TW202315591A - Vascular and aortic connectors with robotic delivery - Google Patents

Abstract

A deployment tool and associated method are disclosed for implanting a vascular connector in a patient. The vascular connector deployment tool has a housing, an inner sheath extending distally from the housing, a floating mandrel, a vascular connector disposed coaxially about the mandrel, and an outer sheath telescopically deployed over an inner sheath. The outer sheath constrains the vascular connector around the mandrel in an insertion profile when the outer sheath is disposed over the vascular connector. The inner sheath may be rotated to cause the outer sheath to retract relative to the floating mandrel and expose sequential portions of the vascular connector. A drive disposed within the housing and coupled to a proximal end of the outer sheath translates rotational motion of the inner sheath into longitudinal motion of the outer sheath.

Description

Vascular and aortic connectors useful for robotic delivery and methods of placement thereof

The present invention relates generally to vascular connectors and aortic connectors, and more particularly to deployment tools and methods for deploying such connectors.

The circulatory system includes the aorta and other large-bore vessels, as well as smaller-bore vessels and capillaries. The use of interventional therapy to replace or brace a diseased or damaged vessel may involve the use of synthetic grafts to maintain or restore patency of the affected vessel to perfuse downstream anatomy. Although diseases and other conditions are known to affect all types of blood vessels, due to blood flow and pressure being pumped through the aorta, diseases and other conditions affecting the aorta may be more serious and more likely to result in death. Thus, the examples discussed below are constructed in the context of an aortic graft, but it should be understood that the techniques of the present disclosure are applicable to other parts of a patient's vasculature.

Aortic aneurysm is a serious condition that can affect any part of the aorta. An aortic aneurysm in the abdomen is called an abdominal aortic aneurysm, or AAA; an aortic aneurysm in the chest cavity is called a thoracic aortic aneurysm, or TAA, and an aneurysm in the chest cavity above the aortic arch is called an aortic arch aneurysm. Aortic aneurysms can be caused by different causes such as untreated or severe high blood pressure, smoking, general diseases such as Marfan’s syndrome, and degenerative dilation of the aortic wall. Thoracic aortic aneurysms are caused by relaxation of the aortic wall, resulting in localized dilation, and are a life-threatening condition. Patients with thoracic aneurysms are usually asymptomatic until the aneurysm expands. The most common symptoms are pain and aortic rupture. A ruptured aneurysm can cause severe internal bleeding that can quickly lead to shock or death.

Patients with acute dissection are typically painful and are classified as an emergency because the risk of aortic wall rupture and dissection could compromise the integrity of the aortic valve and affect myocardial perfusion by affecting the origin of the coronary arteries. Typically, dissection of the ascending aorta extending into or involving any artery of the aortic arch requires surgical insertion of a graft to replace the diseased portion of the ascending aorta and an additional graft to reconstruct the aorta from any dissection or disease present. Arterial blood flow in each branch of the artery. The graft can be connected to the vasculature by expanding the connector from the insertion configuration to the deployment configuration to secure the graft to the vessel. The procedure may also involve the insertion of an additional stent designed to provide blood flow from the ascending aorta to the vasculature distal to the descending aorta. Conditions affecting other parts of the patient's vasculature may also be treated in a similar manner.

Compound thoracic aortic disease includes acute A-dissection (AAD) and chronic A-dissection (CAD), as well as aortic arch aneurysms with or without involvement of the ascending and descending aorta. Aortic dissection is the result of a tear in the inner layer of the aortic wall that allows blood to enter and separate the vessel layers of the vessel wall. Acute aortic dissection was defined as those identified within the first 2 weeks after the initial tear, whereas chronic dissection was defined as those identified over a period greater than 2 weeks. Aortic dissections are classified according to their location and extent of involvement of the thoracic aorta. Stanford type A dissection affects the ascending aorta and can extend to the arch and descending thoracic aorta. Stanford type B dissection does not affect the ascending aorta but usually involves the descending thoracic aorta ending at the origin of the left subclavian artery. About two-thirds of aortic dissections are Stanford type A.

