Applicator for attaching an implant

Abstract

In an applicator (10) for attaching an implant (6) as a fixing point for a vascular prosthesis to a vessel wall of a blood vessel (7) by penetrating the vessel wall and the implant (6) with at least one penetration element (20), the applicator (1) has a channel (19) for receiving and expelling the at least one penetration element (20) out of the channel (19) and a displaceable first jaw (9) for releasably receiving a first locking piece (23) for the penetration element (20), and the channel (19) has an outlet region which is directed towards the first jaw (9), defines an outlet direction (A) and has an outlet opening (19a) for the penetration element (20), and the first jaw (9) can be displaced in the outlet direction (A) from a starting position into a contact position located closer to the outlet opening (19a) compared to the starting position.

Description

[0001] Applicator for attaching an implant

[0002] The invention relates to an applicator for attaching an implant as a fixation point for a vascular prosthesis to a vessel wall of a blood vessel by penetrating the vessel wall and the implant with at least one penetrating element, preferably with a plurality of penetrating elements, as well as a corresponding set.

[0003] Dissection of the ascending aorta (type A dissection) is a life-threatening condition requiring immediate surgery. In an acute type A dissection, the primary goal of surgical treatment is to restore circulation and prevent or reverse life-threatening complications such as aortic rupture, cardiac tamponade, and myocardial ischemia. The second goal of surgical treatment, if possible, is to resect the tear in the tunica intima (the portal of entry into the false lumen) in the proximal aorta to ensure perfusion of the true lumen and thus the organs.

[0004] The classic surgical treatment of acute type A dissection involves replacing the ascending aorta with a vascular prosthesis in the form of a tubular prosthesis, with the distal anastomosis being performed using the "open" technique and in hypothermic circulation arrest at approximately 25 °C core body temperature.

[0005] Surgical access is achieved through a median sternotomy. With the heart-lung machine and the patient cooled, circulatory arrest is initiated with the patient in the head-down position, and the ascending aorta can be opened. The true lumen is identified, and the ascending aorta is resected down to its distal portion, allowing the distal ascending aorta to be viewed like an open tube.

[0006] In the currently common surgical procedure, the layered or delaminated sections of the aortic wall (tunica intima, tunica media and tunica adventitia) are sutured together using a so-called "sandwich" technique. This is done by inserting an inner implant part, for example a felt strip, i.e. a strip of textile material, in a circular or radial manner inside the aorta and applying it to the aortic wall, and then applying an outer implant part, for example a felt strip, to the vessel outside the aorta in a circular or radial manner. A continuous meandering suture is then placed manually using a polypropylene suture, or single sutures are placed to sew these two felt strips and the aortic wall in between together (sandwich).

[0007] This step of the operation takes approximately 25 minutes, but can be completed ten minutes faster or slower depending on surgical experience. Following this, in a second step, a tubular prosthesis is manually sewn end-to-end to this sandwich stump, the fixation site, using a polypropylene suture.

[0008] After an appropriate venting maneuver, an aortic clamp can now be placed on the now sutured prosthesis, and circulatory arrest is considered to be reversed. This generally completes the most critical phase of the operation. A supracoronary sandwich of the native aorta is then created at the proximal end, closest to the heart, using the same technique described above. The proximal end of the prosthesis is then sutured end-to-end to this sandwich (fixation site), as described above.

[0009] It is obvious that in such a far-reaching operation, in which normal circulation is interrupted and the body and brain are significantly cooled, time is of paramount importance in optimizing the patient's chances of survival and recovery. In particular, the procedure described above for treating the dissection by applying the sandwich suture depends heavily on the individual circumstances of each patient, the extent of the dissection of the vessel wall, and, not least, to a significant extent on the skill of the surgeon.

[0010] Devices have therefore already been developed to simplify and accelerate the attachment of the implant, in particular by replacing the time-consuming step of placing the polypropylene suture in the form of a continuous, meandering suture with the mechanical insertion of penetrating elements, such as staples. For this purpose, devices or applicators have been created which press the penetrating elements outwards from a carrier element and thereby drive them through the implant and the vessel wall. The implant usually consists of an inner and an outer implant part, for example in the form of felt strips or in the form of tubes made of textile material with a relatively short longitudinal extent.

