Patent Publication Number: US-2013237974-A1

Title: Catheter apparatus and method

Description:
TECHNICAL FIELD 
     Various embodiments described herein relate to apparatuses, systems, and methods associated with anastomosis. 
     BACKGROUND 
     Anastomosis, in the medical field, is a connection between two channels, for instance, blood vessels. Such connections can be made between sides of respective vessels, between ends of respective vessels, or between an end of a vessel and a side of another vessel. In various anastomosis procedures, a hole is formed in one or both of the vessels. Such anastomosis procedures can be used in various surgical procedures, such as, for instance, bypass procedures. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       In the drawings, which are not necessarily drawn to scale, like numerals may describe similar components in different views. Like numerals having different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document. 
         FIG. 1  shows a perspective view of a distal end of an example catheter apparatus according to an embodiment of the invention. 
         FIG. 2  shows a side view of an example catheter apparatus according to an embodiment of the invention. 
         FIG. 3  shows a perspective view of a distal end of an example catheter apparatus according to an embodiment of the invention. 
         FIG. 4  shows an end view of a distal end of an example catheter apparatus according to an embodiment of the invention. 
         FIG. 5  shows an end view of a distal end of an example catheter apparatus according to an embodiment of the invention. 
         FIG. 6  shows a cross-sectional view of an example catheter apparatus according to an embodiment of the invention. 
         FIGS. 7A-7D  show simplified cross-sectional views of an example catheter, according to an embodiment of the invention, being used to cut through a vessel wall. 
         FIG. 8A  shows a hole cut through a vessel wall using the catheter apparatus of  FIG. 4 . 
         FIG. 8B  shows a hole cut through a vessel wall using the catheter apparatus of  FIG. 5 . 
     
    
    
     DETAILED DESCRIPTION 
     In the following detailed description, reference is made to the accompanying drawings that form a part hereof and in which are shown, by way of illustration, specific embodiments in which the invention may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the invention. Other embodiments may be utilized and structural, logical, and electrical changes may be made. 
     Referring to  FIGS. 1-4 , in some examples, a catheter apparatus  100  is configured to cut through a vessel wall. The catheter apparatus  100  can be used in various procedures including, but not limited to, anastomosis procedures in which two vessels are fluidly coupled to one another. In some examples, a hole can be cut in the side of one of the vessels (for instance, with end-to-side anastomosis techniques) or in the sides of both of the vessels (for instance, in side-to-side anastomosis techniques). Such anastomosis procedures can be used in various bypass procedures. In some examples, such anastomosis procedures can be used to join blood vessels in various areas of the body, including, but not limited to, in and around the brain, the heart, and the kidneys. Such anastomosis procedures can also be used for joining two tubular structures other than blood vessels, such as intestines, for instance. 
     In some examples, the catheter apparatus  100  includes an elongate body  102 . In some examples, the elongate body  102  is configured for use in surgery. That is, the elongate body  102  can be formed from one or more biocompatible materials that can be relatively easily sterilized. In addition, the elongate body  102  can be formed from one or more flexible materials. In some examples, the elongate body  102  includes a tubular body. The elongate body  102  can include a distal end  102 A configured for insertion within the body. In some examples, the distal end includes a widened portion  104  at or near the distal end  102 A. In some examples, the widened portion  104  is sized to be at least as wide as the width (or diameter) of the vessel through which the catheter apparatus  100  is intended to be guided. By sizing the widened portion  104  at least as wide as the width of the vessel, the widened portion  104  can function to center the distal end  102 A of the catheter apparatus  100  within the vessel to aid in guiding the catheter apparatus  100  through the vessel and positioning it for cutting of the vessel wall. In other examples, the widened portion  104  can be sized to be smaller than the width (or diameter) of the vessel through which the catheter  100  is intended to be guided to allow for greater ease of insertion and guiding of the catheter apparatus  100  within the vessel than if the widened portion  104  were sized as wide or wider than the vessel. In some examples, as described in greater detail herein, the widened portion  104  is sized to correspond with a ring, a clip, or another device used in an anastomosis procedure to inhibit the catheter apparatus  100  from being inserted too far into the vessel to lessen the likelihood of potentially accidentally cutting a portion of a vessel that was not intended to be cut. Although shown as separate from the elongate body  102 , in some examples, the widened portion  104  can be integrally formed with the elongate body  102 . 
     In some examples, the catheter apparatus  100  includes a cutting device  120  disposed at the distal end  102 A of the elongate body  102 . In some examples, the cutting device  120  extends beyond the distal end  102 A. In other examples, the cutting device  120  can be flush with or recessed within the distal end  102 A. In various examples, the cutting device  120  can extend beyond, be flush with, or be recessed within the widened portion  104 . The cutting device  120 , in some examples, includes a substantially ring-shaped cutting portion  122  configured to selectively cut a hole in the vessel wall. In some examples, the ring-shaped cutting portion  122  includes a first dimension and a second dimension, wherein the first dimension is greater than the second dimension. 
