End-to-Side Anastomosis With "Open-Y" Technique on Small Vessels to Increase Patency and Facilitate Anastomosis

Akan, Mi̇that; Çakır, Barış; Gideroğlu, Kaan; Aköz, Tayfun; Kavurmacıoğlu, Levent

doi:10.1097/scs.0b013e3181bf860b

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…There are many types of end-to-side microvascular anastomosis training models, such as those that are ipsilateral to contralateral common carotid arteries ( 9 , 10 ), common carotid artery to external jugular vein ( 11 , 12 ), ipsilateral to contralateral common iliac arteries ( 7 , 9 ), and femoral artery to vein ( 13 – 15 ). Previously, Tayebi Meybodi et al ( 9 ), Hall ( 20 ), and we ( 7 ) have described Prox.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, instead of only practicing these perfectly matched end-to-side anastomoses in microsurgical laboratories, we must learn how to perform these so-called “imperfect” end-to-side anastomoses in the laboratory. Previously, many types of end-to-side microvascular anastomosis training models have been described, such as those that are ipsilateral to contralateral common carotid arteries ( 9 , 10 ), common carotid artery to external jugular vein ( 11 , 12 ), ipsilateral to contralateral common iliac arteries ( 7 , 9 ), and femoral artery to vein ( 13 – 15 ). In this article, three types of end-to-side microvascular anastomotic configurations using the rat common iliac artery (CIA), one with the proximal end of the CIA to the contralateral side of the CIA (Prox.…”

Section: Introductionmentioning

confidence: 99%

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Three types of end-to-side microvascular anastomosis training models using rat common iliac arteries

et al. 2023

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Background: Instead of only practicing these perfectly matched end-to-side anastomoses in microsurgical laboratories, we must learn how to perform these so-called “imperfect” end-to-side anastomoses in the laboratory.MethodsThree types of end-to-side microvascular anastomoses using the rat common iliac artery (CIA), one with the proximal end of the CIA to the contralateral side of the CIA, another with the distal end of the CIA to the contralateral side of the CIA, and the third with the distal end of the CIA to the ipsilateral side of the common iliac vein (CIV), were presented to simulate different end-to-side anastomosis situations in a microsurgical laboratory. Diameters of CIA and CIV, distances between temporary clips, the length of arteriotomy or venotomy, and the distribution of stitches were recorded. The patency rates were evaluated immediately after the anastomosis was completed and 30 min later. After animal euthanasia, the donor vessel was cut close to the anastomotic site, and the orifice size and intimal attachment were evaluated by inspecting them through inside the vessel.ResultsThe diameters of the CIA and CIV were 0.8–1.2 mm and 1.2–1.5 mm, respectively. The end-to-side microvascular anastomosis arteriotomy or venotomy is approximately 2.00–2.50 mm, the distance between the aneurysm clips on the recipient CIA or CIV is approximately 4.00–7.00 mm, and the distance between the corner of the arteriotomy or venotomy and the temporary aneurysm clip was 1.00–3.00 mm. Three types of end-to-side anastomoses using the CIA were successfully performed, and 100% patency rates were achieved immediately and 30 min postoperatively. Good distribution of stitches, wide orifice, and intimal attachment were recorded in the study in all groups.ConclusionsThree types of end-to-side anastomoses using rat CIAs could be efficiently used to mimic three different anastomotic situations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Three types of end-to-side microvascular anastomosis training models using rat common iliac arteries

et al. 2023

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“…8 End-to-side anastomoses are also well described, initially by Godina, 21-23 and Akan furthered the technique to evaluate the “open Y” end-to-side anastomosis compared to end-to-end anastomosis, with statistically significant improvement in flow at 14 days in a rat model. 3…”

Section: Discussionmentioning

confidence: 99%

“…8 End-to-side anastomoses are also well described, initially by Godina, [21][22][23] and Akan furthered the technique to evaluate the "open Y" end-toside anastomosis compared to end-to-end anastomosis, with statistically significant improvement in flow at 14 days in a rat model. 3 While the notion of angled and bifurcated microvascular cross-sections to improve vessel mismatch is not novel, there have thus far been no objective models of the benefits gained from the technique. These mathematical models are solely theoretical and would be impractical to measure and calculate intraoperatively based on the vasculature presented in each unique situation.…”

Section: Discussionmentioning

confidence: 99%

“…Akan et al described utilizing the "open Y" technique to address this common situation with success, and then further analyzed a combination "open Y" end-to-side model. [1][2][3] Similarly, Chen et al 4 evaluated the "open Y" to improve vessel size match and vessel geometry utilizing the superior thyroid artery with similar success rates to traditional microvascular techniques. Wei and Mardini's reconstructive surgery text also suggests solutions for vessel mismatch, including oblique cuts not exceeding an angle of 30°to increase vessel circumference.…”

Section: Introductionmentioning

confidence: 99%

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Mathematical Modeling of Vessel Geometry and Circumference in Microvascular Surgery

Nedrud

Fleissig

Sanjuan-Sanjuan

et al. 2022

Craniomaxillofacial Trauma & Reconstruction

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Introduction Microvascular anastomosis has traditionally been executed with a perpendicular transection through the vessel at the widest diameter to increase circumference and thus increase blood flow while decreasing resistance. In Chen’s 2015 article, it was suggested that an “open Y” would improve vessel size match, and Wei and Mardini discuss angled transections of the vessels. This project aims to explore the geometric configurations feasible at the anastomotic transection and mathematically model the resulting hypothetical increases in circumference. Materials and Methods The mathematical models were theoretically developed by our team. The formulas model increases in circumference of the transection at different distances in relation to the bifurcation of a blood vessel, as well as changes in circumference at different transection angulations. An in vitro exploration as to the anastomotic feasibility of each geometric cut was completed on ten poultry tissue specimens. Results The mathematical models demonstrated the change in vessel circumference, with multiple geometric designs calculated, best shown through diagrams. For example, if the vessel width is 1 mm, the distance from the increasing vessel diameter to the final bifurcation is 1 mm, and the bifurcation angle is 45°, the circumference of the transected vessel increases by 82.8%. Models of transections at different angulations, for instance 30°, 45°, and 60°, yield an increase in elliptical circumference of 8.0%, 22.5%, and 58.1%, respectively. Additional derivations calculate the elliptical circumference at any angle in a single vessel, and at any angle in a bifurcating vessel. Conclusion The theoretical and clinical aim of this project is to increase awareness of the anastomotic creativity and mathematically demonstrate the optimal anastomotic geometry, which has not been objectively explored to our knowledge. An in vivo study would further support clinical improvements, with the aim to map postoperative fluid dynamics through the geometric anastomoses.

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Microsurgical Bypass Training Rat Model: Part 2–Anastomosis Configurations

et al. 2017

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End-to-Side Anastomosis With "Open-Y" Technique on Small Vessels to Increase Patency and Facilitate Anastomosis

Cited by 8 publications

References 14 publications

Three types of end-to-side microvascular anastomosis training models using rat common iliac arteries

Three types of end-to-side microvascular anastomosis training models using rat common iliac arteries

Mathematical Modeling of Vessel Geometry and Circumference in Microvascular Surgery

Microsurgical Bypass Training Rat Model: Part 2–Anastomosis Configurations

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