Mechanical Anastomosis of Small Arteries and Veins with the Unilink Apparatus

Berggren, Anders; Östrup, Leif T.; Lidman, Disa

doi:10.1097/00006534-198708000-00020

Cited by 65 publications

(42 citation statements)

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“…Among the components of this device are gauges for measuring the vessel diameter for appropriate matching of the size of the ring in order to avoid stenosis. Scanning electron microscopy of ringed anastomoses has shown smooth and complete endothelial healing in both arterial and venous anastomoses after 2 weeks 20 and, while marked atrophy of the media at the site of the anastomotic rings was observed, this did not seem to affect the patency rate, which compared favourably with that of sutured controls 17,19,22,102,103 . The Unilink system  fits with Carrel's third and fourth principles, alignment of both intimal layers and absence of intraluminal foreign material.…”

Section: Discussionmentioning

confidence: 90%

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Non-suture methods of vascular anastomosis

Zeebregts¹,

Dungen³

et al. 2003

British Journal of Surgery

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The non-suture techniques can be categorized into five groups based on the materials used: rings, clips, adhesives, stents and laser welding. With all these techniques a faster and less traumatic anastomosis can be made compared with sutures. However, each device is associated with technique-related complications. As a consequence, suturing continues to be the standard approach. The disadvantages of the non-suture techniques include: rigidity and a non-compliant anastomosis with rings; toxicity, leakage and aneurysm formation with adhesives; early occlusion with stents; cost, reduced strength in larger-sized vessels and demand for surgical skills with laser welding. Further refinement is needed before widespread adoption of these techniques can occur. Clips, however, may be particularly promising but long-term evaluation is required.

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Section: Discussionmentioning

confidence: 90%

“…Previous radiation therapy does not appear to be a contraindication to its application 18 , but severely atherosclerotic arteries are 19 . In addition, the rings are permanently placed with subsequent detrimental physiological effects at the anastomotic site, inducing atrophy of the media both at the level of the ring and proximal to it 20 .…”

Section: Ringsmentioning

confidence: 99%

Non-suture methods of vascular anastomosis

Zeebregts¹,

Dungen³

et al. 2003

British Journal of Surgery

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“…This increases the risk for intimal damage, especially in human practice, where slight to moderate arteriosclerotic vessel changes are common. 4 Furthermore, it wastes a greater amount of vessel than a pinned-ring device, and eversion must be manually maintained, requiring a skilled assistant. 2 This absorbable coupler is no longer available for use.…”

Section: Discussionmentioning

confidence: 99%

“…However, the rigid polyethylene rings remained permanently at the anastomotic site, leading to atrophy of the vessel wall. 4,6,7 To resolve this problem, we developed the absorbable pinned-ring device in 1991, and the anastomotic process was designed to be performed only by one person.…”

Section: Discussionmentioning

confidence: 99%

“…4,6,7 The mechanism leading to medial atrophy was thought to be arterial pressure against the rings. Berggren et al 4 have reported that the thickness of vessel wall was reduced to 10-20% of normal at the 16th week, and that vessel continuity was maintained just by intimal thickening Figure 6. A: In the ring group at 6 weeks, the anastomotic cleft had completely disappeared, and the wall thickness had been restored to normal by intimal hyperplasia (Elastica van Gieson, ×100).…”

Section: Discussionmentioning

confidence: 99%

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An absorbable pinned-ring device for microvascular anastomosis of vein grafts: Experimental studies

Muneshige

Ikuta

1999

Microsurgery

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In the rabbit, posterior facial vein segments were grafted to the femoral arteries using either conventional suture technique or a mechanical absorbable pinned-ring device. The purpose of this study was to compare patency rates and anastomotic times for the two different methods. The anastomoses were evaluated macroscopically and using light and scanning electron microscopy. The grafts anastomosed with the absorbable rings exhibited 100% patency, while only 83% of the sutured grafts were patent. The mean anastomotic time using the mechanical pinned-ring device was 18.1 min (range 9.8-30 min). The conventionally sutured anastomoses were completed in a mean time of 60 min (range 50-75 min). The experiment has confirmed that the absorbable pinned-ring device provides a safe and fast way to perform microvascular anastomosis.

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Arterial Coupling for Microvascular Free Tissue Transfer in Head and Neck Reconstruction

Ross¹,

Chow²,

Shin³

et al. 2005

Arch Otolaryngol Head Neck Surg

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To demonstrate the efficacy of arterial coupling. Design: We report our experience in head and neck reconstruction with the Unilink Microvascular Anastomotic System (Synovis MCA, Birmingham, Ala). Data were collected in a consecutive series of 49 patients undergoing composite resection of head and neck tumors followed by free tissue transfer. Setting: All patient care took place at Yale-New Haven Hospital, New Haven, Conn, a university-based tertiary care facility. Patients: Forty-nine consecutive patients aged 43 to 85 years underwent a total of 50 microvascular free tissue transfers using the Unilink coupling device. There were 18 women and 31 men, and the following 3 types of flaps were performed: radial forearm (n = 36), fibula (n=12), and rectus abdominus (n = 2). Interventions: The Unilink coupling device was used in this case series. Each arterial and venous anastomosis was performed with the coupling device. Free tissue transfers were monitored clinically and outcomes were recorded. Main Outcome Measures: Flap survival and thrombosis of the arterial anastomoses were determined, as was median length of stay. Results: There were no flap failures in the series. Of the 50 coupled arterial anastomoses, the predominant coupler size used was 2.5 mm in diameter. Reconstructions included 36 radial forearm, 12 fibular osteocutaneous, and 2 rectus abdominus myocutaneous free flaps. One intraoperative arterial thrombosis occurred, requiring handsewn anastomosis, and another pulled away from the intact coupler in a steroid-dependent patient. There were no complications related to technical performance of the coupling device. The median length of stay was 14 days. Conclusion: While hand-sewn anastomoses in free tissue transfer remain the preferred technique for many microsurgeons, use of the coupler is a viable alternative to sutured anastomoses.

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Mechanical Anastomosis of Small Arteries and Veins with the Unilink Apparatus

Cited by 65 publications

References 0 publications

Non-suture methods of vascular anastomosis

Non-suture methods of vascular anastomosis

An absorbable pinned-ring device for microvascular anastomosis of vein grafts: Experimental studies

Arterial Coupling for Microvascular Free Tissue Transfer in Head and Neck Reconstruction

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