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

Qu, Wei Wei; Muneshige, Hiroshi; Ikuta, Yoshikazu

doi:10.1002/(sici)1098-2752(1999)19:3<128::aid-micr2>3.0.co;2-0

Cited by 10 publications

(3 citation statements)

References 12 publications

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“…However, an 11% failure rate caused by separation of the absorbable coupler after anastomosis has been reported. Another study reported that couplers containing hook-shaped pins increased the frictional force of the pins attaching to the ring to prevent separation of the couplers 15 . Although the study reported complete patency of this coupler, it was composed of an absorbable ring and non-absorbable stainless pins; therefore, it was not completely absorbable.…”

Section: Discussionmentioning

confidence: 99%

New Absorbable Microvascular Anastomotic Devices Representing a Modified Sleeve Technique: Evaluation of Two Types of Source Material and Design

Jeong

Kim

Son

et al. 2019

Sci Rep

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The purpose of this study was to create a new absorbable vascular anastomotic coupler and evaluate the patency and degradation degree. Vascular anastomosis was performed in the jugular vein in 31 New Zealand white female rabbits. The coupler consisted of an inner and outer ring. One side of the jugular vein was passed through and overlapped the inner ring. The opposite side of the jugular vein overlapped the everted jugular vein on the inner ring. Then, the outer ring engaged with the inner ring and completed the anastomosis. The outer rings were also constructed with two shapes including an O-type that had no slit and a C-type with a slit on the outer ring of the O-type coupler to allows expandability of the diameter. A Phase I experiment was performed to evaluate the degradability of the source materials, including the poly (lactic-co-glycolic acid) (PLGA) and polycaprolactone (PCL) couplers. A Phase II experiment was performed to evaluate the patency and anastomosis time of the O-type PLGA and PCL couplers. A Phase III experiment was performed to evaluate the patency and anastomosis time of suture anastomosis (control) and the C-type PLGA coupler. The patency was determined by ultrasonography and open exploration. Histological analysis was performed to determine the degradability of the couplers. In Phase I, the PLGA couplers were completely degraded with good vascular wall remodeling at 8 months, while the PCL couplers demonstrated incomplete degradation. In Phases II and III, the anastomosis time was significantly shorter in the coupler groups than that in the control group. All of the coupler groups demonstrated complete patency of the anastomoses on ultrasonography. In Phase III, the C-type PLGA coupler also demonstrated patency and complete degradation at 8 months. PLGA is a suitable source material for absorbable couplers due to its fast degradability. We devised the O-shaped outer ring for the C-shaped outer ring to increase flexibility, which also demonstrated complete patency during the experimental period. Our absorbable microvascular anastomosis devices could provide rapid and reliable microvascular anastomosis without anastomotic failure.

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Section: Discussionmentioning

confidence: 99%

New Absorbable Microvascular Anastomotic Devices Representing a Modified Sleeve Technique: Evaluation of Two Types of Source Material and Design

Jeong

Kim

Son

et al. 2019

Sci Rep

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“…Mechanical pressure due to a rigid, non-compliant device may also contribute to medial atrophy [18]. The regenerated tissue has less elasticity than a normal vessel, suggesting that mural atrophy may be induced by periodically applied vascular pressure [17,[19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Vessel Remodeling after Intima-to-Intima Contact Anastomosis

et al. 2017

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BackgroundIntima-to-intima microanastomotic vascular remodeling was explored, utilizing a polylactide-caprolactone absorbable vein coupler model (PAVCM), which was designed to simulate a non-absorbable counterpart system with the sole exception of being absorbable.MethodsSix New Zealand white rabbits were used. After transection of the jugular vein, 2 PAVCMs were placed, 1 at each transected end. The stumps were slipped through the PAVCMs, and the venous wall was everted 90° to achieve intima-to-intima contact. Reanastomosis of the transected jugular vein was performed bilaterally in 3 rabbits. In the other 3 rabbits, the jugular vein (20 mm) harvested from one side was interpositionally grafted to the jugular vein on the opposite side to ease the anastomotic tension. Patency testing, ultrasonography, and histologic assessments were conducted postoperatively at weeks 2, 4, 12, 16, 22, and 26.ResultsAll anastomotic sites were patent, without stenosis, occlusion, or dilatation. In the histologic sections, immature endothelial regeneration was observed at week 2, which was completed by week 4. Regeneration of the tunica media was noted at week 12. Between week 22 and week 26, the tunica media fully regenerated and the coupler dissipated entirely.ConclusionsDespite the absence of a coupler to act as an anastomotic buttress, the structure and function of all the vessels appeared normal, even histologically. These outcomes are true milestones in the development of an absorbable vein coupler.

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“…Recognizing these issues, a variety of alternative techniques attempting to eliminate the intraluminal suture have been attempted with limited success. In the past 50 years sutureless techniques utilizing rings/couplers, [9][10][11][12][13][14][15] clips, 8,[16][17][18] stents, [19][20][21][22] and adhesives [23][24][25][26][27] have been described. While achieving patency rates similar to suture anastomosis, these techniques have been associated with increased inflammation due to foreign body response, friction with erosion into adjacent tissue, tissue toxicity resulting in vessel wall necrosis, and aneurysm formation.…”

Section: Introductionmentioning

confidence: 99%

Light-Activated Vascular Anastomosis

et al. 2022

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Background. There have been few advances in technique since vascular anastomosis was performed with silk suture on a curved needle in 1902. This technique results in disruption of the endothelium with exposed intraluminal suture, both of which may lead to thrombocyte aggregation, intimal hyperplasia, and vascular stenosis. A variety of alternative techniques have been explored, with limited success. Photochemical tissue bonding (PTB) is a light-activated methodology of rapidly cross-linking tissue interfaces at the molecular level. Herein, we describe a new technique for anastomosis of venous interposition graft in an ovine model of femoral artery bypass utilizing PTB. Methods. Polypay specific pathogen free sheep (n = 5; 40-45 kg) underwent femoral artery bypass utilizing saphenous vein. The femoral artery was transected and reversed saphenous vein was implanted as an interposition graft. The proximal anastomosis was created as a vein-over-artery cuff utilizing PTB, and the distal anastomosis was created with standard interrupted 8-0 polypropylene suture. Four weeks post-index operation, femoral angiogram was performed to evaluate patency, tortuosity, and luminal diameter. All bypass grafts were harvested and longitudinal and transverse histological sections from the proximal anastomosis were analyzed. Results. The PTB anastomoses (n = 5) were immediately watertight and patent. All animals survived the 28-day study duration. Angiography revealed patent grafts with no aneurysm or stenosis (n = 5). Histologic examination revealed integration of the venous endothelium with the arterial adventitia. Conclusion. Photochemical tissue bonding creates an immediate strong, watertight vascular anastomosis that can withstand physiologic arterial pressure and remains patent at 28 days without the need for intraluminal suture.

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

Cited by 10 publications

References 12 publications

New Absorbable Microvascular Anastomotic Devices Representing a Modified Sleeve Technique: Evaluation of Two Types of Source Material and Design

New Absorbable Microvascular Anastomotic Devices Representing a Modified Sleeve Technique: Evaluation of Two Types of Source Material and Design

Vessel Remodeling after Intima-to-Intima Contact Anastomosis

Light-Activated Vascular Anastomosis

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