     In some examples, the widened portion  104  of the catheter apparatus  100  is sized to correspond with a ring, a clip, or another device used in an anastomosis procedure to inhibit the catheter apparatus  100  from being inserted too far into the vessel to lessen the likelihood of potentially accidentally cutting through a portion of a vessel that was not intended to be cut through. In examples in which the cutting device  120  extends beyond the distal end  102 A, the cutting device  120  or the ring, clip, or other device can be sized to allow the cutting device  120  to fit through the ring, clip, or other device while the widened portion  104  can be sized to be larger than the ring, clip, or other device such that the catheter device  100  is inhibited from passing through the ring, clip, or other device, thereby inhibiting the catheter apparatus  100  from being inserted too far into the vessel to lessen the likelihood of potentially accidentally cutting something (such as a portion of a vessel) that was not intended to be cut. In examples in which the cutting device  120  is flush with or recessed within the distal end  102 A, the widened portion  104  being sized to be larger than the ring, clip, or other device functions in a similar manner to inhibit the catheter device  100  from passing through the ring, clip, or other device to lessen the likelihood of potentially accidentally cutting something (such as a portion of a vessel) that was not intended to be cut. If the catheter apparatus  100  were able to be passed through the ring, clip, or other device, the cutting device  120  could potentially be placed in proximity of another structure (such as another portion of the vessel being cut or a portion of another vessel) and could potentially at least partially cut or damage the structure. 
     In some examples, the catheter apparatus  100  includes a gripping device  140  disposed at the distal end  102 A of the elongate body  102 . The gripping device  140  can be configured to grip the vessel wall to maintain the cutting device  120  proximate the vessel wall during cutting of the hole in the vessel wall. In some examples, the gripping device  140  can be disposed within and surrounded by the substantially ring-shaped cutting portion  122 . In further examples, the gripping device  140  encompasses substantially the entire area within the substantially ring-shaped cutting portion  122 . In other examples, the gripping device  140  can be disposed outside the substantially ring-shaped cutting portion  122 . In still further examples, the gripping device  140  can be disposed both within and outside of the substantially ring-shaped cutting portion  122 . The gripping device  140 , in various examples, is configured to retain a portion of the vessel wall removed during cutting of the vessel wall. That is, with the substantially ring-shaped cutting portion  122 , the cutting device  120  cuts or ablates a similarly sized and shaped ring-shaped portion from the vessel wall, which leaves a free portion of the vessel wall (substantially corresponding to the size and shape of the interior of the substantially ring-shaped cutting portion  122 ) now unattached to the vessel wall, which the gripping device  140  can retain after cutting of the blood vessel and remove from within the body of the patient. 
     In some examples, the gripping device  140  includes a vacuum gripping device  140  that creates a suction force to grip and retain the portion of the vessel wall. In some examples, the gripping device  140  can include a cover  142  at a distal end  140 A of the gripping device  140  to inhibit unwanted objects from being sucked into the end of the gripping device  140 . For instance, in some examples, the cover  142  can be configured to inhibit the cut-out portion of the vessel wall from being sucked into the gripping device  140 . In some examples, the cover  142  can be configured to hold the vessel wall in a particular position with respect to the cutting device  120  during cutting of the vessel wall. For instance, maintaining the vessel wall in the particular position can, among other things, facilitate proper dimensioning of the hole to be cut by inhibiting the vessel wall from being sucked too far into the gripping device  140  (and potentially making a larger than intended hole in the vessel wall) or moving excessively during cutting (and potentially leading to a hole being formed with improper dimensions). 
     The cover  142 , in some examples, can include one or more holes  142 A to allow the suction force of the gripping device  140  to grip the portion of the vessel wall while, at the same time, inhibiting the portion of the vessel wall (or other objects larger than the one or more holes  142 A in the cover  142 ) from being sucked into the distal end  140 A of the gripping portion  140 . The cover  142  shown in  FIGS. 1 and 3  includes a grid-like pattern of substantially square-shaped holes  142 A. However, in other examples, the cover can include differently configured holes (circular, for instance), a screen, protrusions or abutments extending within the distal end  140 A, or other structures or configurations capable of inhibiting objects from being taken in by the gripping device  140 . In some examples, the gripping device  140  is recessed with respect to the ring-shaped cutting portion  122 , such that, when the gripping device  140  grips the vessel wall, a portion of the vessel wall is drawn within the recess (for instance, to abut the cover  142 ). Such a configuration allows for several advantages, including, but not limited to increasing the likelihood that the vessel wall is in close proximity to the ring-shaped cutting portion  122  for cutting of the vessel wall and allowing the portion removed to be retained within the recess, for instance, to decrease the likelihood of the portion separating from the gripping device  140  if, for instance, the distal end of the catheter apparatus  100  brushes against a vessel wall, a clip, a surgical instrument, or any other object prior to removing the catheter apparatus  100  from the body of the patient. Separation or dislodgement of the portion from the gripping device  140  could lead to the portion being released into the bloodstream, which could lead to various issues including, for instance, vessel obstruction or blockage. 
