Patent Publication Number: US-2011054501-A1

Title: Securing device and assembly comprising such a securing device

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is the National Stage of International Application No. PCT/NL2008/050185, filed Apr. 3, 2008, the contents of which is incorporated by reference herein. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to a securing device for an anastomosis connection, comprising a ring;
         in which the ring has an axial axis which is defined as an axis at right angles to the annular plane surrounded by the ring and through the center of the ring;   in which the ring has a first transverse axis and a second transverse axis, which are at right angles to one another and are both also at right angles to the axial axis, and which together define a transverse plane;   in which the first transverse axis divides the ring into a first half and a second half; in which the transverse plane has a first side along which the first half of the ring extends and a second side along which the second half of the ring extends.       

     BACKGROUND OF THE INVENTION 
     Although it is not a securing device, a ring of this type is known for use with an anastomosis connection. A ring of this type is disclosed in EP 750,476. Said publication describes what is referred to as the ELANA technique (Elana=Excimer Laser Assisted Nonocclusive Anastomosis). The present invention is particularly intended for use with the ELANA technique, but can also be used for other medical procedures. 
     The ELANA technique is used to produce an anastomosis without temporarily closing off the receiving vessel, also referred to as target vessel. With the ELANA technique, the through-flow of the target vessel is not interrupted while the anastomosis is performed. Neurosurgeons, as well as other surgeons, use this technique to perform bypass operations. However, this ELANA technique can also be applied in other areas of surgery, such as cardiac surgery and general vascular surgery. The present invention can also be used in the case of these medical procedures. 
     The ELANA technique involves placing an implantable ring around the distal end of a graft vessel, folding the section of the wall of the graft vessel, which is distal from the ring, back over approximately 90° or approximately 180° around the ring in order to form a distal mouth of the graft vessel reinforced by the ring. Said reinforced distal mouth is then attached to the wall of the target vessel, usually by suturing the graft vessel to the target vessel by means of approximately 8 stitches. Depending on the ability of the surgeon, the location of the target vessel and the condition of the patient, said attachment generally takes between 15 minutes and one hour or more. During this attachment procedure, there is still no through-flow connection between the graft vessel and the target vessel. After the attachment procedure, a laser catheter is inserted into the graft vessel in order to create an opening between the graft vessel and the target vessel by burning away the wall section of the target vessel which is situated in front of the distal mouth of the graft vessel. Blood flows through the target vessel during the entire operation, as a result of which temporary closure of the target vessel is prevented. 
     SUMMARY OF THE INVENTION 
     It is an object of the present invention to provide a securing device by means of which the procedure of attaching the graft vessel to the target vessel can be carried out in a relatively quick and easy manner, and by means of which a reliable connection can be achieved. 
     According to the invention, this object is achieved by providing a securing device for an anastomosis connection, comprising a ring provided with two cantilever pins; in which the ring has an axial axis which is defined as an axis at right angles to the annular plane surrounded by the ring and through the center of the ring;
         in which the ring has a first transverse axis and a second transverse axis, which are at right angles to one another and are both at right angles to the axial axis, and which together define a transverse plane;   in which the first transverse axis divides the ring into a first half and a second half;   in which the transverse plane has a first side along which the first half of the ring extends and a second side along which the second half of the ring extends;   in which each cantilever pin, at in each case one attachment site, is connected to the ring by a fixed end in order, in a cantilevered manner, to extend from the ring to the other, free end of the pin, which free end is pointed;   in which, viewed from the ring, the pins extend in the same direction in the transverse plane;   in which, viewed in the transverse plane, the free ends of the pins are situated on the second side of the transverse plane;   in which the attachment sites are situated on the first half of the ring.       

     The first half of the ring also includes the boundary thereof, that is to say the first transverse axis, so that one or both attachment sites can also be on the first transverse axis. 
     The pointed ends of the pins point in the same direction so that they can readily pierce the wall of the target vessel together to end up in the target vessel and then to run in the length direction of the target vessel along the inside of the wall of the target vessel. As the fixed ends of the pins, that is to say the attachment sites, are situated on the first half of the ring, as the pins extend from there underneath the second half of the ring, past said second half, and as, in the position where they are pierced into the target vessel, a section of the wall of the target vessel is situated between the second half of the ring and the pins, the wall of the target vessel provides resistance against tilting of the securing device—with respect to the target vessel—about a tilting axis which runs parallel to the first transverse axis. In addition, the securing device provides a resistance against tilting—with respect to the target vessel—about some other tilting axis. Thus, a relatively stable connection can be achieved. 