Treatment of complex thoracic aortic disease usually requires lengthy and complex open surgery. During such procedures, the patient is usually placed on a cardiopulmonary bypass pump and the heart is stopped to allow the aorta to be clamped and operated on. Although the patient is on cardiopulmonary bypass, the patient is usually cooled to a hypothermic state. The risk of a patient not surviving the procedure is directly related to the duration of time the patient is on pump and hypothermia.

Accordingly, it would be desirable to provide tools and methods for placing aortic connectors for aneurysm repair to facilitate and expedite their placement. Similarly, it would also be desirable to provide tools and methods that can be used to place connectors in other parts of a patient's vasculature. Still further, it would be desirable to provide tools and methods that can be used as part of a machine or robotic automated delivery program. These and other objectives are met by the present disclosure, as will be described in detail in the following materials.

The present disclosure relates to a vascular connector delivery tool having a housing; an inner sheath extending distally from the body housing, wherein the inner sheath is rotatable relative to the housing; a floating mandrel; a connector, It couples the floating mandrel to the distal end of the inner sheath so that the inner sheath can rotate relative to the floating mandrel; a blood vessel connector is coaxially arranged around the mandrel; an outer sheath is telescopically placed in the inner sheath sleeve, wherein when the outer sheath is disposed on the blood vessel connector, the outer sheath is configured to constrain the blood vessel connector in an insertion configuration around the mandrel; and a driver is disposed in the housing and is coupled to the proximal end of the outer sheath end and is configured to convert rotational motion of the inner sheath into longitudinal motion of the outer sheath.

In one aspect, the driver can be coaxially disposed on the proximal portion of the inner sheath and engaged with external threads on the proximal portion of the inner sheath. The driver can travel along a guide in the housing that allows longitudinal movement and resists rotational movement.

In one aspect, the driver can be configured to translate a first predetermined amount of rotation of the inner sheath into a first known amount of longitudinal movement of the outer sheath. The first known amount of longitudinal movement may expose the distal portion of the vascular connector. Further, the driver may be configured to convert a second predetermined amount of rotation of the inner sheath into a second known amount of longitudinal movement of the outer sheath, and wherein the second known amount of longitudinal movement exposes the vascular connector proximal part.

In one aspect, the inner sheath has an interface extending from the proximal end of the housing, the interface configured to rotate the inner sheath.

In one aspect, the floating mandrel can include a shoulder configured to engage and resist proximal longitudinal movement of the vessel connector when the outer sheath is retracted.

In one aspect, the vascular connector is visible through the outer sheath. Alternatively or additionally, the outer sheath may have a marking configured to indicate the position of the vessel connector prior to retraction of the outer sheath.

In one aspect, the vascular connector can be a self-expanding connector capable of maintaining radial force over a temperature range of 19°C to 37°C.

In one aspect, the floating mandrel and inner sheath can have a guide wire lumen.

The present disclosure also includes a method for implanting a vascular connector in a patient. The method includes providing a vascular connector deployment tool comprising a housing; an inner sheath extending distally from the body housing, wherein the inner sheath is rotatable relative to the housing; a floating mandrel; a connector coupling the floating mandrel to the distal end of the inner sheath so that the inner sheath can rotate relative to the floating mandrel; a vessel connector coaxially disposed about the mandrel, and an outer sheath , telescopically placed on an inner sheath, wherein when the outer sheath is disposed on the vascular connector, the outer sheath is configured to constrain the vascular connector in an insertion configuration around the mandrel. At least a distal portion of the vascular connector is positionable within a first lumen for conducting blood from a patient. A rotatable inner sheath retracts the outer sheath relative to the floating mandrel and exposes the distal portion of the vascular connector. The distal portion of the vessel connector can be secured within the first lumen by expanding a portion of the vessel connector from the insertion configuration.

In one aspect, rotation of the inner sheath longitudinally moves a driver disposed within the housing and coupled to the proximal end of the outer sheath. Rotating the inner sheath includes imparting a first predetermined amount of rotation to cause a first known amount of longitudinal movement of the outer sheath such that the first known amount of longitudinal movement exposes the distal portion of the vessel connector.

In one aspect, the further manipulation may include coaxially advancing a second lumen for conducting the patient's blood over the deployment tool until an end of the second lumen is adjacent the opening of the first lumen. Rotating the inner sheath further retracts the outer sheath relative to the floating mandrel and exposes the remainder of the vessel connector. The remainder of the vessel connector can be secured within the second lumen by expanding a portion of the vessel connector from the insertion configuration. Further rotating the inner sheath may include imparting a second predetermined amount of rotation to the inner sheath to cause a second known amount of longitudinal movement of the outer sheath such that the second known amount of longitudinal movement exposes the proximal portion of the vessel connector.