     Referring now to  FIG. 5 , in some examples, a catheter apparatus  500  is configured to cut through a vessel wall and can be similar to the catheter apparatus  100  described herein. In some examples, the catheter apparatus  500  includes an elongate body similar to the elongate body  102  described herein. In some examples, the elongate body  502  includes a tubular body. The elongate body can include a distal end configured for insertion within the body. In some examples, the distal end includes a widened portion  504  at or near the distal end. In some examples, the widened portion  504  is sized to be at least as wide as the width (or diameter) of the vessel through which the catheter apparatus  500  is intended to be guided. By sizing the widened portion  504  at least as wide as the width of the vessel, the widened portion  504  can function to center the distal end of the catheter apparatus  500  within the vessel to aid in guiding the catheter apparatus  500  through the vessel and positioning it for cutting of the vessel wall. In other examples, the widened portion  504  can be sized to be smaller than the width (or diameter) of the vessel through which the catheter  500  is intended to be guided to allow for greater ease of insertion and guiding of the catheter apparatus  500  within the vessel than if the widened portion  504  were sized as wide or wider than the vessel. In some examples, as described in greater detail herein, the widened portion  504  is sized to correspond with a ring, a clip, or another device used in an anastomosis procedure to inhibit the catheter apparatus  500  from being inserted too far into the vessel to lessen the likelihood of potentially accidentally cutting a portion of a vessel that was not intended to be cut. Although shown as separate from the elongate body, in some examples, the widened portion  504  can be integrally formed with the elongate body. 
     In some examples, the catheter apparatus  500  includes a cutting device  520  disposed at the distal end of the elongate body. In some examples, the cutting device  520  extends beyond the distal end. In other examples, the cutting device  520  can be flush with or recessed within the distal end. In various examples, the cutting device  520  can extend beyond, be flush with, or be recessed within the widened portion  504 . The cutting device  520 , in some examples, includes a substantially ring-shaped cutting portion  522  configured to selectively cut a hole in the vessel wall. In some examples, the ring-shaped cutting portion  522  includes a first dimension and a second dimension, wherein the first dimension is greater than the second dimension. In some examples and in a manner similar to that described herein with respect to the widened portion  104  of the catheter apparatus  100 , the widened portion  504  of the catheter apparatus  500  is sized to correspond with a ring, a clip, or another device used in an anastomosis procedure to inhibit the catheter apparatus  500  from being inserted too far into the vessel to lessen the likelihood of potentially accidentally cutting through a portion of a vessel that was not intended to be cut through. 
     In some examples, the catheter apparatus  500  includes a gripping device  540  similar to the gripping device  140  described herein. The gripping device  540  can be configured to grip the vessel wall to maintain the cutting device  520  proximate the vessel wall during cutting of the hole in the vessel wall. In some examples, the gripping device  540  can be disposed within and surrounded by the substantially ring-shaped cutting portion  522 . In further examples, the gripping device  540  encompasses substantially the entire area within the substantially ring-shaped cutting portion  522 . In other examples, the gripping device  540  can be disposed outside the substantially ring-shaped cutting portion  522 . In still further examples, the gripping device  540  can be disposed both within and outside of the substantially ring-shaped cutting portion  522 . The gripping device  540 , in various examples, is configured to retain a portion of the vessel wall removed during cutting of the vessel wall. That is, with the substantially ring-shaped cutting portion  522 , the cutting device  520  cuts or ablates a similarly sized and shaped ring-shaped portion from the vessel wall, which leaves a free portion of the vessel wall (substantially corresponding to the size and shape of the interior of the substantially ring-shaped cutting portion  522 ) now unattached to the vessel wall, which the gripping device  540  can retain after cutting of the blood vessel and remove from within the body of the patient. 
     In some examples, the gripping device  540  includes a vacuum device that creates a suction force to grip and retain the portion of the vessel wall. In some examples, the gripping device  540  can include a cover  542  at a distal end  540 A of the gripping device  540  to inhibit unwanted objects from being sucked into the end of the gripping device  540 . For instance, in some examples, the cover  542  can be configured to inhibit the cut-out portion of the vessel wall from being sucked into the gripping device  540 . In some examples, the cover  542  can be configured to hold the vessel wall in a particular position with respect to the cutting device  520  during cutting of the vessel wall. For instance, maintaining the vessel wall in the particular position can, among other things, facilitate proper dimensioning of the hole to be cut by inhibiting the vessel wall from being sucked too far into the gripping device  540  (and potentially making a larger than intended hole in the vessel wall) or moving excessively during cutting (and potentially leading to a hole being formed with improper dimensions). 
