WO1999030637A1

WO1999030637A1 - Medical treatment of a diseased anatomical duct

Info

Publication number: WO1999030637A1
Application number: PCT/FR1998/002086
Authority: WO
Inventors: Gérard Chevillon; Guy Nadal; Samy Anidjar
Original assignee: B. Braun Celsa
Priority date: 1997-12-16
Filing date: 1998-09-29
Publication date: 1999-06-24
Also published as: FR2810876B1; FR2810876A1

Abstract

The invention concerns a medical set comprising a implant for treating a diseased anatomical duct, wherein part of the duct (V) wall is externally lined with at least a lining (140'a), substantially opposite the implant (100) proximal and/or distal ends. Means (361) fixing the lining to the implant press, through the duct wall, the implant against said duct, and means for setting the lining and fixing means enable to dispose them around said duct. The invention is useful for treating an aneurysm in particular.

Description

MEDICAL TREATMENT OF ANATOMIC CONDUIT CONDITION

The invention relates to a medical assembly improving the conditions for placing and holding an implant in an anatomical conduit, in particular if it is a vascular implant, or stent, for aneurysm adapted to be placed at least in part by the percutaneous endoluminal route.

In the field, different types of implants and different fitting techniques are known.

Thus, in patents US-A-5,527,355 or US-A-5,707,378, it is taught an apparatus and a method for treating aneurysm by applying a band around the outer surface of the vessel, in places where are located the spring means for holding the implant against the vessel (stents).

Thus, is there a known medical assembly for the treatment of a disease of an anatomical conduit comprising:

an implant that can be inserted into the duct to be treated, the implant having a general axis and having substantially along this axis two free ends, respectively proximal and distal,

- at least one lining for externally lining at least part of the wall of the duct, substantially facing the proximal end of the implant, - and means for fixing the lining to the implant, through the wall of the conduit, to apply the implant internally against the wall of the conduit

In these patents, two strips of lining are even provided, at the proximal and distal ends of the implant, which is adapted to be able to be introduced in a radially tightened state. After which, it occupies a radially deployed state to treat the aneurysm.

A certain number of problems remain despite everything linked to the conditions of positioning the strip around the duct considered, of fixing the implant to the wall of this duct, as well as to the possible effective sealing conditions to be obtained vis-à-vis the fluid that can circulate there.

Note that in these patents, the system for attaching each strip around the duct can pose a problem, in particular if it is the aorta, since it can be particularly difficult to seek to make it completely around.

It may also be difficult for the practitioner to succeed in precisely positioning the lining strip opposite the corresponding end of the implant, since failing this, the attachment of one to the other will risk to be defective. Indeed, this fixation is effected by the hooks linked to one of the stents of the implant.

The solution proposed for this in the invention consists in particular in that the medical assembly also comprises means for positioning the fixing means, which are distinct from the implant, for putting these fixing means in place. preferably from outside the duct, towards the implant.

Thus, the implant fixing hooks are not used to fix the lining, the conduit and the implant between them. Moreover, in the invention, the implant can be devoid of any anchoring hook to the conduit. The approach from the outside of the duct seems technically, to date, the least dangerous for the patient, all the more if, as is proposed elsewhere, the fixation band (s) of liner / implant is carried out, through the conduit, by means of surgical staples, using as means of positioning a surgical stapler adapted to introduce and bend the free ends of each staple from exclusively one side of the conduit considered. An endoscopic (or laparoscopic) approach is proposed.