In one aspect, the first lumen is a blood vessel and the second lumen is a graft.

In one aspect, positioning at least the distal portion of the vascular connector within the first lumen can include making the vascular connector visible through the outer sheath. Alternatively or additionally, positioning at least the distal portion of the vascular connector within the first lumen may include using a marker indicating the position of the vascular connector prior to retraction of the outer sheath.

It should be understood at the outset that this invention is not limited per se to particularly exemplified materials, structures, procedures, methods or configurations, which may vary. Thus, while there are many of the foregoing options, those similar or equivalent to those described herein can be used in the practice or embodiment of the invention, which describes the preferred materials and methods.

It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments of the invention only and is not intended to be limiting.

The detailed description set forth below in relation to the accompanying drawings is to be considered a description of exemplary embodiments of the invention and is not intended to represent the only exemplary embodiments in which the invention may be practiced. The term "exemplary" as used throughout the present specification means "serving as an example, instance, or illustration" and should not necessarily be construed as preferred or superior to other exemplary embodiments. The detailed description includes specific details for the purpose of providing a thorough understanding of the exemplary embodiments of the present description. It will be apparent to those having ordinary skill in the art to which this invention pertains that the illustrative embodiments described herein may be practiced without these specific details. In some instances, well-known structures and devices are shown in block diagram form in order to avoid obscuring the novelty of the illustrative embodiments presented herein.

For convenience and clarity purposes only, directional terms such as up, down, left, right, below, above, above, below, below, behind, behind and forward may be used with respect to the attached drawings. These similar directional terms should not be construed in any way as limiting the scope of the invention.

Unless otherwise defined, all technical and scientific terms used in this application have the same meaning as commonly understood by those skilled in the art to which this invention belongs. As used in this document and commonly used in the art, the term "substantially" and similar similar terms refer to normal variations in finished product dimensions and other characteristics resulting from manufacturing tolerances and other manufacturing imprecisions. Finally, as used in this specification and the appended claims, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise.

Referring to FIG. 1 , a vascular connector 10 is shown, which may be adapted for use in the aorta or other suitable location in the patient's vasculature, by connecting a vessel 12 (eg, a cuttable vessel) to a graft 14 (eg, a branch). graft) to assist in establishing or restoring fluid or blood connectivity. Graft 14 may be made of any suitable substance or material, such as, but not limited to, polytetrafluoroethylene (PTFE) or polyester, such as polyethylene terephthalate (PET), sometimes referred to as DACRON® brand polyester , available from E. I. Du Pont De Nemours and Company of Wilmington, Delaware. The blood vessel connector 10 can be expanded from a first insertion diameter to a second placement diameter, and has the ability to expand from a first insertion diameter to a second placement diameter and firmly hold the blood vessel connector in the blood vessel 12 and in the expanded state. Any structure within graft 14. As an example, the vascular connector 10 may include a plurality of hoops 16 extending around, similar in design to a stent. The hoops 16 may be spaced apart longitudinally, in which case adjacent hoops 16 may be connected by one or more tie rods 18 . Alternatively, adjacent hoops 16 are not spaced apart, but abut or overlap each other. In this configuration, such adjacent hoops 16 may be fixed to each other, for example by laser welding. The hoop 16 may be made of metal or other materials. Each ferrule 16 may have a composite shape, wherein the ferrule 16 is made of wire, or by laser cutting a tube, or otherwise manufactured such that the ferrule 16 has a compound shape, such as a zigzag, a repeating zigzag, Zigzag curves or other shapes. Such a shape allows the ferrule 16 to expand from an insertion diameter to a deployment diameter. The sawtooth pattern of at least one hoop 16 may be continuously curved, or may comprise straight sections connected by curved sections. In one embodiment, the serrated pattern of hoop 16 may be, for example, that shown in expired US Patent No. 4,580,568, which is incorporated herein by reference in its entirety. However, hoop 16 may be configured in different ways.

