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

Abstract

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.

Técnica de implante e exequibilidade, “in vitro” em aortas porcinas, de anastamose vascular término-terminal

“…A confecção de anastomoses em pequenos segmentos de vasos ou outras estruturas tubulares, provavelmente não será possível com os anéis plásticos referidos na literatura, bem como suas técnicas de utilização O uso de outros dispositivos tem demonstrado resultados experimentais favoráveis, principalmente em anastomoses vasculares venosas, desde próteses absorvíveis (Jeong et al,2019) até dispositivos de compressão magnética (Lu et al,2020).…”

“…Portanto, ainda hoje, a cirurgia cardiovascular e vascular periférica não dispõem de técnicas adequadas que deem segurança total e durabilidade definitiva as anastomoses vasculares (Vokrii et al,2014;Jeong et al,2019;Lu et al, 2020) O dispositivo UAD®, tem como finalidade permitir a realização de anastomoses de qualquer tipo e calibre em quaisquer dois órgãos tubulares, sem sutura, com ou sem clampeamento (Silveira et al, 1998;Granja Filho,2001), com a ausência de fios de sutura na face interna da anastomose, muito baixo risco de vazamentos anastomóticos às altas pressões, além de fácil reprodutibilidade e tempo cirúrgico minimizado.…”

Unique Complications of Venous Anastomotic Couplers: A Systematic Review of the Literature

“…8,9,37 Source materials and designs for resorbable couplers have been evaluated in rabbit models. 50 This would address long-term complications itself and the need for long-term surveillance of these complications.…”

Sutureless vascular anastomotic approaches and their potential impacts

“…Various polymers have been utilized in vascular anastomosis, benefiting from the customizability offered by 3D printing technologies. These polymers include polycaprolactone (PCL), poly (lactic- co -glycolic acid) (PLGA), poly ( l -lactide) (PLLA), and poly ( l -lactide- co -ε-caprolactone) (PLCL) [ 36 , 38 , 39 ]. They have been extensively studied for other medical devices and thus have proven a high degree of biocompatibility and success [ 65 , 66 ].…”