Suture-free laser-assisted vessel repair using CO2 laser and liquid albumin solder

Abstract

Numerous studies have shown that the use of proteinic solders during laser-assisted vascular anastomosis (LAVA) and repair (LAVR) can significantly increase welding strength, but these studies combined solder-mediated LAVA/R with the use of stay sutures, thereby defeating its purpose. In an in vitro study, we examined the leaking point pressures (LPPs) and histological damage profile of porcine carotid arteries following albumin solder-mediated CO(2) LAVR without the use of sutures. Longitudinal arteriotomies (9.1+/-0.8 mm in length) were sheathed with 25% liquid bovine serum albumin solder, and LAVR was performed using a micromanipulator-controlled CO(2) laser operating at 170-mW power and 1.25-mm spot size in continuous wave mode. The welding regime consisted of a transversal zigzag pass followed by one or two longitudinal zigzag passes, producing an irradiance of 13.9 W/cm(2) and energies of 10.5 J and 11.3 J per mm weld, respectively. LPPs were measured by the fluid infusion technique, and histological analysis was performed with light, fluorescence, and polarization microscopy. The LPP of the two-pass welds was 351+/-158 mmHg versus 538+/-155 mmHg for the three-pass welds. Thermal damage was confined primarily to the adventitial layers, with limited heat diffusion into the media below the solder around the coaptation interface.

Laser-assisted vessel welding: state of the art and future outlook

“…The increase in local temperature induces structural alterations in vessel wall proteins, which leads to protein cross-linking and consequent coaptation of the vessel segments. Although the exact types of structural alterations that result in welding are currently elusive [40,44,67], collagen cross-linking is considered to play a major role [4,33,40,44]. The extent to which these interprotein bonds are formed dictates the welding strength [4,33,40,44].…”

“…Solders may be photocoagulated with a water-targeting laser (e.g., CO2 laser [67]) or with visible lasers using a wavelength-specific chromophore dissolved in the solder [24,49-51, 53-55,57,58,60,61,63-66,83,84]. The chromophore enables the absorption of visible light, causing heat generation in exclusively the solder layer, thereby shielding the deeper vascular layer from thermal damage when proper laser parameters are employed.…”

“…First, the relatively low welding strengths produced with LAVW often require additional sutures to reinforce the anastomosis, ultimately defeating the purpose of the modality. [3,[5][6][7][8]10,[12][13][14]18,20,22,24,26,28,30,32,[34][35][36]40,67,69,70] Second, extensive thermal damage may extend to the basal membrane of the intima ( Figure 1) and cause intimal hyperplasia [7,20], thrombosis [7,26], and aneurysm formation [13,15,21,34,38,71,72]. To overcome these disadvantages, several more refined welding techniques have been developed, including sLAVW, scaffold-and solder-enhanced LAVW (ssLAVW) (Figure 2), and photochemical laser-assisted tissue bonding.…”

“…The technique is based on the sutureless coaptation of vessel segments by photothermal or photochemical [48] processes. Photothermal laser vessel bonding currently comprises the most frequently employed technique and can be divided into two distinct modalities, namely native laser-assisted vascular welding (LAVW) and modalities where proteinaceous solders are used to adjoin vessel segments, namely solder-enhanced LAVW (sLAVW) [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67].…”

Laser‐mediated fixation of collagen‐based scaffolds to dermal wounds

“…In vascular surgery laser therapy presents a very promising technique for vascular anastomosis thus preventing the vessel wall from reaction to foreign suture or staple material [3]. This not only reduces procedure time but is also associated with fewer complications [4]. In ophthalmic surgery diode lasers also proof to be a safe and useful tool, for example, for welding of corneal wounds following penetrating keratoplasty and cataract surgery [5].…”