A series of direct carotid end-to-end laser anastomosis vs. direct manual suture was carried out on a series of 70 Wistar rats (mean weight 260 g). Both common carotids (0.8-1.2 mm) were sectioned and repaired. The left side (n = 70) was submitted to laser-assisted microvascular anastomosis (LAMA) performed by means of a diode laser device (wavelength 830 nm and power output 3 W in continuous wave) without chromophore. The right side (n = 70) underwent a control manual suture (CMA). The diode laser energy was delivered into a micromanipulator coupled to a Zeiss operating microscope with a focused spot of 300 microns in diameter. After placement of three 10.0 stitches for edge coaptation, the LAMA was achieved using laser shots (average 3) of 500 mW power, 4.5 s duration, and 700 W/cm2 irradiance each. The CMA was performed by means of six 10.0 stitches. The good vascular flow was confirmed by Doppler spectral analysis (n = 466) carried out from day 0 to day 90. Light and scanning electron microscopy (n = 82) showed that re-endothelialization after LAMA was gaining ground on day 3, whereas collagenous network developed in the media scar by day 10. In contrast, after CMA the arterial repair was delayed on day 20, inducing a media fibrotic scar. The patency rate was 93% in both anastomoses. The shorter operating time (13 min for LAMA vs. 22 min for CMA) and the noncontact laser technique are the main intraoperative advantages. The technical benefits of the diode laser are pointed out.
A carotid end-to-end anastomosis was performed in 50 Wistar rats (mean weight 260 g) by means of a Coherent 900 Argon laser. A micromanipulator coupled to an operating Zeiss OPMI 1 microscope provided a beam with a focused spot of 150 /xm in diameter. After 2 stitches were made (180 ~ apart from each other) to obtain good adjustment of the arterial ends, vessel anastomosis was achieved on common carotids (0.7-1.2 mm in diameter) using 19 laser shots of a mean power output of 300 milliwatts (mW) (1,700 W/cm 2) for 5 sec. Good vascular flow was confirmed by Doppler spectral analysis and angiography performed on day 0, 3, 10, 20, and so forth up to 7 months. Light and scanning electron microscopy showed that the heating effects of the Argon laser caused collagenous fusion of the media on day 0, while the sealing line became reendothelialized on day 10. The patency rate was 76%. Complications such as thrombosis, disruption, and aneurysm must be attributed to initial technical drawbacks.
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