Note that these "staplers", including endoscopic staplers (such as that proposed by ETHICON® in US-A-5,470,010 or US-A-5,333,772), have so far never been intended for the stapling through a conduit in which circulates a fluid (blood vessel in particular), because of the risks of leakage following the perforation by the staple. It is therefore an application which is, to the knowledge of the inventors, unusual and goes against the current prescriptions for the use of this material. Note also that the choice of stapler and staple is important A skin stapler (such as the stapler type ROYAL® of the company AUTOSUTURE) seems inappropriate in that the staple is originally flat, the operative movement of the stapler coming gradually to close it to a "CU" shape, by advancing then bringing together its two free ends. What is a priori effective in bringing two lips closer to a cut does not indeed seem suitable for fixing through an internal conduit for bodily fluid, and in particular a fragile vessel. In this regard, an important characteristic of the invention advises that the staples have a first original state of introduction in the form of substantially "f ~ l", before deformation by the stapler, to penetrate through the lining, the conduit and the implant, then a second state of fixation in the form of a substantially "Cl" after deformation by the stapler when they have penetrated the lining, the conduit and the implant

More generally, and even if fixing means other than staples were used, such as rivets as described in FR 97 16625, another important characteristic of the invention recommends that these fixing means consist of clamping means having, parallel to their axis of introduction (through the aforementioned layers), a different length between a first state of introduction through the external lining, the conduit and the implant, and a second state of fixation after introduction, for then tighten the wall of the conduit between the outer lining and the inner implant, so as to create a seal against the fluid flowing in the conduit, between the implant and the wall of said conduit The (each) lining may be present as a point (or local) pad placed at the location of the fixing means considered, or advantageously as a strip or a split collar, on the periphery of the conduit For ensure a sufficiently uniform contact between the lining and the duct, while ensuring a "soft" contact, this lining will preferably have a frame covered (at least on one inner side) by a buffer pad.

To promote its hold at the time of fixing and over time, the lining will advantageously be mechanically resistant in the direction of its thickness, so that it constitutes a forestay for said fixing means.

And to promote its maintenance over time, the lining may include an "adhesive" layer (favorable to cell development and intended to come into contact with the body duct).

Given that the anatomical conduits do not all have the same section and that the same conduit can also have different sections for different people, an additional consideration of the invention provides that, if it is a strip (or open collar), the lining advantageously has an original length greater than the circumference of the conduit and is breakable to be adapted to the section of this conduit, in a second step.

Still concerning the lining, a complementary characteristic of the invention provides that it is suitable for being traversed by, or that it has structurally, openings (preferably self-sealing) for the passage through it of the fixing means, thus facilitating their passage.

A further aspect of the invention relates to the manner of implanting and using the medical assembly which has just been presented (see claims 14 to 17).

An even more detailed description of the invention will now be provided with reference to the accompanying drawings in which:

- Figure 1 shows the implant in place in an aortic aneurysm with two strips of lining ready to surround it, - Figure 2 shows in perspective and in enlarged view a possible embodiment of one of these bands,

FIG. 3 is an alternative embodiment of a strip according to the same view as FIG. 2,

- Figure 4 shows a needle with suture thread (without pretension of scale),

FIG. 5 shows schematically in enlarged view a fastening clip, in its original state,

- Figure 6 shows schematically (on a smaller scale) the establishment of an alternative embodiment of the implant of Figure 1, with a single lining, - Figure 7 shows an implantation step prior to the situation of Figure 6, FIG. 8 shows an intermediate implantation step between the situations of FIGS. 6 and 7,

- Figure 9 shows, in enlarged view, a local area for fixing an implant, with a staple tight against the implant, - Figure 10 shows a staple in its original state, engaged through a sealing pad,

FIG. 11 shows, in an enlarged view with respect to FIG. 1, a possible embodiment of a fixing liner,

FIG. 12 shows diagrammatically on a small scale the operation of fitting and stapling the linings, for an implant as illustrated in FIG. 1,

- And Figure 13 shows a local view of a possible embodiment of lining.

In what follows, we only consider the case of an implant consisting of a stent intended to treat an aortic aneurysm, even if other vessels, or even other types of condition, can benefit from the improvements made. by the invention.

Thus, FIG. 1 shows an aorta V suffering from an aneurysm 110. The aneurysm is delimited by an upper collar (or upstream) 112 and a lower collar (or downstream) 114. The reference 10 indicates the direction of circulation of the blood . A stent 100, of axis 100c, is implanted at least at the location of the aneurysm.