     The attachment by means of the securing device according to the invention can be improved further, if the sections of the pins extending along the second side of the transverse plane have a tapering zone in which said pins, viewed in the direction of the free ends thereof, taper towards one another. A first advantage thereof is that, as a result of the tapering, the pierced holes in the wall of the target vessel, which were caused by piercing the pointed ends through the wall, will be pulled apart when the pins are pushed further inwards through the pierced holes. In this connection, it has been found that the pins also keep the section of the target vessel between the latter taut after the securing device has been placed. Thus, the wall of the target vessel, in the region of the second half of the ring, will be pulled taut in a direction parallel to the first transverse axis. This facilitates the removal of the section of the wall of the target vessel which is situated in front of the distal mouth of the graft vessel. According to the ELANA technique, a laser can be used for the removal of said section of the wall of the target vessel, but another instrument, such as a knife, can also be used. A second advantage is that, as a result of said tension, the securing device will not readily become dislodged (i.e. slide out again in a direction opposite to the insertion direction). A third advantage is that as a result of said tension, the above-described tilting of the securing device with respect to the target vessel is prevented further. A fourth advantage is that, as a result of the pointed ends, due to the tapering, being closer to one another, said pointed ends can be more readily pierced into a bulging target vessel—through which the blood or another medium is still flowing. After all, the circular arch of the wall of the target vessel—which arch extends between the piercing locations—will be shorter. The target vessel then does not have to be flattened to such a large degree during piercing. 
     It is furthermore advantageous in this connection if, in said tapering zone, the perpendicular projection of said pins on said transverse plane at least partially coincides with the perpendicular projection of the ring on said transverse plane and does not fall within the perpendicular projection of the ring on said transverse plane. The result thereof is, on the one hand, that the pins, viewed in the axial direction, partially exactly overlap the ring and do not obstruct the passageway of the graft vessel to the target vessel, which passageway is to be formed later, and, on the other hand, that the pins do not flatten the target vessel to an excessive degree at the location of the anastomosis which is to be formed. It should be noted here that if the ring is flat and extends in the transverse plane, the projection of the ring on the transverse plane then coincides with the ring itself. 
     According to a further embodiment of the invention, the attachment site of both pins is situated at a distance from the first transverse axis. This results in the wall of the target vessel also being pulled taut in a section of the first half of the ring in a direction parallel to the first transverse axis. In order, in this case, to pull the wall of the target vessel in a relatively large section of the first half of the ring, it is advantageous according to the invention if said distance to the first transverse axis is at least 10% of the radius of the ring, in particular at least 25% of the radius of the ring, more particularly at least 50% of the radius of the ring, even more particularly at least 70% of the radius of the ring. 
     In this case, it is furthermore advantageous if, in the first side of the transverse plane, the perpendicular projection of the pins on said transverse plane coincides with the perpendicular projection of the ring on said transverse plane. The result thereof is that, on the one hand, the pins, viewed in the axial direction, partially exactly overlap the ring and do not obstruct the passageway of the graft vessel to the target vessel, which passageway is to be formed later, and, on the other hand, that the pins do not flatten the target vessel to an excessive degree at the location of the anastomosis which is to be formed. Again, it should be noted here that if the ring is flat and extends in the transverse plane, the projection of the ring on the transverse plane then coincides with the ring itself. Furthermore, this results in the surgeon being able to feel when the widest point between the pins has been passed when fitting the securing device on the target vessel since the resistance which has to be overcome is reduced. The surgeon can then, by feel, accurately determine whether the fitting has been carried out correctly. 
     In order to prevent excessive flattening of the target vessel at the location of the anastomosis, it is advantageous, according to the invention, if the distance between the pins is at most equal to the diameter of the ring. 
     According to a further embodiment, the distance between the free ends is at least equal to the radius of the ring, in particular said distance is at least equal to 1.5× the radius of the ring. This prevents the target vessel from tearing when the pins are being inserted due to excessive stretching of the section of the wall of the target vessel between the pins. 
     In order to ensure that the wall of the target vessel between the attachment points does not sag, it is advantageous, according to the invention, if the distance between the attachment sites of the pins is greater than or equal to the distance between the free ends of the pins. It is advantageous if both these distances are equal or approximately equal. This offers the advantage that the pierced holes are virtually stress-free when the securing device has been fitted. 
