US3561448A

US3561448A - Blood vessel suturing apparatus

Info

Publication number: US3561448A
Application number: US756583A
Authority: US
Inventors: Jacob Peternel
Original assignee: Individual
Current assignee: Individual
Priority date: 1968-08-30
Filing date: 1968-08-30
Publication date: 1971-02-09
Anticipated expiration: 1988-02-09

Abstract

An improved clamp assembly for positioning blood vessels applies suction to end portions of blood vessels to hold the blood vessels in a generally cylindrical shape with outwardly flaring ends which are held in engagement to facilitate interconnecting or sewing together of the blood vessels. Accordingly, the clamp assembly includes a pair of sleeves each of which defines a generally cylindrical manifold which is connected in fluid communication with a source of vacuum or low pressure. The manifold is also connected in fluid communication with an interior portion of the sleeve to thereby apply suction to the outer wall of an empty blood vessel and draw or urge the wall of the empty blood vessel outwardly to a shape similar to the normal shape of the blood vessel.

Description

United States Patent Inventor Appl No, Filed Patented BLOOD VESSEL SUTURING APPARATUS 11 Claims, 5 Drawing Figs.

US. Cl 128/334, 128/346; 279/3 lnt.Cl A61b 17/11 Field of Search 128/334, 335, 346, 303, 297-300; 279/3; 132/38 References Cited UNITED STATES PATENTS 1,151,300 8/1915 Soresi 128/214 2,704,541 3/1955 Wyatt..... 128/303X 10/1956 Moore 2,940,451 6/ 1960 Vogelfanger et al 128/ 334X 3,254,650 6/1966 Collito 128/334 3,361,133 l/l968 Kimberry et a1. 128/346 Primary Examiner-Dalton L. Truluclc Attorney-Yount, Flynn & Tarolli ABSTRACT: An improved clamp assembly for positioning blood vessels applies suction to end portions of blood vessels to hold the blood vessels in a generally cylindrical shape with outwardly flaring ends which are held in engagement to facilitate interconnecting or sewing together of the blood vessels. Accordingly, the clamp assembly includes a pair of sleeves each of which defines a generally cylindrical manifold which is connected in fluid communication with a source of vacuum or low pressure. The manifold is also connected in fluid communication with an interior portion of the sleeve to thereby apply suction to the outer wall of an empty blood vessel and draw or urge the wall of the empty blood vessel outwardly to a shape similar to the normal shape of the blood vessel.

BLOOD VESSEL SUTURING APPARATUS This invention relates to a clamp assembly for positioning and holding blood vessels to be interconnected.

The interconnecting of blood vessels and other tubular body elements is presently done by hand positioning and sewing or suturing of end portions of the blood vessels. This hand positioning and sewing of blood vessels is a time-consuming process which is particularly onerous when a body organ, such as a kidney or heart, is transplanted. Accordingly, it is an object of this invention to provide a new and improved apparatus for facilitating the interconnection of blood vessels and similar tubular body elements.

Another object of thisinvention is to provide a clamp assembly which applies suction to severed blood vessels in such a manner as to hold them in a generally cylindrical shape and to tend to flare the ends of the blood vessels outwardly so that the ends can be pressed together and sutured.

Another object of this invention is to provide a clamp assembly which applies suction to empty end portions of blood vessels to hold them in a shape generally similar to their normal shape and to position the ends of the blood vessels in engagement to thereby facilitate their interconnection.

Another object of this invention is to provide a compact sewing machine for suturing blood vessels held by a clamp assembly constructed in accordance with the foregoing paragraph.

These and other objects and features of the invention will become more apparent upon a consideration of the following description taken into connection with the accompanying drawings wherein:

FIG. I is a schematic plan illustration of a clamp assembly constructed in accordance with the present invention, .the clamp assembly being shown in engagement with end portions of blood vessels to be interconnected;

FIG. 2 is a schematic illustration, taken on an enlarged scale along the line 2-2 of FIG. 1, illustrating the relationship of a pair of sleeves of the clamp assembly to the end portions of the blood vessels;

FIG. 3 is a schematic sectional illustration, taken on an enlarged scale at the position of the line 3-3 of FIG. 1, depicting one of the sleeves of FIG. 2 in an open condition in which the sleeve is adapted to be positioned relative to the end portion of a blood vessel before engaging the blood vessel, the sleeve being shown in dashed lines in a closed condition in which the sleeve engages the blood vessels;

FIG. 4 is a schematic sectional illustration of the sleeve of FIG. 3 in the closed condition with a pair of inserts for sue in engaging relatively small blood vessels; and

FIG. 5 is a schematic illustration on an enlarged scale, of a compact sewing machine for suturing or sewing end portions of blood vessels held by the clamp assembly of FIG. 1.