The implant 100 can in particular be presented as described in patent US-A-4,533,665, or FR-A-2,732,404.

The implant is pressed, towards its proximal end 100a, against the wall P of the vessel V, by means of at least one radially deployable enlarger, usually called "stent", 105.

In addition to the stent 105 (which in this case comprises four stages of zigzag metallic wires wound on themselves on each stage), the implant 100 comprises a flexible, synthetic, biocompatible sheath, 108, for example made of Dacron (registered trademark ), allowing blood to be channeled through it, once the prosthesis is implanted. Each elementary stent is sutured to the sheath, in 161. There is an elementary stent towards the two free ends 100a, 100b of the implant.

The (each) stent 105 is in this case radially "self-expanding" (as in FR-A-2 732 404), although it may, as a variant, be constituted by an openwork metal tube, radially deployable beyond his limit elastic under the effect of an internal force of radial expansion, such as a balloon, as in US-A-4,533,665.

Since in this case, the plating of the implant against the upper and lower collars is effected by means of the first and last stages 105a, 105d of stent, these stages may have a radial force

(or a resistance to radial compression) greater than that of the other stages and / or the rest of the implant This mechanical effect is obtained for example by increasing the number of zigzags on this first stage and / or by reducing the length axial ê of these stages relative to the other stages of the stent. Another solution would be to add an added reinforcement means, such as for example a split ring 150.

Around the duct V, and more particularly around the upper and lower collars, there appears a part 140a, 140b, for lining the duct. Once in place, the strip will locally double the wall of the vessel to promote the establishment of means for fixing each strip to the implant 100, therefore through the wall of the conduit V, in order to apply this implant internally. against the wall P, preferably in a blood-tight manner. Different realizations of the bands can be imagined.

If each strip is sufficiently resistant to crushing, in the direction of its thickness (marked e in FIG. 2), the strip will then advantageously constitute an external forestay for the fixing means, the implant 100 being able, for its part, constitute the internal forestay, this in this case via the stent 105, or even a band, a local pad or a complementary split ring marked 150 in FIG. 1 and fixed (e ) and attached to the proximal end of the implant to support it.

In FIG. 2, the lining is presented as a strap containing one or more wires (303) of metal or plastic (in this case, two parallel wires) embedded in a shock absorbing pad 305 (for example, made of felt), the everything can be covered with a thin 307 envelope, for example in Dacron (registered trademark).

In FIG. 3, the strip 140a comprises a relatively rigid trellis 309, embedded in a protective layer 312 to absorb contact with the vessel. Optionally, layer 312 could only be provided on the inner side where the strip comes into contact with the vessel, the forestay frame 309 then being on the surface.

In another variant not shown, one could imagine making the strip like a felt pad reinforced by an interlacing of metallic or plastic filaments.

Concerning these fixing means, it will be noted that the solution of FIG. 3, or that of reinforced felt, are in particular suitable for a connection by suture (surgical threads) between the strip and the implant 100, the practitioner then acting from the exterior of the vessel (by endoscopy or after stripping) while the solution of FIG. 2 can be provided in particular if the fixing means is of the "clip" type, as illustrated in particular in FIGS. 5, 6 and 9, or even of the "rivet" type as in FR 97 16625.

If the fixing means risk exerting an excessive penetration force on the strip and / or on the sleeve 108 of the prosthesis, then one and / or the other of these two parts may have open passages such as the through cuts, for example in a cross or in a portion of a circle, as shown in 319 in FIG. 2. Note that the size of the meshes 309a of the trellis 309 of FIG. 3 can make it possible to obtain the same effect. In FIG. 4, a curved suture needle 321 has been shown diagrammatically linked to its suture thread 323 to bind the prosthesis and the lining strip together, through the wall of the vessel. The wire 323 is terminated by a knot 325 allowing the wire to hold in place after being laid.

In FIG. 5, a surgical fastening clip 361 in a "U" has been shown diagrammatically.

