Fibrinolytic activity following laser‐assisted vascular anastomosis

Abstract

New technology has allowed tissue bonding to be feasible using carbon dioxide laser energy. Laser-assisted vascular anastomosis (LAVA) has shown comparable patency results with standard suture anastomosis, but LAVA procedures produce thermally induced transmural structural alterations. To assess functional intimal recovery in LAVA versus sutured vessels, a fibrinolytic slide technique was utilized in 21 rats which had LAVA performed in one femoral artery while the opposite limb underwent a conventional microsuture anastomosis. Conventional anastomosis had persistent fibrinolytic activity while LAVA had return of fibrinolytic activity by 48 hours. Intimal fibrinolysis inhibition following LAVA is reversible and this technique does not lead to an increased incidence of thrombosis.

Laser-Assisted End-to-Side Anastomosis

“…5 Recent investigations (manuscript in preparation) indicate that the occurrence of aneurysms is related to the distance between stay sutures. In the femoral artery end-to-end study, this was only 0.5 mm 4 ; in the present study, the four sutures are close to 1.0 mm apart. Thus, increasing the distance between stays increases the aneurysm rate.…”

Laser-assisted vessel welding: state of the art and future outlook

“…Compared to conventional suture anastomosis (CSA), the potential advantages of laser vascular bonding include a reduction in foreign body reaction, liquid-tight sealing (i.e., immediate closure of the incision or wound that prevents bleeding or seeping of fluids from the perfused blood vessels), faster healing, and simpler and more rapid alternatives for minimally invasive and endoscopic anastomotic techniques [1][2][3]5,7,8,[10][11][12]14,16,17,[22][23][24]27,28,30,32,35,36,40,44,45,68,69].…”

“…First, the relatively low welding strengths produced with LAVW often require additional sutures to reinforce the anastomosis, ultimately defeating the purpose of the modality. [3,[5][6][7][8]10,[12][13][14]18,20,22,24,26,28,30,32,[34][35][36]40,67,69,70] Second, extensive thermal damage may extend to the basal membrane of the intima ( Figure 1) and cause intimal hyperplasia [7,20], thrombosis [7,26], and aneurysm formation [13,15,21,34,38,71,72]. To overcome these disadvantages, several more refined welding techniques have been developed, including sLAVW, scaffold-and solder-enhanced LAVW (ssLAVW) (Figure 2), and photochemical laser-assisted tissue bonding.…”