The present invention provides a clamp assembly which holds end portions of empty blood vessels in a generally cylindrical shape by applying suction to the blood vessels. This suction is applied in such a manner as to tend to flare the ends of the blood vessels outwardly. The flared ends of the blood vessels are positioned in abutting engagement by the clamp assembly to facilitate interconnecting the blood vessels by sewing or suturing the flared ends. This sewing or suturing is advantageously performed with a compact, automatic sewing machine.

Although a clamp assembly 10, constructed in accordance with the present invention, can be used to facilitate the interconnection of many different types of tubular body elements, the clamp assembly is illustrated in FIG. 1 in association with the end portions of a pair of blood vessels l2 and 14. The blood vessels I2 and 14 are connected while they are held by positioning

assemblies

16 and 18 with the

ends

20 and 22 of the blood vessels flared outwardly and positioned in abutting engagement (see FIG. 2). The outwardly flaring ends 20 and 22 extend beyond the

positioning assemblies

16 and 18 and can be readily stitched or sutured, as indicated schematically at 24 in FIG. 2, from either or both sides.

Of course, the flow of blood through the blood vessels l2 and I4 is stopped, by suitable clamps, before the blood vessels are interconnected. The walls 32 and 34 of the empty

blood tioning assemblies

16 and 18 include

cylindrical sleeves

36 and 38 which hold the end portions of the blood vessels l2 and 14 in a cylindrical configuration similar to their normal shape.

In order to hold the end portions of the blood vessels in their normal shape, the

sleev'es

36 and 38 include cylindrical inner and outer walls 42 and 44 which are interconnected by annular end walls 48 to form vacuum or suction manifolds 52 (see FIG. 2). The inner walls 42 of the sleeves have a generally cylindrical configuration and define a plurality of passages or apertures 56 which connect the manifolds 52 in fluid communication with the interior of the sleeves. The manifolds 52 are connected by a conduit arrangement 60 (FIG. I) to a vacuum pump or low pressure source 62. Operation of the vacuum pump 62 provides a vacuum or low pressure in the manifolds 52 to thereby apply suction to the outer surfaces of the blood vessel walls 32 and 34 to draw or suck the walls of the blood vessels into engagement with the interior walls 42 of the

sleeves

36 and 38. The walls 32 and 34 of the blood vessels I2 and 14 are then held in a generally cylindrical shape similar to the shape which they normally have when blood is flowing through the blood vessels. In addition, this suction holds the blood vessels against axial movement relative to the positioning assemblies 16 and I8.

The outwardly

flaring ends

20 and 22 of the blood vessels 12 and I4 facilitate positioning and stitching the blood vessels while they are held bythe clamp assembly 10. This outward flaring of the

ends

20 and 22 is promoted by the application of suction to the ends through passages or apertures 66 in the 'walls 48. Thus, when the positioning assembly 16 circumscribes the blood vessel 12, the end 20 of the blood vessel 12 is drawn or flared outwardly by suction applied to the blood vessel through the apertures 66 in the end wall 48. Although only two apertures 66 have been shown in the end wall 48, it should be understood that the end wall 48 has a generally annular configuration and that there are a series of apertures in the end wall so as to apply suction to the end of the blood vessel 12 in many different areas about the flared end 20. The sleeve 38 of the positioning assembly 18 promotes a flaring of the end 22 of the blood vessel 14 in much the same manner as previously described in connection with the blood vessel 12.

To facilitate gripping or engaging the blood vessel with the

positioning assemblies

16 and 18, the

sleeves

36 and 38 are movable from an open position, shown in solid lines for the sleeve 36 and FIG. 3, to a closed position shown in dashed lines in FIG. 3 and solid lines in FIG. 4. To this end the sleeve readily located on opposite sides of a blood vessel. When so located,

sections

70 and 74 are moved to the closed position shown in dash lines in FIG. 3 by operating an actuator handle or lever 94 which is pivotally connected to the arm (see FIG. 1). In the closed position, the

rubber end portions

86 and 88 of the

sections

70 and 74 are brought into sealing engagement so that the sleeve 36 extends around or circumscribes the blood vessel 12.