In FIG. 6, a variant of the case of FIG. 1 is shown schematically. The implant 100 ′ is here intended to be locally fixed and pressed against the duct V by means of a single collar or lace 140 ′ a, at its proximal end 100'a. The distal end 100'b is located at the location of the lower neck of the lower aneurysm 111, near the branch of the external iliac vessel Vi and the hypogastric artery V ₂ . The implant 100 ′ does not have an anchoring hook (whereas they are very often provided in the prior art).

The implant 100 'comprises a proximal part in the shape of "Λ" with an upper common section and two lower branches 101a, 101b. The branch 101a is longer than the other which ends in the aneurysm aortic (before being subsequently connected to a connection implant not described here and shown in phantom lines).

The implant 100 'comprises a fabric sheath 108' supported by a "stent" structure, present inside the sheath except at the distal end portion 100 'b where the sheath is, over a certain length (some centimeters) devoid of any mechanical support frame, as described in WO-A-97/41804 introduced in the present description, by reference.

In fig ^' ure 7, there is shown schematically the technique for implanting the stent 100', by percutaneous endoluminal route (in particular, technique called "SELDINGER"), as well as the establishment of the collar 140'a , preferably laparoscopically.

More specifically, after having made a VA access route through the patient's skin, and having introduced a widening catheter (not shown) on the wire guide 210, the outer sheath 230 enclosing a second sheath 240 near the end distal from which the implant 100 'has been preloaded beforehand, is introduced after removal of the enlarger.

Arrived upstream in zone 110 of the aortic aneurysm, the proximal end of the implant is correctly positioned, radiographically.

The two sheaths 230, 240 are then successively withdrawn, the internal catheter 250 serving, if necessary, as rear support for the implant, so that it does not move back when the sheaths are withdrawn.

The implant 100 'then deploys radially by itself if it is self-expanding, or under the effect of an internal inflation means if such a means has been provided, or by any other equivalent means

Once the implant is deployed, a sheath 310 containing the lining 140'a is engaged laparoscopically (endoscopy), and this substantially at the level of the upstream collar 112 of the aneurysm, transverse to the axis of the vessel and therefore of the implant, via the percutaneous access route VB practiced here in the abdominal area.

Once the distal end 311 of the sheath 310 substantially opposite the end 100'a of the implant, the sheath is removed, with the use again of a rear support catheter 320 on which will be able to press the collar 140'a which, for its introduction, could have been previously extended flat in the sheath, at the end of the "pusher" 320. If the lining 140'a is a strip having an ability to close in on itself in a split ring, as shown in FIG. 1, a progressive release will allow it to naturally surround the collar 112. Otherwise, and in particular if the reinforcement of the lining is not elastically deformable, the introduction (always laparoscopically, preferably at a stripping always possible) of one or more clamps must allow the practitioner to conform the strip 140'a to the shape local exterior of zone 112, in the manner of a split ring. The deformability of the strip which may have a length of between 2 and 6 cm approximately and a thickness of between 0.5 mm and a few millimeters, facilitates its conformation.

If the lining has a safety extra length (see Figure 11), a cut (with lengthening) is then carried out.

If, for fixing this lining, suturing means are used (see FIG. 4), then pliers can then be used to maneuver the needle 321 (previously also introduced laparoscopically inside a catheter or of an introducer sheath), until the practitioner has been able to pass the wire 323, several times through the strip 140'a, the zone 112 of the vessel and the zone 100a of the implant, going around 'at least part of the vessel. Preferably, the wire will be passed behind the stent opposite and / or through the forestay ring of the implant possibly provided (reference 150 in Figure 1), which could be located on the outer periphery of the implant. as in FIG. 9. One could also provide in its place only a simple tampon, for example made of biocompatible felt coated on the outside with silicone and fixed to the endoprosthesis. Advantageously, the suture will be clamped from outside the vessel, so as to apply the portion 100'a of the implant closely against the interior surface of the collar 112, thus ensuring a seal against the blood. It will preferably be the same if the fixing is effected by means of staples such as 361, as shown in FIGS. 5, 8 and 9, the bending zone 363 of the free ends of each staple ensuring effective retention .

