A Technique for Rapid Non-Suture Vascular Anastomosis

Abstract

ABSTRACT:In an attempt to overcome some of the difficulties inherent in vascular anastomosis using standard suture methods, we have developed a technique that allows for rapid non-suture anastomosis of blood vessels. The technique has been used in over 400 anastomoses, including interposition vein grafts in rat, rabbit and dog vessels ranging in size from 0.7 mm to 3 mm in diameter. Animals have been followed for over 1 year postoperatively with serial angiography and histological evaluation including scanning electron microscopy. Stress studies have compared the biomechanical properties of both non-suture and suture anastomosis. The overall patency rate in non-suture end-to-end anastomoses using an interposition vein graft was 85% at 1 year follow up. Histological evaluation revealed a healing pattern that was temporally similar to that of the suture technique. Stress tests revealed no significant difference between suture and non-suture technique. These studies reveal that the non-suture technique compares favourably with the suture technique, and demonstrate the feasibility of applying this technique to man. RESUME: Une technique rapide d'anastomose vasculaire sans suture Dans le cadre d'une recherche visant a surmonter certaines des difficultes inherentes a I'anastomose vasculaire par les methodes de suture standards, nous avons d^veloppe une technique qui permet une anastomose rapide des vaisseaux sanguins sans utiliser de suture. Cette technique a ete utilisee dans plus de 400 anastomoses vasculaires, incluant des greffes de veines par interposition chez le rat, le lapin et le chien, au niveau de vaisseaux dont le diametre variait de 0.7 a 3 mm. Les animaux ont ete suivis sur une periode de I ans apres l'operation, au moyen d'angiographies seriees et d'une evaluation histologique incluant la microscopie electronique a balayage. Les proprietes biomecaniques des anastomoses sans suture et avec sutures ont ete comparees par des etudes de stress. Le taux global de permeabilite dans les anastomoses bout-a-bout sans suture, utilisant une greffe veineuse d'interposition, etait de 85 % a l'examen de controle un an apres la procedure. L'evaluation histologique a montre un pattern de guerison similaire dans le temps a celui des anastomoses par sutures. Des epreuves de stress n'ont revele aucune difference significative entre les techniques avec et sans suture. Ces etudes demontrent que la technique sans suture se compare favorablement a la technique par suture et atteste de la possibility d'appliquer cette technique chez I'humain.Can. J. Neurol. Sri. 1987: 14:92-95

Comparison of Tensile Strength and Thrombus Formation between Mechanical Microvascular Anastomoses Using a Biodegradable Ring Device and Sutured Anastomoses

“…Tensile strength at the anastomotic site has been measured previously in various sutured anastomoses [10][11][12][13][14][15][16] ; however, reports of tensile strength in mechanical anastomoses are few. 17,18 Gilbert and colleagues 17 compared the Unilink anastomotic system with standard suture techniques in terms of anastomotic strength, under conditions of uniaxial loading following Unilink and suture anastomosis of both carotid arteries and facial veins in rabbits. Unilink arterial anastomoses were shown to be significantly stronger than sutured anastomoses at 1 hr and 2 weeks, but no statistically significant differences in venous anastomoses were observed in Unilink and suture anastomoses at any time period evaluated.…”

Microvenous End-to-Side Anastomosis: An Experimental Study Comparing the Unilink System and Sutures

“…To solve this problem, we developed a modified technique. A transverse slit in the recipient vessel wall, instead of a cruciate 16 or circular arteriotomy, 14 secures maximal preservation of the already insufficient tissues. The tensile forces in the vessel acting axially, automatically convert this incision into a circular hole.…”

William M. Lougheed and the Development of Vascular Neurosurgery at the Toronto General Hospital

“…He was unable to complete his last project, the invention of a technique of rapid, nonsuture vascular anastamosis that would enable neurosurgeons to quickly, safely and easily make vascular connections deep within the brain. 22 In December, 1989, at age 66, Lougheed removed his gloves after excising a large convexity meningioma from a young woman and announced to a startled theater that he had just completed his last operation. Not even his secretary for nearly 30 years, Mrs. Joan Kane, knew in advance.…”