     According to a further embodiment of the invention, the pins extend substantially under the transverse plane while the free ends of the pins are situated above the transverse plane. Thus, in the fitted state, the pointed ends can project outwards through the wall of the target vessel. The pointed ends may, if desired, be covered in order to protect the surrounding tissue from the tips, or be treated in another manner. 
     According to yet a further embodiment of the invention, a tangent axis is defined as extending parallel to the first transverse axis and touching the ring; and a projection length is defined as the distance of the free ends to the tangent axis, which projection length is greater than 0.05 mm. This ensures that the pointed ends of the pins project outside the contour of the ring, which offers a good view of the pointed ends during fitting. It is particularly advantageous for said good view if the projection length is at least 0.5× the radius of the ring, in particular at least 1× the radius of the ring. Even when a distal end portion of the wall of the graft vessel is folded back around the ring, the pins will project beyond the thickening, which results from this folding back, and remain visible. As the thickness of the wall of a graft vessel is usually considerably thinner than 0.5 mm, the projection length can be assumed to be at least 0.5 mm. In order not to affect the flexibility of the target vessel too much, it is in this case furthermore advantageous, according to the invention, if the projection length is at most 3× the radius of the ring, preferably at most 2× the radius of the ring. 
     According to yet a further embodiment of the invention, the perpendicular projection of a pin on the transverse plane, over a coinciding zone, coincides with the perpendicular projection of the ring on the transverse plane; and the distance of the pin to the ring in said coinciding zone is substantially at least 0.2 mm and at most 1.5 mm, in particular at most 0.7 mm. Said distance may, for example, be approximately 0.5 mm. This ensures, for graft vessels and target vessels of different dimensions, that, in the coinciding zone, both the vessel wall of the graft vessel and the vessel wall of the target vessel together fit between the ring and the pin in a clamping manner. 
     According to a further embodiment, the ring and pins are made from a single uninterrupted piece of wire, with the pins, from the attachment sites, merging with the ring via a twisted winding in a section of the ring. Thus, it is ensured in a very reliable manner that the pins cannot become detached at the attachment sites of the ring. 
     According to a further aspect, the invention relates to an assembly comprising:
         a securing device according to the invention; and   a graft vessel;       

     in which the distal end of the graft vessel is inserted in the ring. 
     In this case, the pins may be inserted into the section of the wall of the graft vessel which is distal from the ring, but preferably, the pins run through incisions provided in the distal end of the graft vessel. 
     With this assembly, the graft vessel may be either an artificial vessel, such as an artificial blood vessel, or a (natural) donor vessel, which may be of animal origin or of human origin. Preferably, the graft vessel will be taken from the patient himself or be an artificial vessel. The graft vessel and the securing device can be prepared so as to form said assembly completely outside of the patient&#39;s body. This may be carried out in a laboratory at a distance from the patient, even while the patient is not being treated and is, for example, at home. However, this can also be carried out next to the patient while the patient is on the operating table before the operation. 
     According to a further embodiment of the assembly according to the invention, the section of the wall of the graft vessel which is distal from the ring, at least on the second side of the transverse plane, is folded back until it bears against the section of the wall of the graft vessel which is proximal to the ring. Thus, the prepared assembly can be attached to the target vessel while allowing a good view of the pins. 
     According to yet a further embodiment of the assembly, it is advantageous in this case if the projection length is at least 1× the thickness of the wall of the graft vessel, preferably at least 2× the thickness of the wall of the graft vessel. Thus, a sufficiently good view of the pointed ends of the pins is ensured during fitting on the target vessel. 