     The cover  542 , in some examples, can include one or more holes  542 A to allow the suction force of the gripping device  540  to grip the portion of the vessel wall while, at the same time, inhibiting the portion of the vessel wall (or other objects larger than the one or more holes  542 A in the cover  542 ) from being sucked into the distal end  540 A of the gripping portion  540 . The cover  542  shown in  FIG. 5  includes a circular holes  542 A. However, in other examples, the cover can include differently configured holes (differently shaped, for instance), a screen, protrusions or abutments extending within the distal end  540 A, or other structures or configurations capable of inhibiting objects from being taken in by the gripping device  540 . In some examples, the gripping device  540  is recessed with respect to the ring-shaped cutting portion  522 , such that, when the gripping device  540  grips the vessel wall, a portion of the vessel wall is drawn within the recess (for instance, to abut the cover  542 ). Such a configuration allows for several advantages, including, but not limited to increasing the likelihood that the vessel wall is in close proximity to the ring-shaped cutting portion  522  for cutting of the vessel wall and allowing the portion removed to be retained within the recess, for instance, to decrease the likelihood of the portion separating from the gripping device  540  if, for instance, the distal end of the catheter apparatus  500  brushes against a vessel wall, a clip, a surgical instrument, or any other object prior to removing the catheter apparatus  500  from the body of the patient. Separation or dislodgement of the portion from the gripping device  540  could lead to the portion being released into the bloodstream, which could lead to various issues including, for instance, vessel obstruction or blockage. 
     Referring now to  FIGS. 1-5 , the ring-shaped cutting portion  122 ,  522  can take different shapes in various examples. For instance, the ring-shaped cutting portion  122  can include an elliptical ring shape with the first dimension being a major axis of the elliptical ring shape and the second dimension being a minor axis of the elliptical ring shape. In further examples, the ring-shaped cutting portion  122  includes a flattened elliptical ring shape or a “racetrack” shape, as shown in  FIGS. 1-4 . As shown in  FIG. 4 , the flattened elliptical ring-shaped cutting portion  122  can include a first dimension A and a second dimension B, with the first dimension A being greater than the second dimension B. In other examples, as shown in  FIG. 5 , the substantially ring-shaped cutting portion  522  of the cutting device  520  can include a rectangular ring shape, with a first dimension including a length L and a second dimension including a width W. In still further examples, other shapes for the substantially ring-shaped cutting portion are contemplated, such as circular, square-shaped, diamond-shaped, triangular, hexagonal (or any polygonal shape), or the like. 
     Referring specifically to  FIGS. 4 and 5 , in some examples, the size of the ring-shaped cutting portion  122 ,  522  can be determined according to the vessel or vessels to be cut using the ring-shaped cutting portion  122 ,  522 . That is, the first dimension A, L and/or the second dimension B, W can be chosen to correspond to the size of one or more of the vessels that are to be cut using the cutting device  120 ,  520 . In some examples, sizing of the substantially ring-shaped cutting portion  122 ,  522  includes sizing the first dimension A, L to correspond to a size of a first vessel to be cut with the cutting device  120 ,  520 . In some examples, sizing of the substantially ring-shaped cutting portion  122 ,  522  includes sizing the second dimension B, W to correspond to a size of a second vessel to be cut with the cutting device  120 ,  520 . For instance, the first dimension or the major axis A of the flattened elliptical ring-shaped cutting portion  122  can be chosen to correspond to a flow surface of the largest recipient vessel to be cut using the cutting device  120 , and/or the second dimension or the minor axis B of the flattened elliptical ring-shaped cutting portion  122  can be chosen to correspond to a diameter of the smallest recipient vessel to be cut using the cutting device  120 . In another example, the first dimension or the length L of the rectangular ring-shaped cutting portion  522  can be chosen to correspond to a flow surface of the largest recipient vessel to be cut using the cutting device  520 , and/or the second dimension or the width W of the rectangular ring-shaped cutting portion  522  can be chosen to correspond to a diameter of the smallest recipient vessel to be cut using the cutting device  520 . In some examples, the first and second dimensions A, L, B, W the ring-shaped cutting portion  122 ,  522  can be sized and shaped to match a surface area of an anastomosis to a surface area of the recipient vessel, such that the flow surface area of the recipient vessel and the anastomosis surface area is substantially equal to or larger than the flow surface area of the recipient vessel. For instance, the first and second dimensions A, L, B, W the ring-shaped cutting portion  122 ,  522  can be sized and shaped to allow cutting of a hole in a vessel that is substantially equal to (or larger than) the flow surface of the recipient vessel. In this way, stenosis in the recipient vessel can be inhibited. In other examples, the size of one or more of the first and second dimensions A, B, L, W can be sized according to other aspects or dimensions of the one or more vessels to be cut with the cutting device  120 ,  520 . 
