Reduction of Anastomotic Time Through the Use of Cyanoacrylate in Microvascular Procedures

Abstract

Background: Ever since the description of the first microvascular anastomosis, numerous alternative methods have been described to the classical approach. Tissue adhesive has shown promising result in previous studies and can be a fast and efficient alternative which still requires more studies to allow its clinical implementation. Methods: A randomized comparative experimental study was conducted on rats’ femoral arteries and an end-to-end anastomosis was performed in order to compare 2 anastomosis techniques. In one group, a simple interrupted suture was utilized, whereas in the second group a combination between fewer sutures and tissue adhesive was used. The anastomotic time, total operative time, blood flow velocity before, immediately after and 48 hours after the procedure, as well as an independent grading of the anastomosis immediately after the procedure were performed. Magnetic resonance imaging (MRI) was performed in order to assess the degree of stenosis. After euthanasia, histology and scanning electron microscopy (SEM) were performed on the vessels in order to assess possible complications. Results: A total of 24 anastomoses were performed, of which 12 with a classic technique and 12 with an adhesive technique. All the anastomoses were patent with a significant reduction of anastomotic and total operative time. The grading of the anastomoses showed better results in the classic suture group. The blood flow velocities were not statistically significant between the 2 groups. On MRI there was one stenotic anastomosis, whereas histology and SEM showed more complications on the adhesive group. Conclusion: Anastomotic times were significantly lower with a non-significant trend toward more thrombotic complications in the adhesive group. Further improvement of the glue properties and refinement of the technique will likely make it a viable alternative to interrupted suturing in the future.

Validation of Novel Microsurgical Vessel Anastomosis Techniques: A Systematic Review

“…At last, a fair method of validation is performing RCT comparison with conventional suture techniques in animals, which has been conducted in 14 studies included in this systematic review. [3][4][5][8][9][10][11][12][13][14][15][16][17][18] However, only one study among these RCTs succeeded in proper predictive validation, which has been mentioned earlier. 3 The validated techniques in these studies are merely modifications to existing anastomosis techniques or efforts to minimize steps in suturing anastomosis, aiming to reach a faster and more efficient anastomosis time, with the same or improved patency rate as conventional methods.…”

Sutureless vascular anastomotic approaches and their potential impacts

“…Given these challenges, there is a growing inclination in the medical community towards advanced solutions, such as tissue adhesives, sealants, and hemostatic materials [ [88] , [89] , [90] , [91] , [92] , [93] , [94] ]. For example, cyanoacrylate adhesives, brands like Dermabond and SurgiSeal, facilitate rapid bonding and microbial protection, though their inherent brittleness and cytotoxicity can pose limitations in vascular contexts [ [95] , [96] , [97] ]. Fibrin sealants, with Tisseel and Evicel leading the pack, emulate the clotting response of the body, offering flexible seals particularly well-suited for internal vascular connections [ [98] , [99] , [100] ].…”

“…These formulations produce fewer toxic byproducts, promoting usage outside of the body. Although cyanoacrylates present advantages like rapid bonding and watertight seals, they also come with challenges, including brittleness, potential embolization, and high cytotoxicity inside the body [ 96 , 97 ]. Recent research explored the role of 2-octyl cyanoacrylate in vascular anastomosis using a rabbit carotid artery model.…”

“…These results suggest that 2-octylcyanoacrylate adhesive can effectively inhibit stenosis in vascular anastomoses [ 95 ]. Although this may seem promising, the inherent cytotoxicity of cyanoacrylate poses boundaries for adoption for intrabody use and requires further extensive testing and characterization [ 113 ].…”