[0011] For example, WO 2022 / 130274 A1 discloses a device in which a plurality of penetrating elements are mounted in radially outwardly directed guides and can be driven radially outward on supports for the penetrating elements. Theoretically, this device, or rather this applicator for the penetrating elements, offers the possibility of setting all of the penetrating elements required for securing the implant in a single step.When using this applicator, however, there is a risk that if such a large number of penetrating elements are inserted simultaneously, one or more of the penetrating elements may not be inserted correctly. In view of the extremely critical situation when treating the severed aorta, this represents an unacceptable risk. In this case, at least some of the inadequately inserted penetrating elements would have to be removed. In this case, it is practically inconceivable that the operation could be brought to a successful conclusion in time. What makes this even more difficult is that the penetrating elements are basically designed like staples, and so after penetration, two ends protruding from the aortic wall and the outer part of the implant have to be properly bent over.The susceptibility to errors is therefore also increased with regard to the penetrating elements and the applicator with many individual parts and delicate structures is also to be regarded as critical if an absolutely perfect result must be achieved and a correction of the initial result does not seem feasible.

[0012] It is therefore an object of the present invention to provide an applicator with which an implant of the type mentioned above can be applied to an opened aortic wall quickly and, above all, accurately. This applicator also utilizes penetrating elements that are more reliable than those used in the prior art. Furthermore, the present invention should allow not only circumferential, circular sutures to be applied, but also any desired shape of suture to create a fixation site that is adapted to the respective resection.

[0013] To achieve this object, the applicator of the type mentioned at the outset has, according to the invention, a channel for receiving and expelling the at least one penetrating element from the channel, as well as a displaceable, first jaw for releasably receiving a first locking piece for the penetrating element, wherein the channel has an exit region directed towards the first jaw, defining an exit direction and having an exit opening for the penetrating element or for the pin of the penetrating element, and the first jaw is displaceable in the exit direction from an initial position into a contact position which is closer to the exit opening than the initial position. The channel preferably has a circular cross-section.

[0014] The applicator according to the invention thus holds a single penetrating element which, however, in comparison to the prior art, is not bent but interacts with a counterpart to be locked after penetrating the implant and the vessel wall. The counterpart or locking piece allows the penetrating element to be secured without it having to be bent like the penetrating elements of the prior art, and the counterpart can therefore be designed accordingly to enable reliable securing of the penetrating element. Because only a single penetrating element is set with the applicator, the applicator according to the invention can be designed to be simpler in terms of construction and yet still offer improved reliability than the previously known applicator.

[0015] The applicator according to the invention has only a single channel for expelling the penetrating element or the pin, so that the channel can be optimally designed to enable a favorable flow of force from an actuating element of the applicator to the exit area. When the implant is removed in the exit direction, the movable first jaw with the first locking piece held therein moves from an initial position into a contact position which is closer to the exit opening than the initial position and in doing so secures the previously inserted parts of the implant to the vessel wall. In the contact position, the first jaw rests against the outer part of the implant and therefore offers resistance to piercing the implant and the vessel wall with the penetrating element.After the pin has penetrated or punctured the implant and the vessel wall, it comes into action with the first locking piece and is effectively locked in the movable first jaw. The applicator is then released, releasing the locking piece. This also enables visual inspection of the correct placement of the penetrating element before a further penetrating element is placed. In this way, the implant can be attached to the vessel wall quickly and extremely reliably. The first jaw preferably has a recess for releasably receiving the first locking piece, into which the first locking piece is inserted.

[0016] According to a preferred embodiment of the present invention, the outlet opening is formed in a fixed, second jaw of the applicator, the second jaw being designed to releasably receive a second locking piece for the pin. The second jaw preferably has a recess for releasably receiving the second locking piece, in which recess the second locking piece is inserted. When the applicator is used, the implant and the vessel wall in between are clamped between the movable, first jaw and the fixed, second jaw, the two jaws holding two locking pieces for the pin. The penetrating element can thus be designed as a simple pointed pin or as a needle and can therefore be optimally guided in a channel with a circular cross-section.Due to the clamping effect, the locking pieces lie closely against the implant and the penetrating element therefore subsequently secures the implant in reliable contact with the vessel wall.