     Referring again to  FIGS. 1-5 , the cutting device  120 ,  520 , in various examples, can include different forms of cutting mechanisms. In some examples, the cutting device  120 ,  520  can include a laser cutting device  120 ,  520  configured to cut through the vessel wall. In some examples, the laser cutting device  120 ,  520  includes a plurality of optical fibers  124 ,  524  each including an end  124 A,  524 A. The ends  124 A,  524 A of the optical fibers  124 ,  524 , in some examples, are arranged to define the substantially ring-shaped cutting portion  122 ,  522 . For instance, with respect to the example shown in  FIGS. 1-4 , the ends  124 A of the optical fibers  124  are arranged to define a substantially planar flattened ellipse to form the flattened elliptical ring-shaped cutting portion  122 . With respect to the example shown in  FIG. 5 , the ends  524 A of the optical fibers  524  are arranged to define a substantially planar rectangle to form the rectangular ring-shaped cutting portion  522 . In some examples, the substantially ring-shaped cutting portion  122 ,  522  is configured to emit a laser distally from the catheter apparatus  100 ,  500 . 
     Referring now to  FIG. 6 , an example of the catheter apparatus  100  is shown. Although shown and described with respect to the catheter apparatus  100 , it should be understood that the description of  FIG. 6  can apply to at least some examples of the catheter apparatus  500 , as shown and described herein. In some examples, the cutting device  120  can include a laser generator  126  configured to produce the laser energy to be emitted by the ends  124 A of the optical fibers  124 . In some examples, a proximal end of each optical fiber  124  is coupled to the laser generator  126  with the optical fibers  124  running from the laser generator  126 , through the elongate body  102 , and terminating at the substantially ring-shaped cutting portion  122 . In this way, the laser generator  126  can produce a laser which can propagate through the optical fibers  124  and be emitted from the ends  124 A of the optical fibers  124 . In some examples, the laser is emitted from the ends  124 A of the optical fibers  124  which are arranged to form the ring-shaped cutting portion  122  in order to cut or ablate a hole in a vessel wall or other structure. In some examples, various other types of cutting devices  120  are contemplated, including, but not limited to, a scalpel, a punch, a bi/mono polar cutting device, a radiofrequency cutting device, or an ultrasonic cutting device. 
     In some examples, the optical fibers  124  are disposed immediately within the elongate body  102 . The optical fibers  124  can be arranged within the elongate body  102  in various ways, including, but not limited to a continuous ring, a segmented ring, or a single bundle of optical fibers. In some examples, the catheter apparatus  100  includes an inner tube  106 , for instance disposed within the optical fibers  124 . The inner tube  106  can provide additional structure to the catheter apparatus  100 . The inner tube  106 , in some examples, can define, or at least partially define, an inner lumen  144  of the catheter apparatus  100 . 
     In some examples, the catheter apparatus  100  includes an end portion  108  disposed at the distal end  102 A of the elongate body  102 . The end portion  108  can provide, in some examples, a relatively rigid structure for the end of the catheter apparatus  100 . In some examples, the end portion  108  partially defines the inner lumen  144  and provides a nozzle  144 A for the vacuum gripping device  140  disposed at the distal end  102 A of the elongate body  102 . In some examples, the gripping device  140  is configured to create a suction force between the nozzle  144 A and the vessel wall to grip the vessel wall. The vacuum gripping device  140  includes a vacuum source  146  coupled to the nozzle  144 A. In some examples, the vacuum source  146  is coupled to a proximal portion of the inner lumen  144  of the catheter apparatus  100  to fluidly couple the vacuum source  146  with the nozzle  144 A to allow the suction force to be created at the nozzle  144 A with operation of the vacuum source. In this way, operation of the vacuum source  146  allows the gripping device  140  to selectively grip the vessel wall to be cut and also to retain the portion of the vessel wall removed after cutting. The nozzle  144 A, in some examples, is disposed within and surrounded by the substantially ring-shaped cutting portion  122  of the cutting device  120 . In some examples, the nozzle  144 A can be configured to inhibit the cut-out portion of the vessel wall or unwanted objects from being sucked into the end of the gripping device  140  without requiring the cover  142  to be used (although it should be noted that the cover  142  can be used even with the nozzle  144 A being configured to inhibit the cut-out portion of the vessel wall or unwanted objects from being sucked into the end of the gripping device  140 ). For instance, an interior surface of the nozzle  144 A can be substantially conically-shaped to inhibit the cut-out portion of the vessel wall or unwanted objects from being drawn too far into the end of the gripping device  140 . In further examples, the interior surface of the nozzle  144 A can include other shapes to inhibit the cut-out portion or other objects from being drawn too far into the end of the gripping device  140 . 