Figure 8 shows schematically how stapling of the proximal end 100'a of the implant could be carried out, before the distal end 100'b is surgically fixed. For stapling, the type of stapler and staple will be described in more detail below. However, note now the possibility of using a stapler 370 inserted endoscopically to the outer wall of the conduit and loaded with staples such as 361 (Figure 5), the staples being deformed until their state of fixation in tight position of figure 9.

Once a series of clips fixed on the periphery of the collar 140'a, substantially perpendicular to the axis of the conduit, the practitioner proceeds to fix the downstream area 100'b of the implant, as described in WO-A -97 / 41804: Briefly, it is recalled that he has already stripped the approaches to the lower aneurysm 111 and carried out the appropriate ligatures and pinches (as shown diagrammatically at 380, 390 in FIG. 8).

He then grabs the unstructured end 100'b which he cuts to length.

He then surgically connects this cut end to the vessel (s) (for example by sutures, such as 391, 392, Figure 6).

Of course, if there are two vessels to be recanalized (Vi, V ₂ ), the end 100'b is bifurcated as in Figures 6 and 8.

To install and maintain the possible connection implant shown in phantom lines in Figure 6, the practitioner can then proceed as already taught in the prior art.

After verifying that all the implantation instruments and means have been removed, the tracks are then closed again.

As a conduit other than a vascular one on which one could intervene in the context of the invention, mention may be made of the gallbladder (see in this regard WO-A-97/09008, for dimensions, materials, etc., cf. in particular pages 8 to 11).

It should also be noted that, as an alternative, the endoprosthesis 100 could be presented as a bifurcated tube, as in US-A-5,527,355.

Other types of endoluminal implants may also be suitable.

In FIG. 10, the external duct lining has been marked 140 "a. It is a round piece (disc); but it can have any other desired shape (in particular rectangular). Its structure can be made of felt, made of silicone or, more generally, of the same kind as the strip 140a already described. The diameter (or width) dl of this pad is greater by a few millimeters or centimeters than the width d2 of the clip 361, so as to then replace the strip, in this case with a more localized outer covering of the conduit concerned. For the fixation of the endoprosthesis of figure 1, it is advised to proceed as follows:

For the implantation of the implant 100, one can first of all proceed as for the implant 100 ', in the same way for the pose collar 140a (see pose collar 140'a). If the collar is like that of FIG. 11, with a blood-tight strap which extends at 365, 367 beyond a central zone having a reinforcing core 369 in the form of a split ring radially elastically deformable, a setting the length of the collar 140a is made if necessary, the extensions 365, 367 then being breakable (fabric, such as DACRON®). The procedure is the same for the installation and adjustment of the "downstream" collar 140b, except that the implant has then already been entirely released into the vessel V, since it only extends to the place of aneurysm 110.

To then fix each collar / vessel / implant together, in particular by a series of staples 361, the practitioner can use an endoscopic stapler as described in US-A-5,246,156,

US-A-5,333,772, US-A-5,470,010 or also corresponding to the ENDOPATH EMS® model from the company ETHICON, CINCINNATI, OH, U.S.A., which allows stapling only from one side. In addition to this, and whether it is endoscopic or not, this type of unilateral stapler, marked 370 in FIG. 12, is loaded with staples having an original "I" shape, as in FIG. 5, operation of the trigger 371, after having applied the end piece 373 of the stapler against the outer surface of the collar, having the effect first of all of driving a staple through the aforementioned thicknesses (while maintaining its original shape substantially at "I" l "), then, at the end of the stroke, to close its ends to achieve the desired" 03 "shape and to the situation in FIG. 9 where the collar, the vessel V and the implant are tightened Between the two states, the length (l \ then i _) of the clip has therefore been reduced in favor of tightening and sealing.

