 cm.   12. Vascular prosthesis according to any one of claims 1 to 11, characterized in that it comprises, for at least one of said end portions (2), (3), a hollow cylinder (4) for facilitate the passage of a guide wire.   13. Vascular prosthesis according to any one of claims 6 to 11, characterized in that said one or more flexible expandable support members (20) are folded in a split cylinder (5) to be removed after placement in said artery said one or more end portions (2), (3).   14. Vascular prosthesis according to any one of claims 1 to 13, characterized in that at least one of said end portions (2), (3) has two orifices (21), (22) for communicating with an artery cavity and a lateral orifice (23) opening into said bridging body (1) so as to allow a termino-lateral anastomosis.   15. Vascular prosthesis according to any one of claims 1 to 14, characterized in that at least one of said end portions (2), (3) extends in the extension of said bridge body (1). to allow a termino-terminal anastomosis.   16. Vascular prosthesis according to any one of claims 1 to 15, characterized in that said bridging body (1) has two legs (12) connected by a common end portion (2), at least one of said jambs having at its other end an end portion (3).   17. A vascular prosthesis according to any one of claims 1 to 15, characterized in that said bridging body (1) has two legs (12) connected by a common end portion (2), at least one of said legs (12) having a bifurcation (121), at least one of said legs (12) and / or said bifurcation (121) having at its free end an end portion (3).   18. Arterial anastomosis assembly, characterized in that it comprises: at least two end portions (2), (3) having a lumen for communicating with an artery cavity by performing an arteriotomy, said end portions each including an expandable support member (20) and being interconnected by a bridge body (1) with which said end portions (2), (3) communicate and form a unitary assembly; a fixing and / or sealing system intended to be attached to said arteriotomy.   19. An assembly for performing anastomosis, according to claim 18, characterized in that said fixing and / or sealing system comprises at least one of the following elements: at least one sleeve (6); wire (62); at least one strip (62); at least one ring (63).