Once the sleeve 36 has been positioned around the blood vessel 12, the vacuum pump 62 is started and air is drawn through the passages 56 into the manifold 52. The air then flows through a flexible conduit 96 to a passage 98 in the arm 80 and then to flexible tubing 100 which is connected to the vacuum pump 62. This flow of air and the suction applied to the blood vessel 12 is controlled by means of a suitable valve 104 mounted on the arm 80. As was previously explained, the

inward flow of air or suction draws the wall 32 of the blood vessel 12 outwardly into engagement with the interior wall 42 of the sleeve 36 to give the blood vessel 12 a generally cylindrical shape. Also, an inward flow of air through the passage 66 and the end wall 48 tends to pull or bend the end of the blood vessel back into an outwardly flaring position.

The sleeve 38 is generally similar in construction to the sleeve 36 and includes a pair of sections which are pivotally mounted on a second arm 108 of the conduit arrangement 60 by a suitable hinge assembly 109 (FIG. 1). The sections of the sleeve 38 are pivotal between an open condition shown in FIG. 3 for the sleeve 36, and a closed condition by operation of an actuator lever or handle 110 corresponding to the actuator lever or handle 94. The flow of air and the suction applied by the sleeve 38 to the blood vessel 14 is controlled by means of a valve 112 mounted on the arm 108.

To enable the

sleeves

36 and 38 to be positioned in engagement with the end portions of the

blood vessels

12 and 14 when they are separated, the

arms

80 and 108 are pivotally interconnected at 114. A spring 116 engages

end portions

118 and 120 of the

arms

80 and 108 and resiliently presses these cad portions of the arms toward each other to space the

sleeves

36 and 38 apart to thereby enable the separate end portions of the

blood vessels

12 and 14 to be engaged by the clamp assembly 10. Once the

blood vessels

12 and 14 have been engaged in the manner previously explained, the

arms

80 and 108 are manually grasped and squeezed toward each other against the influence of the spring 116 to pivot the arms about the connection 1 14 to the position shown in FIG, 1. The

ends

20 and 22 of the blood vessels are then located in abutting engagement. A suitable latch or clamp 122 is pivotally mounted at 124 on the arm 80 and engages the arm 108 to hold the arms in the position shown in solid lines in FIG. 1 against the urging of the resilient spring 1 16. An adjustment screw 126 is mounted on the clamp 122 to enable the relative position of the

sleeves

36 and 38 to be adjusted. A suitable aperture is provided in the spring 116 to enable the flexible tubing 100 to pass through the Spring.

It is anticipated that the clamp assembly will be used to facilitate the interconnection of blood vessels of different diameters. Accordingly arcuate spacer plates 130 and 132 (FIG. 4) are provided for use with

sleeves

36 and 38 to enable the effective diameter of the interior of the sleeves to be varied in accordance with the size of the blood vessels. The

spacer plates

130 and 132 are mounted on the

sections

70 and 74 and have passages or apertures 136 which are aligned with corresponding apertures or passages 56 in the

sleeves

36 and 38 to connect the interior of the sleeves in fluid communica tion with the suction manifolds 52.

Once the ends and 22 of the blood vessels have been positioned as shown in FIGS. 1 and 2 by the clamp assembly 10, the abutting ends of the blood vessels are stitched or sutured, as is indicated schematically at 24 in FIG. 2, to interconnect the blood vessels. It is contemplated that this stitching or suturing will be done either manually or by means of a suitable sewing device. The outwardly flaring ends 20 and 22 are held by the clamp assembly 10 so as to be easily accessible to facilitate manual or machine sewing from either or both sides. A machine 144 which is adapted for sewing the ends 20 and 22 of the

blood vessels

12 and 14 is illustrated in FIG. 5. However, it should be understood that many different type of machines or devices can be used in conjunction with the clamp assembly 10 to sew blood vessels and other tubular body elements together. For example, a manually operated sewing machine similar to that disclosed in US. Pat. No. 2,928,363 could be used.

