SE514595C2 - Transplant coupling and insertion device for this - Google Patents

Abstract

A graft connector comprises a sleeve (10) and a collar (11). The sleeve (10) has an opening (12) in its circumferential surface and comprises a memory material. The collar (11) consists of a fluid-tight material and is fixed to the sleeve (10) before use of the graft connector. The collar has a shoulder portion (13) extending at least around the opening (12) and a neck portion (14) integral with the shoulder portion (13) and projecting radially from the opening (12). An introducer for the graft connector comprises two L-shaped elements (18, 19), and first releasable means (20, 21, 28-30) for locking the two L-shaped elements (18, 19) together so as to form a T-shaped element (26) having a stem (27) and two oppositely directed arms (24, 25). Removable means (31; 42; 46) are provided for temporarily reducing the diameter of the sleeve (10) during insertion into a blood vessel (2) and also for connecting the arms (24, 25) of the T-shaped element (26) along the sleeve (10) of the graft connector. The sleeve (10) is introduced into the blood vessel (2) through the longitudinal incision made therein by manipulation of the stem (27) of the T-shaped element (26). Then the two L-shaped elements (18, 19) are released from each other and from the sleeve (10) and finally they are retracted from the blood vessel (2).

Description

514 595 2 the incision and a stent are passed through one of the blocking balloons to a position inside the incision, where the stent is expanded by means of a further balloon located inside the stent. For completely secure fixation of the dilated end against the area around the incision in the vessel, some kind of suture was used, primarily to connect the dilated end of the vascular prosthesis to the blood vessel around the incision in it.

This prior art requires that a blockage be made on either side of the intended branch point and that the stent be inserted through the diseased vessel in question and through one of the blocking balloons. In practice, a fixation of the enlarged end of the vascular prosthesis in relation to the vessel in question is also required by means of some kind of suture.

The technique according to US-A-5 456 712 is thus not suitable for use in thin vessels, such as the coronary vessels, or in other situations where the described blocking by means of a balloon from the inside of the vessel is not possible.

A simpler and more reliable shunting of the coronary vessels without the requirement for temporary internal blockages is revealed as a branching device in WO97 / 43961. This branch device has a sleeve which is stretchable radially and has an opening in its outer surface, and a collar consisting of a liquid-tight material and fixed to the sleeve before the branch device is used, which has a shoulder portion which at least extends around the opening. in the mantle surface of the sleeve, and partly a neck portion connected to the shoulder portion, which projects radially from the opening in the mantle surface of the sleeve. The opening in the mantle surface of the sleeve is preferably located asymmetrically relative to the end of the sleeve. This provides an advantage in that the required longitudinal section in the blocked vessel does not have to be made longer than the distance from the neck portion to the nearest end of the sleeve, while the sleeve of the branching device can be kept securely in the vessel due to the fact that the sleeve has a longer part, calculated from the neck portion, which must thus be inserted into the vessel first.

After insertion of the sleeve into the vessel by a reciprocating movement, the shorter part of the sleeve is completely beyond the opening in the vessel, while the longer part of the sleeve covers the main part of the opening in the vessel and can also extend beyond it a distance of substantially the same length as the shorter sleeve. part. Once the sleeve is in the right place in the vessel, it must be fixed in position there. This is possible according to WO97 / 43961 due to the fact that the sleeve is stretchable radially by means of a balloon and retains its stretched shape, ie the shape of the sleeve is permanently deformable. This results in a widening of the vessel, which then clamps the sleeve in place and also clamps the shoulder portion of the collar against the sleeve.

An object of the present invention is to further improve the branching device described in WO97 / 43961 and in particular to improve and simplify the insertion of a graft coupling into a blood vessel.

This object is achieved by means of a graft coupling with the features which appear from the appended claim 1, by means of an insertion device with the features which appear from the appended claim 16 and by means of a combination with the features which appear from the appended claims 23.