     According to another further embodiment of the assembly, the assembly furthermore comprises a catheter, in particular a laser catheter, with the graft vessel being pushed onto the distal end of the catheter. This assembly may also be prepared completely outside the patient&#39;s body. The catheter which has already been pushed into the graft vessel makes it easier to handle the graft vessel when the pins are inserted into the target vessel. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present invention will be explained in more detail with reference to embodiments which are diagrammatically illustrated in the drawing, in which: 
         FIG. 1  shows a bottom view ( FIG. 1A ) and side view ( FIG. 1B ) in accordance with arrow Ib of a first embodiment of the securing device according to the invention; 
         FIG. 2  shows a bottom view ( FIG. 2A ) and a side view ( FIG. 2B ) in accordance with arrow IIb of a second embodiment of the securing device according to the invention; 
         FIG. 3  shows a bottom view ( FIG. 3A ) and side view ( FIG. 3B ) in accordance with arrow IIIb of a third embodiment of the securing device according to the invention; 
         FIG. 4  shows a bottom view ( FIG. 4A ) and side view ( FIG. 4B ) in accordance with arrow IVb of a fourth embodiment of the securing device according to the invention; 
         FIG. 5  shows a bottom view ( FIG. 5A ) and a side view ( FIG. 5B ) in accordance with arrow Vb of a fifth embodiment of the securing device according to the invention; 
         FIG. 6  shows a bottom view ( FIG. 6A ) and side view ( FIG. 6B ) in accordance with arrow VIb of a sixth embodiment of the securing device according to the invention; 
         FIG. 7  shows a perspective bottom view of an assembly according to the invention; 
         FIG. 8  shows, in 3 steps ( FIGS. 8A ,  8 B and  8 C, respectively), how a graft vessel can be attached to a target vessel by means of the securing device according to the invention; 
         FIG. 9  shows a longitudinal section ( FIG. 9A ) and end view ( FIG. 9B ) of a further assembly according to the invention; and 
         FIG. 10  shows a top view of a preferred manner in which the securing device is made from a single piece of wire. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       FIGS. 1 to 6  show six variants of embodiments of the securing device according to the invention. The variant in  FIG. 1  is denoted overall by reference numeral  1 , the variant in  FIG. 2  is denoted overall by reference numeral  2 , the variant in  FIG. 3  is denoted overall by reference numeral  3 , the variant in  FIG. 4  is denoted overall by reference numeral  4 , the variant in  FIG. 5  is denoted overall by reference numeral  5 , and the variant in  FIG. 6  is denoted overall by reference numeral  6 . For the remainder, identical parts in  FIGS. 1 to 6  are also denoted by the same reference numerals. The variant from  FIG. 5 , preferably in combination with the manufacturing procedure using a single wire from  FIG. 10 , is the embodiment which, in the Applicant&#39;s current opinion, is the most preferred embodiment. 
       FIG. 1  shows a securing device  1  comprising a ring  11  and two pins  12 . 
     The ring  11  has an axial axis  13  which passes through the center  14  of the ring and is at right angles to the plane surrounded by the ring. Furthermore, the ring has a first transverse axis  15  and a second transverse axis  16 . The first transverse axis  15 , the second transverse axis  16  and the axial axis  15  together define an orthogonal axial system, that is to say they are all at right angles with respect to one another. 
     The first transverse axis  15  and the second transverse axis  16  together define a transverse plane which, in  FIGS. 1A ,  2 A,  3 A,  4 A,  5 A and  6 A, extends in each case parallel to the plane of the drawing and, in  FIGS. 1B ,  2 B,  3 B,  4 B,  5 B and  6 B, is in each case at right angles to the plane of the drawing. The first transverse axis  15  divides the transverse plane into a first side  17 —in each case to the left of the transverse axis  15  in FIGS.  1 - 6 —and a second side  18 —in each case to the right of the transverse axis  15  in  FIGS. 1-6 . The first transverse axis  15  divides the ring  11  further into a first half  11   a  (in each case the left half in  FIGS. 1-6 ) and a second half  11   b  (in each case the right half in  FIGS. 1-6 ). It should be noted that the boundary between the halves determined by the transverse axis  15  is part of the first half  11   a.    
     The pins  12  each have a fixed end  20  and a free end  21 , which is pointed. Each pin  12  is attached to the ring by the fixed end  21  at an attachment site  19 , in such a manner that the pin  12  extends from the ring  12  in a cantilevered manner as a cantilever pin. As can be seen in  FIG. 1  (and in  FIGS. 2-6 , as well), the free ends of the pins are on the right-hand side of the transverse axis  15 , or in other words on the second side of the transverse plane which is defined by the first transverse axis  15  and second transverse axis  16 . The attachment sites  19  are situated on the other side  17  of the transverse plane near, in this embodiment, the transverse axis  15 . The pins  12  are thus attached to the first half  11   a  of the ring  11 . The pins  12  therefore extend from one side—first side  17 —of the transverse plane to the other side—second side  18 —of the transverse plane. 