The sewing machine 144 is relatively compact and is electrically operable to enable the stitches 24 to be quickly sewn with a minimum of effort. To this end the sewing machine 144 includes solenoid 148 which energizable to move a needle 150 through the

ends

20 and 22 of the blood vessels, that is to the left as viewed in FIG. 5. A rack 154 is moved by the solenoid 148 with the needle to drive a spur gear 156 connected to a hook 158. The hook 158 operates in a known manner to engage thread 160 extending through an eye of the needle 150 to form a stitch on the reverse stroke of the solenoid. The needle 150 and stitches 24 are positioned relative to the

ends

20 and 22 of the

blood vessels

12 and 14 by engagement of an end portion 161 of the sewing machine 144 with the

sleeves

36 and 38. The thread 160 is advantageously supplied to the needle 150 from a spool 162 mounted on a casing 164 of the sewing machine 144. The solenoid 148 is energized by pressing an actuator button connected to leads 174 and 176 from a suitable source of power.

In view of the foregoing description, it can be seen that the clamp assembly 10 facilitates the interconnection of blood vessels and similar tubular elements of the body by applying suction to them to hold them in their normal, generally cylindrical shape with the ends of the blood vessels flaring outwardly. These outwardly flaring ends are positioned in an abutting engagement so that they can be readily interconnected by either manual sewing or by means of a sewing machine, similar to the sewing machine 144 of FIG. 5. The suction is transmitted to the

sleeves

36 and 38 through hollow

tubular arms

80 and 108 which also function as a handle to locate the sleeves in a desired relationship relative to the blood vessels when the sleeves are in the open condition illustrated in FIG. 3. Once the blood vessels have been engaged by the

sleeves

36 and 38 and brought together against the influence of the spring 116, the outwardly flaring ends 20 and 22 are held in engagement and are easily accessible for sewing or suturing.

1 claim:

1. A clamp assembly for positioning blood vessels to be interconnected, said clamp assembly comprising first positioning means for engaging one end portion of a blood vessel, said first positioning means including first suction means adapted to apply suction to said one end portion of a blood vessel to thereby hold said one end portion of a blood vessel in a predetermined shape, second positioning means for engaging another end portion of a blood vessel, said second positioning means including second suction means adapted to apply suction to said other end portion of a blood vessel to thereby hold said other end portion to a blood vessel in a predetermined shape generally similar to the shape of said one end portion of a blood vessel, said first and second suction means each including means for applying suction to said end portions in a direction parallel to the longitudinal axis of the blood vessel so that the ends of said end portions flare outwardly in a direction substantially perpendicular to the longitudinal axis of the blood vessel, and support means for supporting said first and second positioning means for relative movement therebetween and locating said first and second positioning means in a relationship relative to each other in which said one end portion of a blood vessel and said other end portion of a blood vessel are adjacently located, said means for locating said first and second positioning means being adapted to retain the flared end portions in abutting engagement disposed substantially perpendicular to the longitudinal axis of the blood vessel to facilitate interconnecting said end portions.

2. A clamp assembly as set forth in claim 1 further including first valve means for controlling the amount of suction applied to said one end portion of a blood vessel by said first suction means and second valve means for controlling the amount of suction applied to said other end portion of a blood vessel by said second suction means to thereby enable the amount of suction applied to each of said end portions to be independently regulated.

3. A clamp assembly as set forth in claim 1 wherein said first and second positioning means each include a sleeve having a generally cylindrical inner wall and an outer wall spaced therefrom to form a manifold having a generally circular cross-sectional configuration with a plurality of passages formed in said inner wall and extending substantially perpendicular to the longitudinal axis of the blood vessel between said manifold and an interior portion of said sleeve, said manifold being operable to apply suction to an outer surface of an end portion of a blood vessel located in said sleeve to hold a substantial portion of the end portion of the blood vessel in a generally cylindrical shapewhile said means for applying suction to said end portion in a direction parallel to the longitudinal axis of the blood vessel holds the end of said end portion flared outwardly in a direction substantially perpendicular to the longitudinal axis of the blood vessel.

4..A clamp assembly as defined in claim 3 further including means cooperable with said generally cylindrical inner wall to reduce the cross-sectional area defined by said interior portion of said sleeve and in which a blood vessel is adapted to be held to thereby enable said clamp assembly to be utilized with blood vessels of various diameters. I g e 5. A clamp assembly as set forth in claim 3 wherein said sleeve includes first and second interconnected sections, said sections being relatively movable between an open condition in which ends of said sections are spaced apart to enable the end portion of a blood vessel to be readily positioned between said sections and a closed condition in which the ends of said sections are positioned in engagement to circumscribe the end portion of a blood vessel.

