Abstract: Anastomosis procedures are achieved through the use of an intraluminally directed anvil apparatus. The apparatus is inserted at a catheter site and is then positioned through the lumen of the blood vessel to a remote anastomosis site. The intraluminally directed anvil apparatus has an anvil pull extending from an anvil. At the anastomosis site, the anvil is extended through the wall of the vessel at an initial piercing. The anvil is too large to pass through the initial piercing so the anvil pull can be used to pull the anvil against the wall of the vessel and distend the vessel wall in preparation for being cut to form an opening. The apparatus is used with a cutter to form openings in a wall of a blood vessel. After the opening is formed then the vessel is joined with another vessel.