The graft coupling thus comprises a sleeve which has an opening in its mantle surface and comprises a memory material, a collar consisting of a liquid-tight material and a collar fixed to the sleeve before the graft coupling is used, which has a shoulder portion which extends at least around the opening in the sleeve. mantle surface, and partly a neck portion connected to the shoulder portion, which projects radially from the opening in the mantle surface of the sleeve, and removable means for temporarily reducing the diameter of the sleeve during insertion into a blood vessel. The removable means may comprise a suture which encloses at least a part of the sleeve and thereby reduces the diameter of the sleeve.

The graft connector may further include edge means for cutting the suture once the sleeve is inserted into the blood vessel.

The edge means suitably comprises a needle with an edge-provided hole at its tip, through which hole the suture extends.

The insertion device may further comprise two L-shaped elements, first releasable means for joining the two L-shaped elements to form a T-shaped element with a shaft and two oppositely directed arms, and second releasable means for coupling the T shaped arms of the element along the sleeve of the graft coupling. Thereby, the sleeve can be inserted into the blood vessel through the longitudinal section made in it by manipulating the shaft of the T-shaped element and the two L-shaped elements can be released from each other and from the sleeve and then withdrawn from the blood vessel.

The suture should enclose at least a portion of the sleeve and arms of the T-shaped member, which may have a longitudinal channel in which the needle is located.

It must be possible to retract the needle from the longitudinal channel in the T-shaped element. A cover can also enclose the free ends of the shaft in its non-retracted condition. Furthermore, the needle and the cover lock the two L-shaped elements to each other.

According to the present invention, an insertion device is provided for a T-shaped graft coupling, which comprises a sleeve which is intended for insertion into a blood vessel through a longitudinal section therein, the sleeve having an opening in its mantle surface and a collar adjoining extends to the opening, extends radially therefrom and extends out of the longitudinal opening in the blood vessel, when the sleeve is inserted into the blood vessel. This insertion device has two L-shaped elements, first releasable means for locking the two L-shaped elements to form a T-shaped element with a shaft and two oppositely directed arms, and other releasable means for coupling the arms of the T-shaped element along the sleeve of the graft coupling, whereby the sleeve can be inserted into the blood vessel through the longitudinal section made therein by manipulating the shaft of the T-shaped element and the two L-shaped elements can be released from each other and from the sleeve and then withdrawn from the blood vessel.

In such an insertion device, the other releasable means for connecting the sleeve of the graft coupling in parallel with the arms of the T-shaped element may comprise a suture which encloses at least a part of the sleeve and the arms of the T-shaped element.

The other releasable means for coupling the sleeve of the graft coupling in parallel with the arms of the T-shaped element may further comprise an edge for cutting off the suture.

More specifically, the other releasable means for coupling the sleeve of the graft coupling in parallel with the T-shaped element may comprise a needle with an edge-provided hole at its tip, through which hole the suture extends. The T-shaped element may have a longitudinal channel in which the needle is located.

The needle is preferably retractable from the longitudinal channel of the T-shaped element and has a cover which encloses the free ends of the shaft in its non-retracted position. The needle and cover can also lock the two L-shaped elements together.

One way to connect the T-shaped graft connector described above to a blood vessel involves the steps of locking the T-shaped member to the sleeve, reducing the diameter of the sleeve, making a longitudinal incision in the blood vessel, inserting the sleeve through the incision into the blood vessel. the blood vessel using the shaft as a holder, the collar extending radially out of the incision in the blood vessel, releasing the sleeve from the T-shaped element to allow the sleeve to expand inside the vessel. and removing the T-shaped element from the blood vessel.

An alternative method of making a bifurcation connector to a blood vessel using the T-shaped graft connector and the T-shaped member includes the steps of locking the T-shaped member to the sleeve so that the sleeve extends along the arms and the collar extends into mainly along the shaft, to reduce the diameter of the sleeve, to make a longitudinal incision in the blood vessel, to insert the sleeve through the incision into the blood vessel using the shaft as a holder, the collar extending radially out from the incision in the blood vessel, to release the sleeve from the T-shaped member to allow the sleeve to expand within the vessel, and to remove the T-shaped member from the blood vessel.