In one embodiment, different hoops 16 may be made of different materials. For example, at least one hoop 16 may be made of a superelastic material, such as Nitinol, and at least one other hoop 16 may be made of a plastically deformable material, such as 316L stainless steel. Different materials may be interspersed between adjacent hoops 16 so that hoops 16 are not adjacent to hoops 16 composed of the same material. In other embodiments, several hoops 16 composed of the same material may be grouped together, and at least one hoop 16 composed of a different material may be adjacent to the group of several hoops 16 . For example, the ferrule 16 at the outer end of the vessel connector 10 may be constructed of stainless steel, while the remainder of the ferrule 16 may be constructed of a superelastic material such as Nitinol. By using ferrules 16 made of different materials, vessel connector 10 can take advantage of the different properties of these different materials. For example, one or more ferrules 16 made of superelastic material are useful for self-expanding vascular connector 10 . One or more additional ferrules 16 made of a plastically deformable material such as 316L stainless steel may be used to maintain the expansion of the lumen or lumen of the vascular connector 10 since such materials are more resistant to hoop stresses, And it is not easy to revert to a different crystal phase after expansion. Furthermore, such hoops 16 are manufactured to be structurally set to maintain their radial force over a temperature range of 19°C to 37°C. Although the term "cuff" is used herein, the cuff 16 need not be perfectly round when viewed end-on, and can have different shapes and curvatures to suit a particular application. In some embodiments, hoop 16 is substantially circular when viewed from the end.

In one embodiment, several opposite ends of the blood vessel connector 10 each expand to the same or similar diameter in the deployed state. In other embodiments, one end expands to a different diameter than the other end in the deployed state to allow connection of vessels 12 and grafts 14 having different diameters. The difference in diameter may be controlled by controlling the diameter of the ferrules 16 at each end, by providing different combinations of ferrules 16 having different materials, or in any other suitable manner.

As mentioned above, the vascular connector 10 can be used to connect the blood vessel 12 to the graft 14, and correspondingly preferably, half the length of the connector 10 needs to be placed in the blood vessel 12 first, and then the other half of the connector 10 can be placed. within the graft 14 to effectively connect the blood vessel 12 to the graft 14 . Accurate placement of an appropriate amount of connectors 10 into both the blood vessel 12 and the graft 14 is advantageous, because placing too many connectors 10 in the blood vessel 12 can compromise connections within the graft 14, while in the blood vessel 12 Placing too few connectors 10 compromises the connection within the blood vessel 12, and it will be understood that both situations can be disastrous for the patient. Proper visualization greatly facilitates any open surgical procedure, so the presently disclosed techniques enhance the ability to accurately assess the proper amount of connector 10 within a vessel 12 or branch graft 14 during surgery, as discussed in detail below.

Thus, vascular connector 10, or a connector of similar nature, may be placed using deployment tool 20, shown in cross-section in FIG. 2 and partially schematically in exploded view in FIG. 3 depicting the coaxial relationship of the various components. The placement tool 20 includes a housing 22 containing a nut driver 24 coupled to an outer sheath 26 and driven by rotation of an inner sheath 28 . At the distal end of the deployment tool 20 is a floating mandrel 30 with a blunt, atraumatic tip 32 . As shown, vessel connector 10 surrounds floating mandrel 30 and is held in its compressed configuration at least partially against floating mandrel 30 by outer sheath 26 . Outer sheath 26 is telescopically disposed over inner sheath 28 , floating mandrel 30 and connector 10 and is selectively retractable via rotation of inner sheath 28 . In particular, the nut driver 24 has a projection 34 that moves longitudinally within a rail 36 of the housing 22, these components being shown in the detailed inset of FIG. 2 . The nut driver 24 also has internal threads 38 which engage external threads 40 on the proximal portion of the inner sheath 28, acting as a lead screw to produce the desired longitudinal direction corresponding to the rotation of the inner sheath 28. sports. As outer sheath 26 is coupled to nut driver 24, proximal movement of nut driver 24 produces a corresponding retraction of outer sheath 26 to expose and seat connector 10, as described in further detail below. As shown in FIG. 3, the coupling of ball 42 and receptacle 44 maintains the relative longitudinal position of floating mandrel 30 relative to inner sheath 28, but allows inner sheath 28 to rotate freely during deployment. Shoulder 46 has an outer diameter similar to the inner diameter of outer sheath 26 and resists unintended proximal movement of connector 10 during deployment when the outer sheath is retracted. In an alternate embodiment, a similar function may be provided by a shoulder structure located near the distal end of the inner sheath 28 . A guidewire lumen 48 is provided by the floating mandrel 30 and inner sheath 28 to facilitate advancement of the placement tool 20 to a desired location within the patient's vasculature.

