Sutureless Microvascular Anastomosis using Intravascular Stenting and Cyanoacrylate Adhesive

Aizawa, Tetsushi; Kuwabara, Masahiro; Kubo, Satoshi; Domoto, Takashi; Aoki, Shimpo; Azuma, Ryuichi; Kiyosawa, Tomoharu

doi:10.1055/s-0037-1605587

Cited by 17 publications

(10 citation statements)

References 23 publications

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“…28 Looking ahead, sutureless anastomotic technologies can possibly further minimize the consequences of intraoperative anastomotic failures elucidated in this study. [29][30][31] There may also be cost savings related to choosing delayed-immediate as opposed to immediate DIEP flap reconstruction, as this option has been associated with shorter operative time, and this finding should be explored in future work. 32 We recognize that our study is not without limitations.…”

Section: Discussionmentioning

confidence: 99%

Predictors and Consequences of Intraoperative Anastomotic Failure in DIEP Flaps

Chen

Varagur

Xun

et al. 2022

J Reconstr Microsurg

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BACKGROUND: Successful intraoperative microvascular anastomoses are essential for deep inferior epigastric perforator (DIEP) flap survival. This study identifies factors associated with anastomotic failure during DIEP flap reconstruction and analyzes the impact of these anastomotic failures on post-operative patient outcomes and surgical costs. METHODS: A retrospective cohort study was conducted of patients undergoing DIEP flap reconstruction at two high-volume tertiary care centers from January 2017 to December 2020. Patient demographics, intraoperative management, anastomotic technique, and post-operative outcomes were collected. Data were analyzed using Student’s t-tests, chi-square analysis, and multivariate logistic regression. RESULTS: Of the 270 patients included in our study (mean age 52, majority Caucasian [74.5%]), intraoperative anastomotic failure occurred in 26 (9.6%) patients. Increased number of circulating nurses increased risk of anastomotic failure (Odds Ratio (OR) 1.02, 95% Confidence Interval (CI) 1.00-1.03, P<0.05). Presence of a junior resident also increased risk of anastomotic failure (OR 2.42, 95% CI 1.01-6.34, P<0.05). Increased surgeon years in practice was associated with decreased failures (OR 0.12, CI 0.02-0.60, P<0.05). Intraoperative anastomotic failure increased the odds of post-operative hematoma (OR 8.85, CI 1.35-59.1, P<0.05) and was associated with longer operating room times (bilateral DIEP: 2.25 hours longer, P<0.05), longer hospital stays (2.2 days longer, P<0.05), and higher total operating room cost ($28,529.50 versus $37,272.80, P<0.05). CONCLUSION: Intraoperative anastomotic failures during DIEP flap reconstruction are associated with longer, more expensive cases and increased rates of post-operative complications. Presence of increased numbers of circulators and junior residents was associated with increased risk of anastomotic failure. Future research is necessary to develop practice guidelines for optimizing patient and surgical factors for intraoperative anastomotic success.

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Section: Discussionmentioning

confidence: 99%

Predictors and Consequences of Intraoperative Anastomotic Failure in DIEP Flaps

Chen

Varagur

Xun

et al. 2022

J Reconstr Microsurg

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“…After the T-shaped metal stents were inserted, cyanoacrylate glue was used to reinforce the anastomotic region because retention was weak with the T-shaped metal stents alone. A recent study used temporary intravascular stenting during sutureless microvascular anastomosis with a cyanoacrylate adhesive, and the short-term safety outcomes of this technique were established at the experimental stage 21 . However, the end-to-side anastomosis may have exerted a different pattern of hydrodynamic stress on the glued areas; future experiments using ex-vivo stress tests may be necessary.…”

Section: Discussionmentioning

confidence: 99%

A Novel Method of End-to-Side Microvascular Anastomosis Using T-Shaped Metal Stents: A Porcine Study

Sugiura

Sarukawa

Kamochi

et al. 2021

Journal of Craniofacial Surgery

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End-to-side anastomosis requires highly specialized techniques. An easy end-to-side anastomosis technique enables anastomosis of vessels with different diameters and under various situations. We invented T-shaped metal stents and evaluated novel methods of end-to-side sutureless anastomosis, confirming their safety, effectiveness, and operability. We performed 8 end-to-side sutureless anastomoses in 4 7-to 11-month-old, male Mexican hairless piglets. After induction of anesthesia, the left femoral artery was resected by approximately 8 cm, and the superior and posterior stumps of the resected femoral artery underwent an end-to-side anastomosis with the right femoral artery by the placement of the metal stents with subsequent use of adhesive for the circumferential area. The patency of blood vessels and the presence of thrombosis were evaluated by ultrasonography or contrast-enhanced computed tomography and histology 4 weeks postoperatively. All the animals survived the procedure; no thrombosis was identified in any of the 8 anastomosis sites according to imaging studies performed 4 weeks postoperatively. Histological examination confirmed the probe patency of blood vessels and neointimal cell proliferation around stent branches. End-to-side anastomosis is possible with T-shaped metal stents. In the future, we aim for the practical application of these stents by improving their operability.

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“…Given these challenges, there is a growing inclination in the medical community towards advanced solutions, such as tissue adhesives, sealants, and hemostatic materials [ [88] , [89] , [90] , [91] , [92] , [93] , [94] ]. For example, cyanoacrylate adhesives, brands like Dermabond and SurgiSeal, facilitate rapid bonding and microbial protection, though their inherent brittleness and cytotoxicity can pose limitations in vascular contexts [ [95] , [96] , [97] ]. Fibrin sealants, with Tisseel and Evicel leading the pack, emulate the clotting response of the body, offering flexible seals particularly well-suited for internal vascular connections [ [98] , [99] , [100] ].…”

Section: Sutureless Anastomotic Approaches Undergoing Developmentmentioning

confidence: 99%

“…These formulations produce fewer toxic byproducts, promoting usage outside of the body. Although cyanoacrylates present advantages like rapid bonding and watertight seals, they also come with challenges, including brittleness, potential embolization, and high cytotoxicity inside the body [ 96 , 97 ]. Recent research explored the role of 2-octyl cyanoacrylate in vascular anastomosis using a rabbit carotid artery model.…”

Section: Sutureless Anastomotic Approaches Undergoing Developmentmentioning

confidence: 99%

Sutureless vascular anastomotic approaches and their potential impacts

Ribaudo,

He,

Madira

et al. 2024

Bioactive Materials

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Sutureless Microvascular Anastomosis using Intravascular Stenting and Cyanoacrylate Adhesive

Abstract: IVaS plays a supportive role in sutureless microvascular anastomosis with cyanoacrylate adhesive. The short-term safety of this technique has now been confirmed at the experimental stage.

Cited by 17 publications

References 23 publications

Predictors and Consequences of Intraoperative Anastomotic Failure in DIEP Flaps

Predictors and Consequences of Intraoperative Anastomotic Failure in DIEP Flaps

A Novel Method of End-to-Side Microvascular Anastomosis Using T-Shaped Metal Stents: A Porcine Study

Sutureless vascular anastomotic approaches and their potential impacts

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