[0017] In order to reliably expel the penetrating element from the channel and to effect the expulsion of the penetrating element from the channel in a simple and cost-effective manner in terms of equipment, the applicator according to the invention is further developed in a preferred embodiment in such a way that a shear-resistant, and preferably flexible, expulsion element is guided in the channel for expelling the penetrating element from the channel, wherein the expulsion element can preferably be driven by a push rod in the direction of the outlet opening. For this purpose, the expulsion element can be designed, for example, as a fully compressed tension spring. Such a tension spring has a very slight pitch of the individual coils, so that the coils touch one another in the normal state of the spring.Although the spring is therefore completely flexible in order to follow curved sections of the channel, it is more or less completely rigid when guided to prevent it from deflecting sideways. This is the case in a channel such as the one in the present invention. The channel and the ejection element could, however, also be designed as a Bowden cable, for example. The ejection element can preferably be driven in the direction of the outlet opening by means of a push rod. Such a push rod can be driven in the conventional manner by simple mechanical means and by manual force. Furthermore, according to a preferred embodiment, the push rod can also be designed to be flexible in order to allow the applicator according to the invention to be bent depending on the requirements of the surgical field. This makes it possible, under certain circumstances, to treat even relatively inaccessible areas with an appropriate suture.

[0018] If the expulsion element can be driven in the direction of the outlet opening against the action of a first spring element, as corresponds to a preferred embodiment of the present invention, the expulsion element is automatically reset when the user has set the penetration element.

[0019] According to a preferred embodiment of the present invention, the first jaw can be driven by a gear mechanism for a linear displacement from the starting position into the contact position. This serves to convert an actuating movement by the user, for example on a handle of the applicator according to the invention, into the desired direction of displacement of the first jaw in order to displace the first jaw accordingly. The gear mechanism can additionally be designed to suitably select both the displacement path of the first jaw and its drive force depending on a desired force that must be applied by the surgeon.

[0020] According to a preferred embodiment of the present invention, the gear is driven by a drive rod, wherein the drive rod is preferably driven counter to the action of a second spring element. The drive rod can run at any angle to the direction of displacement of the first jaw and thus allows a deflection of the drive direction, which is predetermined by the actuating movement of the surgeon or user of the applicator according to the invention and other mechanical components of the applicator, in the direction of displacement of the first jaw. As already discussed in connection with the expulsion element, a spring-loaded mounting of the drive rod can be used to return the drive rod to its original position while returning the first jaw to its original position.

[0021] According to a preferred embodiment of the present invention, the drive rod is driven by a push rod, with the expulsion element and the drive rod preferably being driven by the same push rod. The concept of driving the moving parts of the applicator according to the invention by means of push rods is considered advantageous in order to be able to implement limited drive paths in a controlled manner, with the force introduction to the moving parts via a push rod taking up only a small amount of space, which is naturally considered advantageous in a surgical instrument.When using a single push rod to drive both the expulsion element and the first jaw by one and the same push rod, as corresponds to a preferred embodiment of the present invention, a desirable reduction in the number of parts of the applicator according to the invention is achieved, and the movements of the first jaw and the expulsion element can be synchronized with one another via the common drive element of the common push rod. As already mentioned, the push rod according to a preferred embodiment can also be flexible and thus bendable to a certain extent in order to enable bending of the applicator according to the invention depending on the requirements of the surgical field.

[0022] In order to transmit the force applied to the push rod for driving the first jaw to the drive rod, it can be provided according to a preferred embodiment of the present invention that the drive rod is coupled to the push rod by means of a drive sleeve coupled to the push rod for joint displacement, wherein the drive sleeve is preferably driven by the push rod against the action of a spring sleeve. The drive sleeve enables a decoupling of drive force from the axis of the push rod to the drive rod, which is particularly advantageous when the push rod drives both the drive rod and the ejection element. Thus, in this preferred embodiment, the push rod can act axially on the ejection element and create a further force path to the drive rod via the drive sleeve. If according to the preferred

[0023] In this embodiment, a spring sleeve which is in particular firmly connected to the push rod and acts resiliently on the drive sleeve, with simultaneous actuation of the ejection element and the first jaw by a common push rod, offset drive movements with different drive path lengths of the first jaw and the ejection element can be achieved. In this way, with a single movement of the push rod, the first jaw can be brought into contact with a retaining ring for the implant or with the implant itself and the ejection element can then be moved further in order to set the penetrating element. In this case, there is no further movement of the first jaw because when the first jaw and thus the first locking piece are fully in contact with the outer part of the implant, the spring sleeve compresses and the drive sleeve is therefore not positively guided by the push rod.

[0024] Preferably, the push rod is driven by an actuating element that interacts with the push rod via a further gear mechanism. The actuating element can, for example, be designed as an actuating lever on a handle element of the applicator according to the invention, so that the user only has to press the lever to insert the penetrating element in order to actuate the applicator.