6. A clamp assembly as set forth in claim 5 further including hinge means for pivotally interconnecting said sections and actuator means for selectively operating said sections between said open and closed conditions. i

7. A clamp assembly as set forth in claim 6 further. including said means mounted on the ends of said sections for sealing a joint between said sections when said sections are in saidopen condition.

8. A clamp assembly as set forth in claim 1 wherein said means for supporting and locating said firstand second positioning means includes fluid conduit 'means connected at one end to said first positioning means and at another end to said second positioning means, said fluid conduit means being adapted to t be connected to a source of low pressure to thereby enable said first and second suction means to apply suction to the end portions of blood vessels.

9. A clamp assembly as set forth in claim 8 wherein said ends of said fluid conduit means are-resiliently interconnected and tend to assume a first position, said means for locating said first and second positioning means further including latch means for holding said ends of said fluid conduit means in a predetermined relationship with each other against the influence of said resilient interconnection to therebyretain said one end portion of a blood vessel in engagement with another end portion of a blood vessel. 7 i

10. A clamp assembly for positioning blood vessels to be in terconnected, said clamp assembly comprising first positioning means for engaging one end portion of the blood vessel and applying suction thereto to thereby hold said one end portion of a blood vessel in a predetermined shape, second posi tioning means for engaging another end portion of a blood of the blood vessel in such a manner as to tend to flare said one end portion outwardly, said second positioning means including means for applying suction to said other end portion of a blood vessel in such a manner as to tend to flare said other end portion outwardly, said means for locating said first and second positioning means being adapted to retain the flared end portions in abutting engagement, said first and second positioning means each including a sleeve havin a generally cylindnca inner wall and an outer wall spaced t erefrom to form a manifold having a generally circular cross-sectional configuration with a plurality of passages formed in said inner wall and extending between said manifold and an interior portion of said sleeve, said manifold being adapted to be connected to a source of low pressure to thereby apply suction to an outer surface of an end portion of a blood vessel located in said sleeve to hold the end portion of the blood vessel in a generallycylindrical shape.

11. A clamp assembly for positioning blood vessels to be interconnected, said clamp assembly comprising first position ing means for engaging one end portion of a blood vessel and applying suction thereto to thereby hold said one end portion of a blood vessel in a predetermined shape, second positioning means for engaging another end portion of a blood vessel and applying suction thereto to thereby hold said other end portion of a blood vessel in a predetermined shape generally similar to the shape of said one end portion of a blood vessel,

and means for locating said first and second positioning means in a relationship relative to eachother in which said one end portion of a blood vessel and said other end portion of a blood vessel are adjacent to thereby facilitate interconnecting said end portions, said first and second positioning means each in cluding a sleeve having a generally cylindrical inner wall and an outer wall spaced therefrom to form a manifold having a generally circular cross-sectional configuration with a plurality of passages formed in said inner wall and extending between said manifold and an interior portion of said sleeve, said manifold being adapted to be connected to a source of low pressure to thereby apply suction to an outer surface of an end portion of a blood vessel located in said sleeve to hold the end portion of the blood vessel in a generally cylindrical shape, said sleeve having an end wall interconnecting said inner and outer walls, said end wall having a plurality of passages therein connected in fluid communication with said manifold for applying suction to the end portion of a blood vessel in such a manner as to tend to flare the end portion of a blood vessel outwardly.

Claims

3. A clamp assembly as set forth in claim 1 wherein said first and second positioning means each include a sleeve having a generally cylindrical inner wall and an outer wall spaced therefrom to form a manifold having a generally circular cross-sectional configuration with a plurality of passages formed in said inner wall and extending substantially perpendicular to the longitudinal axis of the blood vessel between said manifold and an interior portion of said sleeve, said manifold being operable to apply suction to an outer surface of an end portion of a blood vessel located in said sleeve to hold a substantial portion of the end portion of the blood vessel in a generally cylindrical shape while said means for applying suction to said end portion in a direction parallel to the longitudinal axis of the blood vessel holds the end of said end portion flared outwardly in a direction substantially perpendicular to the longitudinal axis of the blood vessel.