The T-shaped graft coupling and the T-shaped element are preferably already releasably read to each other upon delivery for insertion into a blood vessel.

The method of making a branch connection to a blood vessel then comprises the measures of making a longitudinal incision in the blood vessel, inserting the sleeve and arms of the T-shaped element through the incision into the blood vessel using the shaft about a holder, the collar extending radially from the incision in the blood vessel, releasing the sleeve from the T-shaped member to allow the sleeve to expand within the vessel, and removing the T-shaped member from the blood vessel.

The reading of the T-shaped element at the sleeve may involve at least partially enclosing the sleeve and arms with suture, which can be released from the T-shaped element by cutting or shearing.

Alternatively, the reading of the T-shaped element at the sleeve may comprise inserting one of the arms and an adjacent part of the sleeve into a tube made of a plastic film, for example made of PTFE, and then shrinking the tube. 514 595 7 to thereby also reduce the diameter of the sleeve, which can be released from the T-shaped element by a longitudinal section through the tube.

As a further alternative, the reading of the T-shaped element at the sleeve may comprise making a tube of each arm and a plastic film sheet, which tube encloses an adjacent part of the sleeve, and reducing the diameter of the sleeve. Here, the diameter of the sleeve can be reduced by shrinking the plastic film, when the pipe is manufactured, or the diameter of the sleeve can be reduced at the same time as the pipe is manufactured.

The invention will now be described in more detail with reference to the accompanying drawings.

Fig. 1 is a perspective view showing a heart with two schematically shown bypasses of coronary vessels, each with its own blockage.

Fig. 2 is a perspective view and shows, among other things, some parts of a graft coupling according to the invention included in the invention.

Fig. 3 shows the parts of Fig. 2 in a composite condition before insertion into a blocked vessel.

Fig. 4 is a perspective view showing the graft coupling and spaced elements in an embodiment of an insertion device according to the present invention.

Fig. 5 is a side view showing the graft coupling and insertion device of Fig. 4 in a composite condition prior to insertion into a blocked vessel.

Fig. 6 is an end view of the graft coupling and insertion device of Fig. 5.

Fig. 7 is a cross-sectional view taken along the line VII-VII in Fig. 8 is a cross-sectional view through the tip of a needle and partially through arms shown in Fig. 4 and illustrates a first embodiment of means for coupling the insertion device to the graft coupling. 10 15 20 25 30 35 514 595- 8 Fig. 9 is a schematic view showing a second embodiment of means for coupling the introducer to the graft coupling.

Fig. 10 is a schematic view illustrating a third embodiment of means for coupling the insertion device to the graft coupling.

The heart shown in Fig. 1 has two coronary vessels 2, 3, each of which has its own blockage 4, 5, i.e. a constriction or obstruction. Fig. 1 schematically illustrates how its blockages 4, 5 are bypassed by means of two grafts or vessels 6, 7, which may be taken from the patient himself. More specifically, one end of the vessel 6 is connected after the blockage, seen in the normal direction of flow in the vessel 2, and its other end is connected to the aorta 8, so that a sufficient amount of oxygen-rich blood will be supplied to the already blocked the coronary vessel 22 after the blockage therein. The same applies to the vessel 3.

To carry out the coupling of the vessel 6 to the coronary vessel 2, the embodiment of a graft coupling or branching device according to the invention shown in Figures 2-8 can be used. The main components of this branch device are a sleeve 10 and a collar 11 attached thereto. The sleeve 10 consists of a memory material which is not rejected by the body tissue. Its structure is such that it has a predetermined diameter, which can be reduced by compression. Upon release of the compression, the sleeve 10 will automatically expand to its predetermined, larger diameter.

A suitable material for the sleeve 10 is in the form of a net which allows compression and expansion.