     Furthermore, in the figures, R denotes the radius of the ring  11 ; S denotes a tangent line on the ring which runs parallel to the transverse axis  15 ; L denotes the projection length of the pins, that is to say the distance of the ends of the pins  12  up to the tangent line S; M denotes the distance of the pin  12  up to the ring  11 , viewed in the direction of the axial axis; Q denotes the distance between the attachment sites  19 ; Y denotes the distance between the pins  12 , viewed in the direction of transverse axis  15 ; Z denotes the distance between the pointed ends of the pins  12 , viewed in the direction of transverse axis  15 ; and X denotes the perpendicular distance of the attachment site  19  to the transverse axis  15 . 
       FIG. 1  shows that the projection length L is greater than the radius R of the ring  11  and is smaller than 3× the radius R of the ring  11 . L is shown here as being approximately  2 R, but this length may very well be shorter. 
     The securing device  2  from  FIG. 2  differs from the securing device  1  from  FIG. 1  in that, with the securing device  1 , the pins  12  extend substantially parallel to the transverse plane, while with the securing device  2 , the pins  12  initially run underneath the transverse plane, are curved upwards towards the transverse plane and project above the transverse plane (the position of which in  FIG. 2B  corresponds to the position of the second transverse axis  16 ) with their free ends. The advantage thereof is that, after having first been inserted by being pushed through a vessel wall  30  (see  FIG. 7 ), the pins ( 12 ) stick out of the vessel wall  30  again by their pointed ends  21  (not shown in  FIG. 7 ). 
     The securing device  3  from  FIG. 3  differs from the securing device  1  from  FIG. 1  in that the pins  12 , viewed from the fixed ends  20  towards the free ends  21 , taper towards one another—see the indicated tapering zone  22 . The result thereof is that the pointed ends  21  can be inserted into a vessel wall at a relatively close distance to one another—at an intermediate distance Z—and that the pierced holes—i.e. where the pointed ends  21  have penetrated the vessel wall—will be pulled apart when the pointed ends are pushed in further and through the vessel wall, due to the fact that the distance Y between the pins increases. The vessel wall is thus stretched. 
     The securing device  4  from  FIG. 4  is substantially a combination of the securing device  3  from  FIG. 3  and the securing device  2  from  FIG. 2 . The pins  12  both taper towards one another and run upwards so that their pointed ends project above the transverse plane. 
     The securing device  5  from  FIG. 5  differs from the securing device  3  from  FIG. 3  in that, with the securing device  5 , the attachment sites  19  are situated at a distance X from the first transverse axis  15 , and in that the section of the pins  12  which extends along the first side  17  of the transverse plane extends exactly underneath the first half of the ring. As the ring  11  lies in the transverse plane, the perpendicular projection of the ring on said transverse plane coincides with the ring. In the case of the perpendicular projection of the pins  12  on the transverse plane, said projection in the first side  17  of the transverse plane thus coincides with the ring (or the perpendicular projection of the ring on that same transverse plane, respectively). The advantage of positioning the attachment sites  19  at a distance X to the first transverse axis is inter alia that the vessel wall is stretched (in the extending direction of the first transverse axis  15 ) across a larger section of the ring, and that pulling the securing device out of the vessel wall of the target vessel (in the extending direction of the second transverse axis  16 ) is rendered more difficult. 
     The securing device  6  from  FIG. 6  is essentially a combination of the securing device  5  from  FIG. 5  and the securing device  4  from  FIG. 4 . In addition to the attachment sites being provided at a distance X, the pins  12  also extend upwards so that they project above the transverse plane by their pointed ends  21 . 
       FIG. 7  diagrammatically shows a perspective view of an assembly according to the invention. This assembly comprises a graft vessel  40  and a securing device  5 , which, in the Applicant&#39;s current opinion, is preferred. Incisions have been made in the distal end of the graft vessel  40  so that four—or more or fewer, such as in particular two—flaps  31 ,  32 ,  33 ,  34  are created. After the distal end of the graft vessel  40  has been inserted in the ring  11 , flap  33  is formed by cutting the distal end or, if flap  33  has already been formed beforehand, the distal end of the graft vessel  40  is positioned in such a manner, if this is still necessary, that the flap  33  is situated exactly between the attachment sites  19 . The flaps  32 ,  33  and  34  may, if desired, form a single entity, in which case two further incisions become obsolete. The flaps  31 ,  32 ,  33  and  34  are folded back around the ring as a result of which the ring  11  is hidden from view here. In FIG.  7 , the flaps are shown as being folded back over approximately 90°. In practice, the flaps, in particular flap  31 , may be folded back up to approximately 180° during the attachment on a target vessel  50  discussed in  FIG. 8  in order to maintain a good view of the pins  12 . If the pins  12  are longer than the flap  31 , as is illustrated in  FIG. 7 , said folding back up to 180° is still advantageous, although folding back over 90° may already be sufficient in this case. The ring  11  keeps the lumen  35  of the graft vessel  40  at the distal end of the graft vessel  40  open. The pins  12  have been inserted into flaps  34  and  32 , respectively, and extend from the fixed ends  22  towards the free ends  21 . Incidentally, it should be noted that folding back the distal end of the graft vessel around the ring, according to the invention, is also possible without making any incision (in which case no separate flap is formed). In that case, the pins  12  will then be pushed through the wall of the graft vessel. 