4. A clamp assembly as defined in claim 3 further including means cooperable with said generally cylindrical inner wall to reduce the cross-sectional area defined by said interior portion of said sleeve and in which a blood vessel is adapted to be held to thereby enable said clamp assembly to be utilized with blood vessels of various diameters.

5. A clamp assembly as set forth in claim 3 wherein said sleeve includes first and second interconnected sections, said sections being relatively movable between an open condition in which ends of said sections are spaced apart to enable the end portion of a blood vessel to be readily positioned between said sections and a closed condition in which the ends of said sections are positioned in engagement to circumscribe the end portion of a blood vessel.

6. A clamp assembly as set forth in claim 5 further including hinge means for pivotally interconnecting said sections and actuator means for selectively oPerating said sections between said open and closed conditions.

7. A clamp assembly as set forth in claim 6 further including said means mounted on the ends of said sections for sealing a joint between said sections when said sections are in said open condition.

8. A clamp assembly as set forth in claim 1 wherein said means for supporting and locating said first and second positioning means includes fluid conduit means connected at one end to said first positioning means and at another end to said second positioning means, said fluid conduit means being adapted to be connected to a source of low pressure to thereby enable said first and second suction means to apply suction to the end portions of blood vessels.

9. A clamp assembly as set forth in claim 8 wherein said ends of said fluid conduit means are resiliently interconnected and tend to assume a first position, said means for locating said first and second positioning means further including latch means for holding said ends of said fluid conduit means in a predetermined relationship with each other against the influence of said resilient interconnection to thereby retain said one end portion of a blood vessel in engagement with another end portion of a blood vessel.

10. A clamp assembly for positioning blood vessels to be interconnected, said clamp assembly comprising first positioning means for engaging one end portion of the blood vessel and applying suction thereto to thereby hold said one end portion of a blood vessel in a predetermined shape, second positioning means for engaging another end portion of a blood vessel and applying suction thereto to thereby hold said other end portion of a blood vessel in a predetermined shape generally similar to the shape of said one end portion of the blood vessel, and means for locating said first and second positioning means in a relationship relative to each other in which said one end portion of the blood vessel and said other end portion of a blood vessel are adjacent to thereby facilitate interconnecting said end portions, said first positioning means including means for applying suction to said one end portion of the blood vessel in such a manner as to tend to flare said one end portion outwardly, said second positioning means including means for applying suction to said other end portion of a blood vessel in such a manner as to tend to flare said other end portion outwardly, said means for locating said first and second positioning means being adapted to retain the flared end portions in abutting engagement, said first and second positioning means each including a sleeve having a generally cylindrical inner wall and an outer wall spaced therefrom to form a manifold having a generally circular cross-sectional configuration with a plurality of passages formed in said inner wall and extending between said manifold and an interior portion of said sleeve, said manifold being adapted to be connected to a source of low pressure to thereby apply suction to an outer surface of an end portion of a blood vessel located in said sleeve to hold the end portion of the blood vessel in a generally cylindrical shape.

11. A clamp assembly for positioning blood vessels to be interconnected, said clamp assembly comprising first positioning means for engaging one end portion of a blood vessel and applying suction thereto to thereby hold said one end portion of a blood vessel in a predetermined shape, second positioning means for engaging another end portion of a blood vessel and applying suction thereto to thereby hold said other end portion of a blood vessel in a predetermined shape generally similar to the shape of said one end portion of a blood vessel, and means for locating said first and second positioning means in a relationship relative to each other in which said one end portion of a blood vessel and said other end portion of a blood vessel are adjacent to thereby facilitate interconnecting said end portions, said first and second positioning means each including a sleEve having a generally cylindrical inner wall and an outer wall spaced therefrom to form a manifold having a generally circular cross-sectional configuration with a plurality of passages formed in said inner wall and extending between said manifold and an interior portion of said sleeve, said manifold being adapted to be connected to a source of low pressure to thereby apply suction to an outer surface of an end portion of a blood vessel located in said sleeve to hold the end portion of the blood vessel in a generally cylindrical shape, said sleeve having an end wall interconnecting said inner and outer walls, said end wall having a plurality of passages therein connected in fluid communication with said manifold for applying suction to the end portion of a blood vessel in such a manner as to tend to flare the end portion of a blood vessel outwardly.