According to the invention, the sleeve further has an axially elongate opening 12, the dimensions of which, when the sleeve 10 is expanded, can be deformed in a manner similar to the way in which the sleeve itself is deformed, i.e. a shortening in the axial direction and an extension in the circumference. the circuit direction. The opening 12 can thus have a reduced 10 15 20 25 30 35. <1 f 'f ~ _. . f ._ <«1" i '... _ .. _ .. t V Rc.' "'^,' _ <-, ^ ~ K 1 ff <<< ~ m:,. . 9 length in the axial direction of the sleeve 10 but an increased width in the circumferential direction of the sleeve 10.

The collar 11 consists of a liquid-tight and preferably flexible or even elastic material, which of course must be such that it is not repelled by body tissue. More specifically, the collar 11 has a shoulder portion 13 and a neck portion 14.

The shoulder portion 13 has a shape which substantially adjoins the shape of the sleeve 10. It has such a size that it overlaps the opening 12 and thus extends over the sleeve 10 around the opening 12. The overlap is also so large that it remains in the event of a some change in the size of the opening 12, as described below.

The shoulder portion 13 can also completely enclose at least part or all of the sleeve 10, in which case the material of the shoulder portion 10 is so elastic that it does not substantially counteract either a compression or an expansion of the sleeve 10, as described in the following.

Preferably, the shoulder portion 13 encloses the entire sleeve 13, as shown in Fig. 2.

The neck portion 14 of the collar 11 is a direct extension of the shoulder portion 13 and is substantially in the shape of a cylinder. The most important function of the neck portion 14 is to serve as a coupling part for the graft or the new vessel 6.

For the coupling between the neck portion 14 and the vessel 6, a rigid support sleeve 15 and a clamping or locking sleeve 16 can be used according to the embodiment illustrated in Figs. 2 and 3 of the drawings. The end of the vessel 6 is intended to be inserted into and through the support sleeve 15, and the outermost part of the vessel 6 must then be folded or retracted over the outside of the support sleeve. This folding back of the end of the vessel 6 is shown in Fig. 2, however with the support sleeve 15 separated from the vessel 6. In order to complete the coupling, the support sleeve 15 is inserted with the tightened vessel 6 in the open end of the neck portion 14. Then the clamping sleeve 16 is applied and clamped around the neck portion 14, which is then pressed together with the internally located reclined part of the vessel against the outside of the support sleeve. As a result, a secure and tight connection is achieved between the neck portion 4 and the vessel 6.

The clamping sleeve 16 itself can be divisible to be inserted from the side over the neck portion 14 before clamping, which is conveniently performed by the clamping sleeve 16 having hooks at their free ends before clamping, which engage with each other and allow easy clamping of the clamping sleeve around the neck portion 14.

To fix the sleeve 10 and the collar 11 relative to, for example, the blood vessel 2 in Fig. 1, the sleeve 10 is made of a memory material and removable means are used to temporarily reduce the diameter of the sleeve 10 during insertion into the blood vessel 2. By releasing these removable means, the sleeve 10 can expands in place in the blood vessel 2, so that the blood vessel 2 also expands and is thus pressed against the sleeve 10 to fix its position in the blood vessel 2.

At the same time, the collar 11 or more precisely the shoulder portion 13 will be clamped between the blood vessel 2 and the sleeve 10, so that the position of the collar 11 will be securely fixed relative to the blood vessel 2 and a liquid tight closure between it and the collar 11 is obtained without any suture required.

It is suitable that the coupling between the collar 11 and the new vessel 6 is first prepared. Thereafter, the sleeve 10 can be inserted with a reciprocating movement into, for example, the vessel 2 via an opening which is formed therein by a longitudinal incision. The branching device is then fixed in the vessel 2 by releasing the removable means, whereby the sleeve 10 is expanded.

To complete the operation, the free end of the new vessel 6 must be connected to a blood vessel, eg aorta 8, which can provide sufficient blood flow to the vessel 2 after the blockage 4.

In an alternative way of performing the bypass operation by means of the graft coupling according to the invention, the new vessel 6 is first connected to the blood vessel, e.g. aorta, which can give a sufficient blood flow, and then connected to the vessel. with the block.