In one embodiment, the interface 50 at the proximal end of the inner sheath 28 is configured to mate with a robotic arm or similar tool so that delivery or deployment of the connector 10 can be accomplished under machine control. Notably, a precise amount of rotation can be applied to the inner sheath 28 to achieve a similarly precise amount of retraction of the outer sheath 26, which would facilitate the multi-stage delivery of the connector 10 described above. However, in other embodiments, the inner sheath 28 may also be manually actuated and may have a handle or other actuator suitable for this purpose.

Outer sheath 26 may cover the entire length of vascular connector 10 prior to retraction, and it may be desirable to sequentially deploy different predetermined portions of connector 10 based on the characteristics of connector 10 and the goals of the placement procedure. In the following example, for purposes of illustration (not limitation), the distal 3.5 cm portion of a 7 cm connector may be placed in the patient's native blood vessel 12 during the first stage, and then, after proper positioning, the remaining proximal 3.5 cm Portions may be placed in graft 14. The distance can vary as needed depending on the length of the connector 10 and the desired coverage ratio. Outer sheath 26 may be formed from a suitable polymeric material, such as nylon (polyamide), urethane, polypropylene, and polyamide copolymers, such as polyether block amide (PEBAX®), or other materials may be used . In some embodiments, outer sheath 26 has sufficient translucent properties to allow visualization of connector 10 to help ensure proper placement, such as by using a substantially clear and transparent polymer. It should be appreciated that clarity is relative, and for the purposes of this disclosure, any difference in optical characteristics sufficient to enable connector 10 to be visible through outer sheath 26 may be used. Alternatively, the outer boot 26 may have markings 52 to indicate the relative position of the connector 10 . For example, marking 52 may represent the midpoint of connector 10 prior to any retraction of outer sheath 26 .

As will be appreciated, the controlled amount of retraction of outer sheath 26 facilitates accurate placement of connector 10 within vessel 12 and graft 14 . For example, in a symmetrical placement procedure involving the connector 10, the connector 10 can be placed within the blood vessel 12 by positioning the placement tool 20 (possibly also under automatic control of the machine), and giving the inner sheath 28 a known The amount of rotation, so that half of the connector 10 is exposed and placed. Subsequently, after the graft 14 is positioned over the proximal portion of the connector 10, the inner sheath 28 may be given another known amount of rotation to complete deployment. Again, it should be understood that rotation of the inner sheath 28 to seat the connector 10 can also be performed manually, if desired.

By way of illustration only and not limitation, FIGS. 4-7 schematically depict connection of vessel 12 to graft 14 with connector 10 using deployment tool 20 . As shown in FIG. 4, deployment tool 20 may be advanced into vessel 12 (possibly while passing through lumen 48) based on visualization through outer sheath 26 or use of connectors, markers 52, or a combination of these and other techniques. lead, but not shown in this view for clarity), until the desired number of connectors 10 have been positioned within the blood vessel 12 . Next, FIG. 5 schematically illustrates the placement of the distal portion of the connector 10 disposed within the blood vessel 12 due to rotation of the inner sheath 28 . As noted, this can be performed under machine automation by imparting a predetermined amount of rotation via interface 50 . As noted above, the lead screw function of the external threads 40 engaging the internal threads 38 of the nut driver 24 converts rotation of the inner sheath 28 into longitudinal movement of the outer sheath 26 as it is coupled to the nut driver 24 . Specifically, rotation of the inner sheath 28 in the appropriate direction causes the outer sheath 26 to retract, exposing the connector 10 sequentially from its distal end to its proximal end. The coupling engagement of ball 42 and receptacle 44 maintains floating mandrel 30 in the same relative longitudinal position within deployment tool 20 and does not rotate with inner sheath 28 . Additionally, shoulder 46 helps to overcome friction of outer sheath 26 to prevent longitudinal displacement of connector 10 . As shown, retraction of the outer sheath 26 allows the now exposed distal portion of the connector 10 to expand from the floating mandrel 30 from its inserted configuration to its deployed configuration to engage and secure the blood vessel 12 . Next, as shown in FIG. 6 , graft 14 may be advanced coaxially over deployment tool 20 until it is adjacent to vessel 12 , such as by abutting or otherwise coming close enough. Further rotation of the inner sheath 28 now causes additional retraction of the outer sheath 26 to expose the remaining proximal portion of the connector 10 so that it can expand from its inserted configuration to its deployed configuration to engage and secure the graft 14 . The deployment tool 20 can now be withdrawn proximally, leaving the connector 12 in place to connect the vessel 12 to the graft 14 . Although the embodiment shown in FIGS. 4 to 7 discusses connecting a vessel 12 to a graft 14 in an end-to-end configuration, the technique can be applied to any vessel, graft, or other lumen that connects a patient's blood. combination, and can also be used with intravascular access through openings formed in the side walls of blood vessels, grafts, or other lumens.