Note that this effect of varying the length of the fixing means would also exist if rivets as described in FR 97 16625 were used, in place of staples. Regarding blood tightness, the use of a self-sealing coating 372 (such as a layer of silicone; Figure 11) on each collar should solve the problem outside the vessel. Internally, if a risk remains, the intermediate buffer 150 in FIG. 9 provides a solution. But there is then an additional thickness to be passed through to the transvascular fixation means. Another solution consists in coating externally with a layer of self-sealing material at least the proximal and / or distal ends of the implant sleeve (see zones 395 and 397 in FIG. 1). Of course, to thus tightly fix the collars, the practitioner will have had to make several series of transcutaneous incisions, if an endoscopic approach has been preferred to a vascular denudation.

In Figure 13, there is shown a portion of a lining identified here 140b. The particularity of the latter is that its inner surface 355 (which must come into contact with the conduit V) is made of an "adhesive" material or promoting adhesion to the conduit, such as a material favorable to cell growth, such as a polyester or a TEFLON® foam. On the other hand, its outer surface 357 is in a "non-adhesive" manner, or more exactly not favorable to adhesion to an anatomical part and in particular not favorable to cell growth on contact with it, such as a silicone. The lining 140b can comprise two layers 355, 357 as in FIG. 13, with for example an external silicone tongue and an internal polyester pad, or a central core (for the mechanical aspect) covered respectively internally and externally with two films 355 , 357. The reverse can be provided on the strip 150 (external "adhesion", facing the duct, and possibly internal "non-adhesion").

Claims

1.- Medical unit for the treatment of an affection of an anatomical conduit (V, Vi, V ₂ ) comprising:

- an implant (100, 100 ') insertable into the duct to be treated, the implant having a general axis (100c) and having substantially along this axis two free ends, respectively proximal and distal (100a, 100b; 100'a, 100 'b),

- at least one lining (140, 140a, 140b, 140'a) for externally lining at least part of the wall of the conduit, substantially facing the proximal end of the implant,

- Means for fixing (321, 323, 361) of the lining to the implant, through the wall of the conduit, characterized in that it further comprises means (310, 320, 370) for positioning the fixing means, which are distinct from the implant, for positioning these fixing means, preferably from outside the duct, in the direction of the implant

2.- Medical unit for the treatment of a condition of a blood vessel (V, Vi, V ₂ ) comprising:

an implant (100, 100 ′) which can be inserted into the vessel to be treated, the implant which has a general axis (100c) and has substantially along this axis two free ends, respectively proximal and distal (100a, 100b; 100'a, 100'b), being adapted to occupy a first radially constricted state, for its introduction into the conduit, or a second radially deployed state in which it has the general shape of a single or bifurcated tube intended to be placed substantially in abutment against the wall of the vessel, towards its proximal and distal ends,

- lining means (140, 140a, 140b, 140'a) for externally lining the wall of the vessel, substantially facing the proximal and distal ends of the implant, - means (321, 323, 361) for fixing the means for lining the implant, through the wall of the vessel, characterized in that it also comprises means (310, 320, 370) for positioning the fixing means, which are distinct from the implant, to set up these fixing means, preferably from outside the conduit, in the direction of the implant.

3.- assembly according to claim 1 or claim 2, characterized in that the (the) lining (s) (140, 140a, ...) has (s) a frame (303, 309, 369) to be mechanically resistant to crushing in the direction of its (their) thickness (e) in order to constitute an external forestay for said fixing means passing through the wall of the duct in question.

4.- assembly according to one of claims 1 to 3, characterized in that the (the) lining (s) has (s) a protective pad (305, 312), at least on one inner side intended to be placed against the considered conduit.

5.- assembly according to claim 3 or claim 4, characterized in that the frame of the (the) lining (s) (140, 140a, ...) is deformable to be shaped to the external shape of the conduit considered , like a split ring, noticeably.

6.- An assembly according to any one of claims 2 to 5, characterized in that the frame of the (the) lining (s) has structurally, or is adapted to be crossed by, openings (319) self-sealing for the passage through them fixing means (361).