According to another alternative, an artery vessel originating from the aorta or another artery, such as the internal thoracic artery, capable of providing sufficient blood flow can be used as the new vessel 6, thus coupling is required only at one end.

It should be emphasized that in the methods described above the collar 11 is fixed to the sleeve 11 from the beginning and that the shoulder portion 13 preferably encloses the entire sleeve 10.

Fig. 4 shows a T-shaped graft coupling 17, i.e. the elements 10-14 in Fig. 2 in a composite state. Elements 18-21 of an insertion device or inserter are further illustrated. These elements 18-21 comprise two L-shaped elements 18 and 19, a tubular needle 20 and a capsule 21. The L-shaped elements 18 and 19 each have a shaft portion 22 and 23, respectively, and an arm 24 and 25, respectively. The arms 24 and 25 have different lengths, the arm 24 being longer than the arm 25. This difference in length corresponds to the asymmetrical position of the opening 12 in the sleeve 10.

The two L-shaped elements 18 and 19 can be assembled to form a T-shaped element 26 with a shaft 27, formed by the two shaft portions 22 and 23, as shown in Figs. 5 and 6, and the arms 24 and 25, extending in opposite directions. The two L-shaped elements 18 and 19 can be locked in the composite state by means of the capsule 21 and the needle 20.

The reading effect of the capsule 21 is achieved when the capsule 21 is pushed down on the free end of the shaft 27, whereby the corresponding ends of the shaft portions 22 and 23 are prevented from moving away from each other.

The reading action of the needle 20 is the result of the cross-sectional shape of the shank portions 22 and 23, as illustrated in Fig. 7. The shank portion 22 has a V-shaped groove 28 and the shank portion 23 has a cross-sectional profile having a shape complementary to the cross-sectional shape of the groove 10. 15 20 25 30 35 514 595, 12 28. A longitudinal channel 29 of circular cross-section is formed partly in the shaft portion 22 and partly in the shaft portion 23, so that an edge 30 of the shaft portion 23 is locked in the inner corner of the groove 28, when the needle 20 is inserted into the channel 29.

In order to be able to insert the sleeve 10 into a blood vessel, in which an opening of substantially the same length as the length D in Fig. 3 is made through an incision, the sleeve must be compressed temporarily during insertion. According to the invention, this compression is achieved by means of removable means, such as a suture enclosing at least a part of the sleeve 10 as well as the enclosing shoulder portion 13. In its compressed state, the sleeve 10 can be inserted through the incised opening in the blood vessel through a recurrent movement, leaving the neck portion 14 close to one end of the longitudinal opening in the blood vessel.

According to the present invention, the introducer is preferably used for the above-described insertion of the sleeve 10 into the blood vessel. More specifically, the L-shaped elements 18 in which a longitudinal section has and 19 are assembled according to the above description to form the T-shaped element 26, after which the sleeve 10 is compressed and coupled along the arms 24 of the T-shaped element 26. and 25. This coupling is made by other releasable means so that the arms 24 and 25 can be released from the sleeve 10, when the sleeve 10 is inserted into the blood vessel and correctly placed therein. The compression of the sleeve 10 should preferably be suppressed substantially simultaneously, so that the sleeve 10 expands and assumes a fixed position in the blood vessel.

When the arms 24 and 25 are released from the sleeve 10, they can be released from each other. They can then be easily removed from the blood vessel one at a time.

The compression of the sleeve 10 and the enclosing shoulder portion 13 can be done by a suture 31, shown in Fig. 8.

This suture 31 is wrapped around the sleeve 10 and the shoulder portion 13 to enclose at least a portion of these and 10. <- f f, - y,. c <m, f 4 «» - ~ \ ._. 1 - * '' '' *. .- _ .- v- wl '* - r «, _ í _ c <1' 'i' - (_. _« n <em- «<. - 13 thereby reducing the diameter of the sleeve. It is further advantageous that the same suture 31 is used for coupling the sleeve 10 to the arms 24 and 25, so that cutting the suture 31 by means of an edge member means that the arms 24 and 25 will be released from the sleeve 10 and the memory material in the sleeve 10 will be allowed to extend the sleeve to the preformed tuned diameter.