While the invention has been described in detail, it will be apparent to those skilled in the art that various changes and modifications can be made and equivalents employed without departing from the invention. It should be understood that the present invention is not limited to the details of construction, component arrangements and/or methods described above or illustrated in the drawings. The statements in the abstract of this article, and any general statements in this article, are illustrative only; they are not and cannot be construed as limiting the scope of the patent application. Again, the illustrations are illustrative only and not restrictive. Section headings and subheadings are for the convenience of the reader only and should not and cannot be construed as having any substance, implication or interpretation, and should not and cannot be taken to indicate that all information pertaining to any particular topic should be included in any particular heading or subtitles found or restricted. Accordingly, the invention is not to be restricted or restricted except in accordance with the claims and their legal equivalents.

10: Vascular connector 12: blood vessel 14:Graft 16: hoop 18: tie rod 20: Placing tools 22: shell 24: Nut driver 26: Outer sheath 28: inner sheath 30: floating mandrel 32: tip 34: protruding part 36: guide rail 38: internal thread 40: external thread 42: Ball 44: jack 46: shoulder 48: lumen 50: interface 52: mark

Further features and advantages of the disclosure will become apparent from the following and more particular description of the preferred embodiment, as illustrated in the accompanying drawings, and wherein like reference characters generally mean the same throughout parts or elements, and of which:

FIG. 1 schematically illustrates a blood vessel connector for connecting blood vessels and grafts according to an embodiment of the present disclosure.

2 schematically illustrates a partial cross-sectional view of a placement tool for positioning and placing a vascular connector according to an embodiment of the present disclosure.

FIG. 3 schematically depicts an exploded view of components of the placement tool of FIG. 2 in coaxial relationship, according to an embodiment of the present disclosure.

Figure 4 schematically illustrates the positioning of a vascular connector within a blood vessel, according to an embodiment of the present disclosure.

5 schematically illustrates retraction of the outer sheath of the deployment tool to allow expansion of the distal portion of the vessel connector to secure it within the vessel, according to an embodiment of the present disclosure.

Figure 6 schematically illustrates advancing a graft over a placement tool to bring it closer to a blood vessel, according to an embodiment of the present disclosure.

7 schematically illustrates further retraction of the outer sheath of the deployment tool to allow expansion of the remainder of the vascular connector to secure it in the graft, according to an embodiment of the present disclosure.

10: Vascular connector

12: blood vessel

14:Graft

16: hoop

18: tie rod

Claims (20)