     In some examples, the cover  142 , although shown as being substantially flat in  FIG. 6 , can be differently shaped. For instance, the cover  142 , when viewed in cross section, can be slanting or sloping, substantially pyramidal, substantially conical, substantially spherical, wave-shaped, or zig-zag-shaped. In some examples, the cover  142  can be attached to the end portion  108 . For instance, the cover  142  can be integrally formed with the end portion  108 . In some examples, the cover  142  is separately formed but attached to the end portion  108  in some manner including, but not limited to a snap fit, a friction fit, an adhesive, welding (for instance, ultrasonic welding), a threaded connection, or some other manner of attachment. 
       FIGS. 7A-7D  show a simplified depiction of the catheter apparatus  100  cutting through a vessel wall  700 . Although shown and described with respect to the catheter apparatus  100 , it should be understood that the description of  FIGS. 7A-7D  can apply to at least some examples of the catheter apparatus  500 , as shown and described herein. 
     Referring to  FIGS. 7A-7D , the catheter apparatus  100  can be used to cut through the vessel wall  700  in the context of anastomosis, for instance. It is noted that the depiction is simplified at least in part because the catheter apparatus  100  is shown merely with the vessel wall  700  to be cut. That is, the catheter apparatus  100  is not shown disposed within a vessel. In at least some example anastomosis procedures, the catheter apparatus  100  would be disposed within a vessel for cutting of the vessel wall  700 . Also, only one vessel wall  700  is shown and no other vessel or vessel wall is shown attached to the vessel wall  700 . In at least some example anastomosis procedures, the vessel wall  700  would be attached (for instance, clipped, sutured, or otherwise affixed) to a portion (for instance, a vessel wall or an end of another vessel) during cutting of the vessel wall  700 . 
     In some examples, in use, the catheter apparatus  100  is advanced along arrow X toward the vessel wall  700  to be cut, as shown in  FIG. 7A . Once positioned proximate the vessel wall  700 , the gripping device  140  can be used to grip the vessel wall, as shown in  FIG. 71B . In some examples, the gripping device  140  actually draws in a portion  700 A of the vessel wall  700  into the recess of the gripping device  140  with respect to the cutting device  120 . In some examples, gripping the vessel wall  700  includes creating the suction force between the nozzle  144  (see  FIG. 6 ) of the gripping device  140  and the vessel wall  700 . In further examples, the gripping device  140  includes a vacuum gripping device  140  for creating the suction force to grip the vessel wall. 
     As shown in  FIG. 7C , the vessel wall  700  can then be cut using the cutting device  120  disposed at the distal end of the catheter apparatus  100 . In some examples, the cutting device  120  can include the substantially ring-shaped cutting portion  122  similar to that described herein in which the first dimension is greater than the second dimension of the substantially ring-shaped cutting portion  122  (see  FIG. 4 ). The gripping device  140  can be disposed within and surrounded by the substantially ring-shaped cutting portion  122  of the cutting device  120 . The cutting device  120  can be configured to cut the vessel wall  700  along the substantially ring-shaped cutting portion  122  to form a hole  702  in the vessel wall  700 . In some examples, cutting the vessel wall  700  includes emitting a laser distally from the substantially ring-shaped cutting portion  122 , with the laser being configured to cut through or ablate the vessel wall  700 . As shown in  FIG. 71 ), once a portion  700 A is cut from the vessel wall  700 , the portion  700 A can be retained by the catheter apparatus  100  using the gripping device  140 . In this way, the portion  700 A of the vessel wall  700  can be removed with movement of the catheter apparatus  100  in the direction of arrow Y and removal of the catheter apparatus  100  from the body of the patient. 
     Depending upon the shape of the cutting portion of the cutting device, variously shaped holes can be formed in the vessel wall using the catheter apparatuses  100 ,  500  described herein and used, for instance, as shown in  FIGS. 7A-7D . For instance, referring to  FIGS. 4 and 8A , using the catheter apparatus  100  including the substantially flattened elliptical ring-shaped cutting portion  122 , a substantially flattened elliptical hole  702  can be formed in the vessel wall  700 , with dimensions of the hole  702  substantially corresponding to the dimensions (the major axis A and the minor axis B) of the substantially flattened elliptical ring-shaped cutting portion  122 . In another example, referring to  FIGS. 5 and 8B , using the catheter apparatus  500  including the rectangular ring-shaped cutting portion  522 , a rectangular hole  702 ′ can be formed in a vessel wall  700 ′, with dimensions of the hole  702 ′ substantially corresponding to the dimensions (the length L and the width W) of the rectangular ring-shaped cutting portion  522 . In other examples, cutting portions including different shapes are contemplated herein. 