The needle 20 is used to cut the suture 31. More specifically, the suture 31 is guided through holes 32 and 33, which extend through the shaft portions 22 and 23 adjacent the arms 24 and 25. The needle 20 has corresponding holes 34 at its tip which receive the suture 31, which preferably has two holes 34 so that the suture 31 will extend times between the holes 32 and 33. edges with a sharp edge 35, are cut off when the needle 20 is moved out of the channel 29 in the shaft 27. rotational movement of the needle 20 in the channel 29 in the shaft 27.

As shown in Fig. 8, the arms 24 and 25 each have a series of holes 36-39 and 40-41, respectively, distributed longitudinally from the tip. Holes 36, 37 and 40, 41 are used to ensure that the suture 31 makes at least one turn around the sleeve 10 near the tip of each of the arms 24 and 25 and consequently near the ends of the sleeve 10. More specifically, the suture 31 may follow a path from the hole 32 to the hole 36 closest to the tip of the arm 24, down through this hole 36, around the compressed sleeve 10 and in between the arm 24 and the sleeve 10 to the hole 37 closest to the hole 36, up through this hole 37, around the compressed sleeve 10 and in between the arm 34 and the sleeve 10 to the hole 38 closest to the hole 37, up through this hole 38, around the sleeve 10 to the hole 39 closest to the hole 38, up through this hole 39, around the compressed sleeve 10 and back to and through the hole 32 in the shank portion 22. The suture 31 then passes through the hole 34 into the needle 20 and the hole 33 in the shank portion 23 to the hole 40 into the tip of the arm 25, down through this hole 40, around the compressed sleeve 10 and in between the arm 25 and the sleeve 10 to the hole 41 closest to the hole 40, up through this hole 40, 10 14 20 25 30 35 514 595 .ilj 14 around the compressed sleeve 10 and back to and through the hole 33 in ekefcpefeiee 23 een hälen 34 i nålen zo.

The suture 31 thus forms an endless loop, which connects the arms 24, 25 and the T-shaped element 26 to the sleeve 10 and also compresses the sleeve 10.

It should be pointed out that the suture can be guided along others 36-39, 40 and 41. should preferably not make a full turn around the sleeve 10 paths through the heel 32, 33, 34, the suture and the arm 24 or 25, as it may risk a full rotation. constant removal of the suture 31.

The suture 31 represents a first embodiment of removable means for temporarily reducing the diameter of the sleeve during insertion into a blood vessel. The suture 31 also constitutes other removable means for coupling the arms of the T-shaped element 26 along the sleeve 13 of the graft coupling. Of course, separate sutures can be used as the removable member and the other releasable member.

A second embodiment of the removable means and the second releasable means is illustrated in Fig. 9 and comprises a tube 42, which is made of a film material, preferably a plastic film, such as PTFE film. This tube 42 is pushed over the arm 24 and an adjacent portion of the sleeve 10 (as shown) and then shrunk, whereby the sleeve 10 is compressed (as is the enclosing shoulder portion 13) and also connected to the arm 24. A corresponding tube (not shown) is used for to connect the arm 25 to an adjacent part of the sleeve 11 and compress this part of the sleeve 10. To release the sleeve 10 from the arms 24, 25, the tube 42 has a strip 43, which has a free end 44 and is folded back over the tube 42 along perforations 45. By pulling the strip 43 at its free end 44, the tube 42 is opened along the perforations 45, so that the opened tube 42 can be removed. As a result of the opening, the sleeve 10 is released from the arms 24, 25 and allowed to expand.

A third embodiment of the removable means and the second releasable means is illustrated in Figs. 1014 20 514 595, 15 and comprises a substantially rectangular film ground 46, which is connected to the longitudinal edges of the arm 24, so that the arm 24 and the film ground 46 forms a tube enclosing the adjacent portion of the sleeve 10 (as well as the corresponding portion of the enclosing shoulder portion 13).