A vascular connector placement tool comprising: a shell; an inner sheath extends distally from the housing, wherein the inner sheath is rotatable relative to the housing; a floating mandrel; a connector coupling the floating mandrel to the distal end of the inner sheath such that the inner sheath is rotatable relative to the floating mandrel; a vascular connector disposed coaxially with the floating mandrel; an outer sheath telescopically positioned over the inner sheath, wherein when the outer sheath is disposed over the vascular connector, the outer sheath is configured to restrain the vascular connector around the floating mandrel such that it is in the shape of an insertion; and A driver is disposed within the housing and coupled to the proximal end of the outer sheath and configured to convert rotational motion of the inner sheath to longitudinal motion of the outer sheath. The blood vessel connector placement tool as claimed in claim 1, wherein the driver is coaxially disposed on the proximal portion of the inner sheath, and engages with the external thread on the proximal portion of the inner sheath. The vascular connector placement tool of claim 2, wherein the driver travels along a rail in the housing that allows longitudinal movement and resists rotational movement. The vessel connector placement tool of claim 2, wherein the driver is configured to translate a first predetermined amount of rotation of the inner sheath into a first known amount of longitudinal movement of the outer sheath. The vascular connector placement tool of claim 4, wherein the first known amount of longitudinal movement exposes the distal portion of the vascular connector. The vessel connector placement tool of claim 5, wherein the driver is configured to translate a second predetermined amount of rotation of the inner sheath into a second known amount of longitudinal movement of the outer sheath, and wherein The second known amount of longitudinal movement exposes the proximal portion of the vascular connector. The vessel connector placement tool as claimed in claim 4, wherein the inner sheath has an interface extending from the proximal end of the housing, and the interface is configured to rotate the inner sheath. The vessel connector placement tool of claim 1, wherein the floating mandrel includes a shoulder configured to engage and resist longitudinal movement of the proximal end of the vessel connector when the outer sheath is retracted . The blood vessel connector placement tool as claimed in claim 1, wherein the blood vessel connector is visible through the outer sheath. The vessel connector placement tool of claim 1, wherein the outer sheath includes a marker configured to indicate the position of the vessel connector before the outer sheath is retracted. The blood vessel connector placement tool as claimed in claim 1, wherein the blood vessel connector is a self-expanding connector capable of maintaining radial force within a temperature range of 19°C to 37°C. The vascular connector placement tool of claim 1, wherein the floating mandrel and the inner sheath include a guide wire lumen. A method of implanting a vascular connector in a patient, comprising: A blood vessel connector placement tool is provided, the blood vessel connector placement tool includes a housing; an inner sheath extending distally from the body housing, wherein the inner sheath is rotatable relative to the housing; a floating mandrel; a connector coupling the floating mandrel to the distal end of the inner sheath so that the inner sheath can rotate relative to the floating mandrel; a vascular connector disposed coaxially with the floating mandrel, disposed coaxially about the mandrel, and an outer sheath telescopically positioned over the inner sheath, wherein when the outer sheath is disposed on the vessel connector, the outer sheath is configured to be bound around the the vascular connector of the floating mandrel makes an insertion configuration around the mandrel; positioning at least the distal portion of the vascular connector within a first lumen for guided placement in the patient's blood; rotating the inner sheath to retract the outer sheath relative to the floating mandrel and expose the distal portion of the vascular connector; and A distal portion of the vascular connector is secured within the first lumen by expanding a distal portion of the vascular connector from the insertion profile. The method of claim 13, wherein rotation of the inner sheath causes longitudinal movement of a driver disposed within the housing and coupled to the proximal end of the outer sheath. The method of claim 14, wherein rotating the inner sheath includes imparting a first predetermined amount of rotation to cause a first known amount of longitudinal movement of the outer sheath such that the first known amount of longitudinal movement reveals The distal portion of the vascular connector. The method as described in claim item 15, which further comprises: coaxially advancing a second lumen for guiding the patient's blood over the deployment tool until the end of the second lumen is adjacent the opening of the first lumen; further rotating the inner sheath retracts the outer sheath relative to the floating mandrel and exposes the remainder of the vascular connector; and The remaining portion of the vascular connector is secured within the second lumen by expanding the remaining portion of the vascular connector from the insertion configuration. The method of claim 16, wherein further rotating the inner sheath comprises imparting a second predetermined amount of rotation to the inner sheath to cause a second known amount of longitudinal movement of the outer sheath such that the second already A known amount of longitudinal movement exposes the proximal portion of the vascular connector. The method of claim 16, wherein the first lumen is a blood vessel, and the second lumen is a graft body. The method of claim 13, wherein placing at least a distal portion of the vascular connector positioned within the first lumen comprises viewing the vascular connector through the outer sheath. The method of claim 13, wherein placing at least the distal portion of the vascular connector within the first lumen comprises using a marker that indicates the vascular connection prior to retraction of the outer sheath location of the device.

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