Experimental microvascular sleeve anastomosis in size discrepancy vessels

Computational Modeling of Microarterial Anastomoses With Size Discrepancy (Small-to-Large)

“…5 were performed. To better visualize the resulting solutions, these figures were animated (see supplemental video, additional online content [1][2][3][4][5][6][7][8]. A single pulse from 0.27 to 0.40 s is used for analysis and discussion purposes.…”

“…Where the size discrepancy is greater than can be managed by this maneuver, techniques are available, each of which either increases the circumference of the cut end of the smaller vessel, or decreases the circumference of the cut end of the larger vessel. Where the upstream vessel is smaller, the mismatch may also be dealt with by invaginating it inside the larger downstream vessel to a lesser or greater extent [5][6][7]. Techniques to increase the circumference of the smaller vessel include a fishmouth incision [8,9], or oblique section [10].…”

Reply of the Authors: Reproductive organ transplantation: advances and controversies

“…In modern microvascular literature several methods are used to establish an appropriate anastomosis. Discrepancies in the cut end diameters of blood vessels have been managed by many geometric methods to reduce the risk of thrombosis (3,4). Minor discrepancies <1:1.5 usually are dealt with by dilatation with the use of a jeweler's forceps (5).…”

“…Discrepancies exceeding 1:1.5 are usually dealt with by the oblique cut, fish mouth cut, or end-to-side anastomosis (5). When a major discrepancy is anticipated and the upstream donor vessel is smaller than the recipient one, a sleeve anastomosis can be performed (4). Other geometrical designs (oblique cut or Y cut), devices, glues or adhesives, and laser-assisted anastomosis are to be considered according to the surgeon's experience (3,4).…”

“…When a major discrepancy is anticipated and the upstream donor vessel is smaller than the recipient one, a sleeve anastomosis can be performed (4). Other geometrical designs (oblique cut or Y cut), devices, glues or adhesives, and laser-assisted anastomosis are to be considered according to the surgeon's experience (3,4). In conclusion after reviewing the microvascular surgery literature, end-to-side is not associated with higher patency rates than end-to-end, and side-to-side almost never is used in microsurgery except when performing arteriovenous fistula for hemodialysis.…”