A corresponding film mark (not shown) is to be used for the arm 25 and the adjacent part of the sleeve 10. The film mark 46 can be shrunk to compress the adjacent part of the sleeve 10 and connect this part to the arm 24.

Alternatively, the edge of the film ground 46 may be attached to one of the longitudinal edges of the arm 24. The film mark 46 is then wound around the sleeve 10 and attached to the other longitudinal edge of the arm 24. The sleeve 10 is preferably compressed at the same time, but alternatively the film mark 46 can be shrunk backwards.

The film mark 46 can be released from compression of the sleeve 10 by means of a longitudinal perforation 47, the release being triggered by applying a pulling force to the L-shaped element 18 upon retraction of the arm 24 from the interior of the vessel, for example the crown vessel 2.

Alternatively, the film mark 46 could have a releasable coupling to one of the longitudinal edges of the arm 24.

Those skilled in the art will recognize that several modifications of the above-described embodiments of the graft connector and introducer are conceivable within the scope of the invention, as defined by the appended claims. "'¿-'; 7J? F1ÉI ï, Mät 'kCräÜ-.Üfaßïrïtšä 219,. 92 .KJFY (P1 f: C C-É C 1 u .. f f;' -2- .Li-TT

Claims (23)

10 15 20 25 30 35 514 595, 16 PATENT REQUIREMENTS A graft coupling, comprising a sleeve (10), which has an opening (12) in its mantle surface and comprises a memory material, a collar (11) consisting of a liquid-tight material and fixed to the sleeve (10) before the graft coupling is used. , which has partly a shoulder portion (13), which at least extends around the opening (12) in the mantle surface of the sleeve (10), and partly one with the shoulder portion (14), (12) in the sleeve which projects radially from (10) removable means (31; 42; 46) hanging neck portion mantle surface, as well as for temporarily reducing the opening of the sleeve (10) during insertion into a blood vessel (2). The graft connector of claim 1, wherein the removable means (31; 42; 46) comprises a suture (31) enclosing at least a portion of the sleeve (10) and (10). Graft coupling according to claim 2, further thereby reducing the diameter of the sleeve. gripping edge means (20, 34, 35) for cutting off the suture (31), once the sleeve (10) is inserted into the blood vessel (2), the memory material being allowed to expand the sleeve (10). The graft connector of claim 3, wherein the egg means (20, 34, 35) comprises a needle (20) having an edge-provided hole (34, 35) at its tip, through which hole the suture (31) extends. The graft coupling of claim 4, further comprising (18, 19), first releasable means (20, 21, 28-30) for assembling two L-shaped elements from the two L-shaped elements (18, 19). for forming a T-shaped element (26) with a shaft (27) (24, 25), second releasable means (31; 42; 46) for coupling (26) (24, 25) along the sleeve of the graft coupling (10) , whereby the sleeve (10) and two oppositely directed arms and sleeves of the T-shaped element are insertable into the blood vessel (2) through the longitudinal section made therein by manipulating the T-shaped element. (26) shafts (27) (18, 19) are releasable from each other and from the sleeve (10) and then retractable from the blood vessel (2). A graft coupling according to any one of claims 2-5, and the two L-shaped elements wherein the suture (31) encloses at least a part of the sleeve (10) and the arms (24, 25) of the T-shaped element (26). The graft coupling of claim 5, wherein the T-shaped member (26) has a longitudinal channel (29) in which the needle (20) is located. The graft connector of claim 7, wherein the needle (31) is retractable from the longitudinal channel (29) of the T-shaped member (26) and has a housing (21) enclosing the free ends of the shaft (27) thereof. non-withdrawn permits. A graft coupling according to claim 8, wherein the needle (20) and the cover (21) lock the two L-shaped elements (18, 19) to each other. A graft coupling according to any one of claims 1-9, wherein the opening (12) in the casing portion of the sleeve (10) is asymmetrically located relative to the ends of the sleeve (10). A graft coupling according to any one of claims 1-9, wherein the sleeve (10) consists of a net-like material. A graft coupling according to any one of claims 1-11, wherein the sleeve (10) consists of a stent material. A graft coupling according to any one of claims 1-12, wherein the collar (11) consists of an elastic material. A graft coupling according to any one of claims 1-13, wherein the shoulder portion (13) of the collar (11) is attached to the outside of the sleeve (10). The graft connector of claim 14, wherein the shoulder portion (13) completely encloses at least a portion of (10). Insertion device for a T-shaped graft sleeve coupling, which comprises 1014 25 30 35 514 595. 