[0025] According to a preferred embodiment of the present invention, the push rod, the spring sleeve and the drive sleeve are arranged in a distal housing region of the applicator and can thus be designed as a drive unit. Preferably, the first and second jaws, the gear and the drive rod as well as the channel and the expulsion element are arranged in a head of the applicator which can be detachably connected to the distal housing region. Overall, this results in a modular design of the applicator according to the invention which, under certain circumstances, makes it possible to design parts of the applicator as disposable articles and other parts as reusable. For example, the head could be disposable and the remaining part of the applicator reusable.If the push rod is designed to be flexible in order to enable bending of the applicator according to the invention, at least the distal housing region of the applicator according to the invention is also designed to be flexible.

[0026] According to a preferred embodiment of the present invention, the penetrating element is arranged as a straight pin, preferably a metal pin, in the exit region of the channel distal to the expulsion element, wherein the pin forms a support for the expulsion element at a proximal end facing the expulsion element. The penetrating element can thus be expelled from the exit region of the channel along a defined axis and driven through the locking piece(s).

[0027] The first locking piece, and preferably the second locking piece, are according to a preferred

[0028] An embodiment of the present invention is designed as clamping discs. Clamping discs are known in the art as shaft locks and allow a pin, in this case the penetrating element, to be inserted once. Retraction is then no longer possible without the application of considerable force, since a frictional connection occurs between the clamping disc and the pin or the penetrating element in the withdrawal direction. Therefore, once the penetrating element is driven out, it is immediately secured.

[0029] To prevent damage to the surrounding tissue at the fixation site by the penetrating elements, the present invention is preferably further developed in such a way that a locking piece is enclosed in a plastic sheath penetrable by the penetrating element. The plastic sheath can be easily penetrated by the implant during attachment, i.e., during insertion of the penetrating element, and subsequently covers the tip of the penetrating element.

[0030] Alternatively or additionally, the present invention can preferably also be further developed in such a way that a locking element has a hollow metal cap for the penetration of the penetrating element. The hollow metal cap can also serve to shield the tip of the penetrating element and can also be suitable for bending the tip of the penetrating element if the penetrating element itself is too long.

[0031] According to a further aspect of the present invention, a set is created for attaching an implant as a fixation point for a vascular prosthesis to a vessel wall of a blood vessel, comprising at least one applicator as just described, the head of which is connected to or separated from the distal housing region of the applicator, a first retaining ring for holding an inner implant part, and a second retaining ring for holding an outer implant part. According to a preferred embodiment of the present invention, the set further comprises the implant in the form of a first implant part, which is arranged externally on the first retaining ring, and a second implant part, which is arranged internally on the second retaining ring, wherein the first and the second implant part are preferably designed as a tube made of textile material.The retaining rings with the implant parts already arranged on them can be placed inside and outside on the vessel stump and the implant can then be fixed or attached to the vessel wall using a penetrating element from the head of the applicator.

[0032] In order to enable rapid work, the set according to the invention additionally comprises at least one further head for attachment to the distal housing region of the applicator. The set preferably comprises a plurality of, for example, twelve to sixteen heads, each with a penetrating element and the corresponding locking pieces, wherein the heads are placed one after the other on the housing region of the applicator to completely apply the implant to the vessel wall. This can be optimized even further according to a preferred embodiment of the present invention if, for example, two applicators with a distal housing region are included in the set, so that one applicator can be provided with a head, while a penetrating element is placed with the other applicator. The surgeon then receives the appropriately prepared applicator with the head attached, and the assistant can place a further head onto the first applicator.The invention is explained in more detail below with reference to an exemplary embodiment shown in the drawing. Figures 1 and 2 show perspective views of the applicator according to the invention, Figures 3 to 5 show an overall view of the applicator according to the invention in section at various stages of setting a penetrating element, Figures 6 to 9 show detailed views of the applicator according to the invention in section at various stages of setting a penetrating element, and Figures 10a and 10b show detailed views of a penetrating element.

[0033] In Figure 1, a handle of the applicator 1 according to the invention is provided with the reference number 2. The handle 2 has a distal housing region 2a and a head 3 is placed on the distal housing region 2a, wherein the head 3 can be secured to the distal housing region 2a or the handle 2, for example, by a bayonet lock. The handle 2 also has an actuating element, the lever 4, which can be actuated by a user. A second, outer retaining ring is provided with the reference number 5b and it can be seen that an outer, second implant part 6b made of a textile material is inserted inside the retaining ring 5b and is brought into contact with the vessel wall 7 by means of the second or outer retaining ring 5b.