     Referring again to  FIGS. 1-5 , the example catheter apparatuses described herein are advantageous in several respects. For instance, while previous catheter shapes were prone to creating stenosis in a recipient artery, the shapes of the substantially ring-shaped cutting portions  122 ,  522  allow for the creation of a flow surface (a hole in a vessel wall) that is substantially equal to (if not larger than) the flow surface of the recipient vessel so that the likelihood of creating a stenosis in the recipient vessel is lessened. Moreover, in some examples, the shapes of the substantially ring-shaped cutting portions  122 ,  522  (and the corresponding gripping devices  140 ,  540 ) are configured to facilitate maneuvering of the catheter apparatuses  100 ,  500  within the desired vessels and successful cutting of the vessel wall and capturing of the portion removed from the vessel wall. That is, the elliptical or flattened elliptical ring-shaped cutting portion  122 , with the major axis A being greater than the minor axis B, and the rectangular ring-shaped cutting portion  522 , with the length L being greater than the width W, enable movement of the respective catheter apparatuses  100 ,  500  through the desired vessels by sizing the dimensions A, B, L, W of the ring-shaped cutting portions  122 ,  522  to correspond with the vessels to be cut. Also, the shape of the ring-shaped cutting portions  122 ,  522  (and the corresponding shapes of the gripping portions  140 ,  540 ), with the first dimensions A, L being greater than the second dimensions B, W, allows for an increased cutting and gripping surface area for each catheter apparatus  100 ,  500  in relation to the size constraints of the vessels with which the catheter apparatuses  100 ,  500  are to be used. Because of the increased surface areas of the ring-shaped cutting portions  122 ,  522  and the gripping devices  140 ,  540 , the likelihood of a clean cut by the ring-shaped cutting portions  122 ,  522  is increased and the gripping of the vessel wall, initially, and retention of the removed portion is facilitated. Although described with respect to substantially elliptical and rectangular ring-shaped cutting portions  122 ,  522  (and corresponding gripping devices  140 ,  540 ), it should be understood that other shapes optimizing the available cutting and gripping surface areas are contemplated herein. 
     Additional Notes and Examples 
     Example 1 can include subject matter (such as an apparatus, a system, a method, a means for performing acts, or a machine-readable medium including instructions that, when performed by the machine, cause the machine to perform acts) that can comprise a catheter apparatus configured to cut through a vessel wall. The catheter apparatus can comprise: an elongate body including a distal end; a cutting device disposed at the distal end of the elongate body, the cutting device including a substantially ring-shaped cutting portion including a first dimension and a second dimension, wherein the first dimension is greater than the second dimension, wherein the cutting device is configured to selectively cut a hole in the vessel wall; and a gripping device disposed at the distal end of the elongate body, the gripping device configured to grip the vessel wall to maintain the cutting device proximate the vessel wall during cutting of the hole in the vessel wall, the gripping device further configured to retain a portion of the vessel wall removed during cutting of the vessel wall. 
     Example 2 can include or use, or can optionally be combined with the subject matter of Example 1 to include or use a catheter apparatus, wherein the cutting device includes a laser cutting device configured to cut through the vessel wall. 
     Example 3 can include or use, or can optionally be combined with the subject matter of Example 2 to include or use a catheter apparatus, wherein the laser cutting device includes a plurality of optical fibers each including an end, the ends of the optical fibers arranged to define the substantially ring-shaped cutting portion. 
     Example 4 can include or use, or can optionally be combined with the subject matter of Examples 1-3 to include or use a catheter apparatus, wherein the substantially ring-shaped cutting portion is configured to emit a laser distally from the catheter apparatus. 
     Example 5 can include or use, or can optionally be combined with the subject matter of Examples 1-4 to include or use a catheter apparatus, wherein the substantially ring-shaped cutting portion includes an elliptical ring shape, wherein the first dimension includes a major axis and the second dimension includes a minor axis. 
     Example 6 can include or use, or can optionally be combined with the subject matter of Example 4 to include or use a catheter apparatus, wherein the elliptical ring shape of the substantially ring-shaped cutting portion includes a flattened elliptical ring shape. 
     Example 7 can include or use, or can optionally be combined with the subject matter of Examples 1-6 to include or use a catheter apparatus, wherein the substantially ring-shaped cutting portion includes a rectangular ring shape, wherein the first dimension includes a length and the second dimension includes a width. 
     Example 8 can include or use, or can optionally be combined with the subject matter of Examples 1-7 to include or use a catheter apparatus, wherein the gripping device includes a vacuum device including a nozzle disposed at the distal end of the elongate body, the vacuum device configured to create a suction force between the nozzle and the vessel wall to grip the vessel wall. 
     Example 9 can include or use, or can optionally be combined with the subject matter of Example 8 to include or use a catheter apparatus, wherein the nozzle is disposed within and surrounded by the substantially ring-shaped cutting portion of the cutting device. 
     Example 10 can include or use, or can optionally be combined with the subject matter of Example 8 to include or use a catheter apparatus, wherein the vacuum device includes a vacuum source coupled to the nozzle. 
     Example 11 can include or use, or can optionally be combined with the subject matter of Examples 1-10 to include or use a catheter apparatus, wherein the elongate body includes a tubular body. 
