Implantable medical devices (800) for connecting tissue layers or to circumvent occluded body conduits and tissue structures. The implantable medical devices include apposition portions (802, 804), a central region (806), and a covering material (812). The methods of using the devices include endoscopic deployment, and the devices may include self-expanding frameworks that facilitate a secure connection between the tissue structures. In some embodiments, one or more tethers (810 a, b, c) are used to longitudinally contract the device in