[0034] In Figure 2 and the subsequent figures, identical elements are provided with identical reference numerals. It can be seen that the lever 4 was actuated in the direction of arrow 8 and that, accordingly, a displaceable first jaw 9 was displaced in the direction of arrow 12 toward the outer retaining ring 5b. The first jaw 9 rests against the second retaining ring 5b and holds it and the outer implant part 6b.

[0035] In the sectional view according to Figure 3, a corresponding first or inner retaining ring 5a and a first, inner implant part 6a can be seen, which are placed against the wall of the vessel 7. Furthermore, in Figure 3 the displaceable first jaw 9 can be seen in an initial position and thus spaced from the vessel 7 or from the outer retaining ring 5b. The first jaw 9 can be displaced in the direction of the arrow 12 by means of a gear 10, which in turn is driven by a drive rod 11, by actuating the lever 4, whereby the first jaw 9 is lowered onto the outer, second implant part 6b. The drive rod 11 is coupled to a push rod 15 via a drive sleeve 13 and a spring sleeve 14. The spring sleeve 14 contains a spring 16.

[0036] The push rod 15 acts axially and through the mediation of a first spring element 17 on an expulsion element 18, which can be driven through the channel 19 by the push rod. A penetrating element or pin 20 is mounted in the channel 19 and is expelled from the channel by the expulsion element 18.

[0037] Figure 4 shows that when the lever 4 is actuated, the push rod 15 is moved in the direction of the arrow 21, so that the push rod 15 drives the first spring element 17 and thus the ejector element 18 through the channel. At the same time, the drive rod 11 was moved in the direction of the arrow 21 by the action of the spring sleeve 14 and the drive sleeve 13, so that the first jaw 9 was moved into the contact position in contact with the second retaining ring 5b by the action of the gear 10. The movement phases of the ejector element 18 and the displaceable first jaw 9 are decoupled from one another by the action of the spring sleeve 14, so that the ejector element 18 can be moved further by the action of the push rod 15 when the first jaw 9 is already in the contact position.

[0038] In Figure 5, it can be seen that upon further actuation of the lever 4 in the direction of arrow 8, the pin 20 is pushed out of the channel 19 and through the vessel 7 and the implant parts 6a and 6b, whereby the implant parts 6a and 6b are fixed to the vessel 7. Due to the action of the first spring element 17 and the second spring element 22, the applicator 1 according to the invention is reset when the lever 4 is released.

[0039] In Figure 6, the initial position of the first jaw 9 is more clearly visible, and it can be seen that a first locking piece 23 for the penetrating element 20 is releasably received in a recess of the first, movable jaw 9. A second locking piece 24 for the penetrating element 20 is releasably received in a recess of the second, fixed jaw 25. A plastic cover for the locking piece 23 is designated by the reference numeral 27.

[0040] In Figure 7, the first jaw 9 is in the contact position, with the first locking piece 23 for the penetrating element 20 also being in contact with the outer implant part 6b. Figure 8 shows a state in which the penetrating element 20 has penetrated the implant parts 6a and 6b as well as the vessel 7, with the second locking piece 24 for the penetrating element 20 being lifted out of the second, stationary jaw 25. The penetrating element or the pin 20 also penetrates the first locking piece 23, with the pin 20 being irreversibly anchored in the locking pieces 23 and 24. A support on the penetrating element 20 for the expulsion element 18 is designated by the reference symbol 20a.

[0041] In the state illustrated in Figure 9, the first jaw 9 is raised in the opposite direction to the direction of arrow 12 by the action of the second spring element 22, and the expulsion element is retracted into the channel 19 by the action of the first spring element 14. The head 3 can thus be retracted in the direction of arrow 26 and replaced in order to insert another penetrating element. The outlet opening of the channel is designated by the reference symbol 19a, and an exit direction parallel to the exit region 19b is defined by the axis A.

[0042] In Figure 10a, the pin 20 can be clearly seen as a penetrating element. The pin 20 has a support 20a for an expulsion element 18 at its proximal end facing away from the tip. The first locking piece is designated 23 and is designed as a shaft lock. A plastic sleeve 27 encloses the locking piece 23 and, as shown in Figure 10b, is penetrated by the penetrating element, i.e. by the pin 20, so that the tip of the pin 20 is enclosed. The plastic sleeve 27 can have a cap 28, or the cap 28 can completely replace the plastic sleeve 27 in order to shield the tip of the pin 20. The second locking piece is provided with the reference number 24 and has on its underside a recess 29 for the support 20a.