     Example 12 can include, or can be combined with the subject matter of one or any combination of Examples 1-11 to optionally include, subject matter (such as an apparatus, a method, a means for performing acts, or a machine-readable medium including instructions that, when performed by the machine, cause the machine to perform acts) that can comprise a catheter apparatus configured to cut through a vessel wall. The catheter apparatus can comprise: an elongate body including a distal end; a laser cutting device disposed at the distal end of the elongate body, the laser cutting device including a substantially elliptical ring-shaped cutting portion, including a major axis and a minor axis, wherein the cutting device is configured to selectively cut a hole in the vessel wall; and a vacuum device including a nozzle disposed at the distal end of the elongate body, the nozzle is disposed within and surrounded by the substantially elliptical ring-shaped cutting portion of the laser cutting device, the vacuum device configured to create a suction force between the nozzle and the vessel wall to grip the vessel wall and to maintain the laser cutting device proximate the vessel wall during cutting of the hole in the vessel wall, the vacuum device further configured to retain a portion of the vessel wall removed during cutting of the vessel wall. 
     Example 13 can include or use, or can optionally be combined with the subject matter of Example 12 to include or use a catheter apparatus, wherein the laser cutting device includes a plurality of optical fibers each including an end, the ends of the optical fibers arranged to define the substantially elliptical ring-shaped cutting portion. 
     Example 14 can include or use, or can optionally be combined with the subject matter of Examples 12-13 to include or use a catheter apparatus, wherein the substantially elliptical ring-shaped cutting portion includes a flattened elliptical ring shape. 
     Example 15 can include or use, or can optionally be combined with the subject matter of Examples 12-14 to include or use a catheter apparatus, wherein the substantially elliptical ring-shaped cutting portion is configured to emit a laser distally from the catheter apparatus. 
     Example 16 can include, or can be combined with the subject matter of one or any combination of Examples 1-15 to optionally include, subject matter (such as an apparatus, a method, a means for performing acts, or a machine-readable medium including instructions that, when performed by the machine, cause the machine to perform acts) that can comprise a method of cutting through a vessel wall. The method can comprise: gripping the vessel wall using a gripping device disposed at a distal end of a catheter apparatus; cutting the vessel wall using a cutting device disposed at the distal end of the catheter apparatus, the cutting device including a substantially ring-shaped cutting portion including a first dimension and a second dimension, wherein the first dimension is greater than the second dimension, the gripping device being disposed within and surrounded by the substantially ring-shaped cutting portion of the cutting device, the cutting device cutting the vessel wall along the substantially ring-shaped cutting portion to form a hole in the vessel wall; and retaining a portion of the vessel wall removed during cutting of the hole in the vessel wall, the portion of the vessel wall retained using the gripping device. 
     Example 17 can include or use, or can optionally be combined with the subject matter of Example 16 to include or use a method, wherein cutting the vessel wall includes emitting a laser distally from the substantially ring-shaped cutting portion, the laser being configured to cut through the vessel wall. 
     Example 18 can include or use, or can optionally be combined with the subject matter of Examples 16-17 to include or use a method, wherein the cutting device includes a substantially flattened elliptical ring-shaped cutting portion configured to cut a substantially flattened elliptical hole in the vessel wall, wherein the first dimension includes a major axis and the second dimension includes a minor axis. 
     Example 19 can include or use, or can optionally be combined with the subject matter of Examples 16-18 to include or use a method, wherein the cutting device includes a rectangular ring-shaped cutting portion configured to cut a rectangular hole in the vessel wall, wherein the first dimension includes a length and the second dimension includes a width. 
     Example 20 can include or use, or can optionally be combined with the subject matter of Examples 16-19 to include or use a method, wherein gripping the vessel wall includes creating a suction force between a nozzle of the gripping device and the vessel wall, the gripping device including a vacuum device. 
     Example 21 can include or use, or can optionally be combined with the subject matter of Examples 16-20 to include or use a method, including sizing the substantially ring-shaped cutting portion of the cutting device to correspond to a vessel to be cut. 
     Example 22 can include or use, or can optionally be combined with the subject matter of Example 21 to include or use a method, wherein sizing the substantially ring-shaped cutting portion includes sizing the first dimension to correspond to a size of a first vessel to be cut with the cutting device. 
     Example 23 can include or use, or can optionally be combined with the subject matter of Example 22 to include or use a method, wherein sizing the substantially ring-shaped cutting portion includes sizing the second dimension to correspond to a size of a second vessel to be cut with the cutting device. 
     Example 24 can include or use, or can optionally be combined with the subject matter of Examples 21-23 to include or use a method, wherein sizing the substantially ring-shaped cutting portion includes sizing the second dimension to correspond to a size of a second vessel to be cut with the cutting device. 
     These non-limiting examples can be combined in any permutation or combination. 
     The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein. 
     In the event of inconsistent usages between this document and any documents incorporated by reference, the usage in this document controls. 
     In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects. 
     The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. §1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.