7.- An assembly according to any one of the preceding claims, characterized in that the fixing means (323, 361) are arranged through an area of the implant (100) provided with a stent (105).

8.- assembly according to any one of the preceding claims, characterized in that the (the) lining (s) (140, 140a, ...) is (are) breakable (s) to be adapted (s) to the outer section of the duct in question.

9.- assembly according to any one of the preceding claims, characterized in that the fixing means consisting of clamping means (361) having, substantially parallel to their axis of introduction, a length (ii, £ ₂ ) different between a first state of introduction through the external lining, the conduit and the implant, and a second state of fixation after introduction, to then tighten the wall of the conduit between the external lining (140, 140a, ...) and the internal implant (100, 100 '), so as to create a seal between the implant and the wall of said conduit with respect to the fluid circulating in the conduit

10. - assembly according to any one of the preceding claims, characterized in that the (some at least of) lining (s) (140 "a) is (are) as a damping pad located essentially at the location of the means fixing, to form a screen outside, and possibly inside, of the conduit considered between these fixing means and said conduit

11.- assembly according to any one of the preceding claims, characterized in that the fixing means comprise surgical staples (361) and the positioning means comprise a surgical stapler (370) adapted to introduce and curl the free ends (363) of a clip from exclusively one side of the conduit considered.

12.- The assembly of claim 11, characterized in that the stapler is an endoscopic stapler (370) adapted to be approached from the conduit, from the outside thereof.

13.- assembly according to claim 11 or 12, characterized in that the staples (361) have a first original state of introduction in a substantially "U" shape, before deformation by the stapler (370), to penetrate through the lining, the conduit and the implant, then a second state of fixation in the form of a substantially "CJ" after deformation by the stapler when they have penetrated the lining, the conduit and the implant

14.- assembly according to any one of the preceding claims, characterized in that the (each) lining (140a, 140b; 140'a) has internally a layer (355) of a material promoting cell growth, to come there in contact with the duct.

15.- A method of implanting a medical implant for the treatment of a condition of an internal anatomical conduit of a body, the conduit comprising a wall, the implant having first and second free ends between which s extends a wall, the second free end being devoid of a support structure, while the first free end is provided with such a structure fixed to the wall of the implant, which method comprises the following steps:

- insert the implant inside the conduit, - place a lining around the conduit, substantially facing the first free end of the implant, the lining comprising a wall,

- introduce into the body, towards the conduit, means for fixing the implant to it, - arrange these fixing means through the wall of the lining, of the conduit and of the implant, towards said first free end of the 'implant, - And link the second free end of the implant to a wall of the duct, fixing it to it by means of surgical connection, without doubling the wall facing the duct externally.

16.- A method of implanting a medical implant for the treatment of a condition of an internal anatomical conduit of a body, the conduit comprising a wall, the implant having first and second free ends between which s extends a wall, the second free end being devoid of a support structure, while the first free end is provided ^" with such a structure fixed to the wall of the implant, which method comprises the following steps:

- insert the implant inside the duct,

- have linings around the duct, substantially facing the first and second free ends of the implant, each lining comprising a wall, - introduce into the body, towards the duct, means for fixing the implant to it,

- Arrange these fixing means through the walls of the lining, the conduit and the implant, towards said first and second free ends of the implant, to fix the walls together.

17. A method according to claim 16, in which the steps of introducing the fixing means and of disposing these means through the walls of the lining, of the conduit and of the implant include:

- Provide, as fixing means, clamping means having an insertion axis and, parallel to this axis, a different length between a first state of introduction through the lining, the conduit and the implant, and a second state of fixation, after introduction,

- introducing said clamping means into the body, in their first state, through the walls of the lining, of the conduit and of the implant,

- And bring said fixing means into their second state, by reducing their length, to tighten together the lining, the conduit and the implant

18.- Method according to claim 16, in which:

- the duct to be treated is a blood vessel,

- And the fixing means comprise surgical staples.