1, ff> y¿ 18 a sleeve (10), which is intended for insertion into a blood vessel (2) through a longitudinal section therein, the sleeve (10) having an opening (12) in its mantle surface, and a collar (11 ), which adjoins the opening (12), extends radially therefrom and extends out of the longitudinal opening (12) in the blood vessel (2), when the sleeve (10) is inserted into the blood vessel (2), which insertion device has two L-shaped elements (18, 19), first releasable means (20, 21, 28-30) for joining the two L-shaped elements (18, 19) to form a T-shaped element (26) with a shaft (27) and two oppositely directed arms (24, 25), and other releasable means (31; 42; 46) for coupling the arms (24, 25) of the T-shaped element (26) along the sleeve of the graft coupling (10). ), whereby the sleeve (10) is insertable into the blood vessel (2) through the longitudinal section made therein by manipulating the shaft (27) of the T-shaped element (26) and the two L- (18, 19) are releasable from each other and from sleeve (10) and then ti retractable from the blood vessel (2). Insertion device according to claim 16, wherein the shaped elements second release means (31; 42; 46) for connecting the sleeve (10) of the graft coupling in parallel with the T- (26) (24, 25) turn (31) enclosing at least a part of the sleeve (10) (24, 25) (26). The insertion device according to claim 17, wherein the arms of the shaped element comprise a su and the arms of the T-shaped element second releasable means (31; 42; 46) for coupling the sleeve (10) of the graft coupling in parallel with the T-shaped element ( 26) arms (24, 25) comprise an edge (35) for cutting the suture (31). Insertion device according to claim 18, wherein the second releasable means for coupling the sleeve (10) of the graft coupling in parallel with the T-shaped element (26) comprises a needle (20) with an edge-provided hole. 514 595 ¿Ä., 5 i§¿¿ 19 (34, 35) at its tip, through which hole (34) the suture (31) extends. Insertion device according to claim 19, wherein the T-shaped element (26) has a longitudinal channel (29), in which the needle (20) is located. Insertion device according to claim 20, wherein the needle (20) is retractable from the longitudinal channel (29) of the T-shaped element (26) and has a cover (21) which has free (27) ends in its non-returnable closes the drawn position of the shaft. Insertion device according to claim 21, wherein the needle (20) and the cover (21) lock the two L-shaped elements (18, 19) to each other. A combination of a T-shaped graft coupling, comprising a sleeve (10), which is intended for insertion into a blood vessel (2) through a longitudinal section thereof, the sleeve (10) having an opening (12) in its mantle surface, and a collar (11) adjacent the opening (12) extends radially therefrom and extends out of the longitudinal opening (12) in the blood vessel (2) when the sleeve (10) is inserted into the blood vessel ( 2), and an insertion device, comprising (18, 19), first releasable means (20, 21, 28-30) for locking together two L-shaped elements of the two L-shaped elements (18, 19) for forming a T-shaped element (26) with a shaft (27) and two 25), second releasable means (31; 42; 46) for coupling oppositely directed arms (24, and the arms (24) of the T-shaped element (26) , 25) along the sleeve (10) of the graft coupling, whereby the sleeve (10) is insertable into the blood vessel (2) through the longitudinal section made therein by manipulating the shaft (27) of the T-shaped element (26) and the two L-shaped The elements (18, 19) are releasable from each other and from the sleeve (10) and then retractable from the blood vessel (2). v »1 1 \ f: (Y \ ') f, fa 1) 3«. \ i \ \ f Ö