       FIG. 8 , in a number of  FIGS. 8A ,  8 B and  8 C, diagrammatically shows the way in which the assembly according to the invention, as illustrated in for example  FIG. 7 , can be attached to a target vessel  50 . 
     The pins  12  are, see  FIG. 8A , pushed through the wall  30  of the target vessel  50 , in accordance with arrow  37 , while fluid, such as blood, flows through the lumen  36 . When the pins  12  have reached the lumen  36  of the target vessel  50 , the pins are pushed in further until the pierced holes  39 —where the pins  12  enter the target vessel—are situated at the attachment site so that the fixed ends  20  of the pins  12  then extend through the vessel wall. This situation is illustrated in  FIG. 8   b.    
     Then, the flaps  31 ,  32 ,  33  and  34 , see arrows  38 , are laid flat against the outside of the wall  30  of the target vessel and attached thereto, for example by gluing and/or stitching. This results in the situation as illustrated in  FIG. 8C . 
       FIG. 9  shows a further assembly according to the invention. This assembly comprises a graft vessel  40 , a securing device  5  and a laser catheter  60  which has been inserted into the graft vessel  40 . The combination of graft vessel  40  and securing device  5  has already been discussed with reference to  FIG. 7 . The laser catheter  60  is essentially known per se from the abovementioned EP 750,476, in which the ELANA technique is described. For a detailed description of the ELANA technique and said laser catheter, reference should therefore be made to EP 750,476, which is deemed to be incorporated in this application by way of reference. Briefly, the laser catheter comprises a bundle of optical fibers  64  through which laser light can be conducted. Said laser light then emerges at the distal end  62  of the fibers  64  and can, if the distal end has been placed against the vessel wall tissue, able to burn a ring of vessel wall tissue away and thus to produce a passageway between a graft vessel and a target vessel after the graft vessel and target vessel have first been connected to one another. Thus, the vessel wall part  37  from  FIG. 8C  can be removed in order to produce the connection. A sleeve  63  is provided around the bundle of fibers, which sleeve  63  is provided with a thickening  67  at the distal end. Inside the bundle of fibers  64 , there is a suction tube  65  with a duct  66  which, during use of the laser, is under a vacuum or at least a partial vacuum. Thus, the vessel wall part  37  ( FIG. 8C ) which is burnt away is securely sucked onto the suction nozzle  69  so that the burnt away vessel wall part  37  can be removed at the same time as the catheter  60  is removed. Pulling the burnt-away vessel wall part  37 , which is to be burnt away, by the pins  12  has the advantage that said burnt-away vessel wall part can be sucked up more reliably by the suction nozzle  69 . 
       FIG. 10  shows a top view of a securing device  7  according to the invention which is made from a single, uninterrupted wire. An annular loop is formed in the wire and at the location where the further wire parts converge, they are twisted together in a zone of the ring, and the wire ends are bent to form pins of the desired shape. Here, the pins  12  are depicted as running parallel with one another, but preferably, the pins  12  will be shaped in accordance with the embodiment from  FIG. 5 . The ring  11  and pins  12  are thus made from a single uninterrupted piece of wire, with the pins  12 , from the attachment sites  19 , merging into said ring  11  by means of a twisted winding  25  over part of the ring. 
     Diameters for the target vessel and graft vessel which are commonly used in practice vary between 1.5 mm and 6 mm, but smaller and larger diameters can also be used. The—internal—diameter of the ring will then vary accordingly, depending on the diameter of the graft vessel to be used. The wall thickness of target vessels is in practice usually in the range of 0.1 to 0.8 mm, and the wall thicknesses of graft vessels are in practice usually in the range from 0.1 to 0.6 mm, but smaller and larger wall thicknesses are also possible for both. Furthermore, the securing device according to the invention can readily be used in neurosurgery, cardiac surgery and general vascular surgery.