End‐to‐end versus end‐to‐side arterial anastomosis patency in microvascular surgery

Abstract

The patency rates of microsurgical end-to-end and end-toside anastomosis in the rat carotid artery were studied. Seventy end-to-end and seventy end-to-side arterial anastomoses, using 10-0 nylon interrupted sutures, were performed on 140 Sprague-Dawley rats. Findings indicated 100% patency in end-to-end as well as end-to-side immediately and 1 week post-anastomosis. This investigation suggests that there is no significant advantage between the methods studied based on vessel patency alone. The decision to perform an end-to-end vs. an end-to-side arterial anastomosis should be based upon the clinical circumstances encountered, since no significant difference in patency rates exists.© 1998 Wiley-Liss, Inc. MICROSURGERY 18:125-128 1998A patent microvascular anastomosis is required for the success of a free tissue transfer or limb replantation. A variety of factors play a role in vessel thrombosis and subsequent flap failure, including surgical technique, presence of vasospasm, atherosclerosis in the recipient or pedicle vessel, as well as significant soft tissue scarring or injury secondary to trauma, infection, or irradiation. Imperfect vessel wall alignment, size discrepancy, interposed adventitia or suture, or iatrogenic intimal injury are several technical factors that result in higher rates of thrombosis.As the application of microsurgery grows, the desirability of performing an end-to-end (EE) vs. an end-to-side (ES) anastomosis continues to be debated. From a technical standpoint, the end-to-end method is an easier procedure to perform. The end-to-side method is preferred when distal flow of the recipient artery must be maintained, or when there is a significant size discrepancy between the two vessels. Some authors suggest that end-to-side is superior. [1][2][3][4][5] This study was performed to determine if any difference in patency rates exists in arterial end-to-end or end-to-side anastomoses, as postulated by Godina. 6 MATERIALS AND METHODSThe laboratory rat is a well-established clinical model for microvascular surgery. End-to-end and end-to-side arterial anastomoses of vessels of approximately 0.7-1.0 mm diameter are possible using the carotid arteries. The common carotid artery is easily accessible in the rat and does not require entry into a major body cavity. One hundred sixtyseven male Sprague-Dawley rats (450-500 g in weight) were used to complete 70 end-to-end and 70 end-to-side anastomoses. Twenty-seven rats that expired during surgery or early postoperative period were excluded. Post-mortem exam demonstrated no thrombus. These deaths were most likely due to anesthetic complications.Sprague-Dawley male rats were anesthetized with intraperitoneal sodium pentobarbital using 60 mg/kg body weight with supplementation as needed. Other than anesthesia, no anticoagulants or other drugs were administered. The surgical technique practiced was consistent with aseptic principles. The trachea was palpated, and a midline incision from the caudal end of the larynx to the suprasternal notch was made. Using blu...

Assessment of arteriovenous fistulas made with the oval-shaped anastomosis technique in the end-stage renal disease patients

“…In the anastomoses of end-to-side, the success rate generally depends on the suitable implementation of arteriotomy at the correct location. A sudden change in vessel diameter can result in turbulence, which may cause thrombosis (Sen et al, 2006;Dotson et al, 1998). Also, vasospasms decrease in endto-side anastomoses, cessation, or low drop associated with vasospasm might be prevented in OSA as well (Dotson et al, 1998;Verhelle and Heymans, 2005;Yoleri and Songur, 2002).…”

Two-Suture Fish-Mouth End-to-Side Microvascular Anastomosis With Fibrin Glue

“…12 Common carotid arteries are easily accessible and have adequate vessel size and patency. 12 Common carotid arteries are easily accessible and have adequate vessel size and patency.…”

CT Angiography for Surgical Planning in Face Transplantation Candidates

“…Both rat microsurgery studies and human vascular surgery studies have shown no differences in patency rates between end-to-end and end-to-side anastomoses. [34][35][36] As the number of procedures and surgical approaches evolve, selection criteria will vary among surgeons, based on personal preferences and complex patient and donor presentations.…”