[0043] In Figure 10b, the penetration element is shown in the locked state, with the pin 20 being clamped by the shaft lock in the first penetration element 23. The support 20a is received in the recess 29.

Claims

Patent claims:

1. Applicator (10) for attaching an implant (6) as a fixation point for a vascular prosthesis to a vessel wall of a blood vessel (7) by penetrating the vessel wall and the implant (6) with at least one penetrating element (20), preferably with a plurality of penetrating elements (20), wherein the applicator (1) has a channel (19) for receiving and expelling the at least one penetrating element (20) from the channel (19) and a displaceable, first jaw (9) for releasably receiving a first locking piece (23) for the penetrating element (20), wherein the channel (19) has a Exit direction (A) defining an exit region with an exit opening (19a) for the penetrating element (20) and the first jaw (9) is displaceable in the exit direction (A) from an initial position into a contact position located closer to the exit opening (19a) compared to the initial position.

2. Applicator according to claim 1, characterized in that the outlet opening (19a) is formed in a fixed, second jaw (25), wherein the second jaw (25) is designed to releasably receive a second locking piece (24) for the penetrating element (20).

3. Applicator according to claim 1 or 2, characterized in that a shear-resistant, and preferably flexible, expulsion element (18) is guided in the channel (19) for expelling the penetrating element (20) from the channel (19), wherein the expulsion element (18) can preferably be driven by a push rod (15) in the direction of the outlet opening (19a).

4. Applicator according to claim 3, characterized in that the expulsion element (18) can be driven against the action of a first spring element (17) in the direction of the outlet opening (19a).

5. Applicator according to one of claims 1 to 4, characterized in that the first jaw (9) can be driven by means of a gear (10) for a linear displacement from the starting position into the contact position.

6. Applicator according to claim 5, characterized in that the gear (10) is driven by a drive rod (11), wherein preferably the drive rod (11) is driven against the action of a second spring element (22).

7. Applicator according to claim 6, characterized in that the drive rod (11) is driven by a push rod (15), wherein preferably the expulsion element (18) and the drive rod (11) are driven by the same push rod (15).

8. Applicator according to claim 6 or 7, characterized in that the drive rod (11) is coupled to the push rod (15) by means of a drive sleeve (13) coupled for joint displacement with the push rod (15), wherein preferably the drive sleeve (13) is driven by the push rod (15) against the action of a spring sleeve (14).

9. Applicator according to claim 6, 7 or 8, characterized in that the push rod (15) is driven by an actuating element (4) which cooperates with the push rod (15) via a further gear.

10. Applicator according to claim 8 or 9, characterized in that the push rod (15), the spring sleeve (14) and the drive sleeve (13) are arranged in a distal housing region (2a) of the applicator (1).

11. Applicator according to claim 10, characterized in that the first and second jaws (9, 25), the gear (10) and the drive rod (11) as well as the channel (19) and the expulsion element (18) are arranged in a head (3) of the applicator (1) which can be detachably connected to the distal housing region (2a).

12. Applicator according to one of claims 3 to 11, characterized in that the penetrating element (20) is designed as a straight pin (20), preferably a metal pin (20), in the exit region of the channel (19) distal to the expulsion element (18), wherein the pin (20) has a support at a proximal end facing the expulsion element (18) (20a) for the expulsion element (18).

13. Applicator according to one of claims 2 to 12, characterized in that the first locking piece (23), and preferably the second locking piece (24), are designed as clamping discs.

14. Applicator according to one of claims 1 to 13, characterized in that a locking piece (23) is enclosed by a plastic sheath (27) which can be penetrated by the penetrating element.

15. Applicator according to one of claims 1 to 14, characterized in that a locking element (23) has a hollow Metal cap (28) for the penetration of the penetrating element (20).

16. Set for attaching an implant (6) as a fixation point for a vascular prosthesis to a vessel wall of a blood vessel (7), comprising at least one applicator (1) according to one of claims 11 to 15, the head (3) of which is connected to or separated from the distal housing region (2a) of the applicator (1), a first retaining ring (5a) for holding an inner implant part (6a), and a second retaining ring (5b) for holding an outer implant part (6b).

17. Set according to claim 16 comprising the implant (6) in the form of a first implant part (6a) which is arranged externally on the first retaining ring (5a) and a second implant part (6b) which is arranged internally on the second retaining ring (5b), wherein preferably the first and the second implant part (6a, 6b) are designed as a tube made of textile material.

18. Set according to claim 16 or 17 comprising at least one further head (3) for attachment to the distal housing area (2a) of the applicator (1) .

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