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

Abstract

Background Anastomotic couplers expedite venous microvascular anastomoses and have been established as an equivalent alternative to hand-sewn anastomoses. However, complications unique to the coupler such as palpability and extrusion can occur. The purpose of this study was to perform a systematic review of the literature to assess complications distinct to the venous anastomotic coupler. Methods A Medline, PubMed, EBSCO host search of articles involving anastomotic venous couplers was performed. Studies involving arterial anastomotic couplers, end-to-side anastomoses, and reviews were excluded. Data points of interest were flap failure, venous thrombosis, hematoma, partial flap necrosis, infection, coupler extrusion, and coupler palpability. Results The search identified 165 articles; 41 of these met inclusion criteria. A total of 8,246 patients underwent 8,955 venous-coupled anastomoses. Combined reoperation rate was 3.3% and all-cause unsalvageable flap failure was 1.0%. Complications requiring reoperation included venous thrombosis (2.0%), hematoma (0.4%), partial flap necrosis (0.4%), and infection (0.3%). Eight patients had palpable couplers and 11 patients had extrusion of couplers (head/neck, hand, and feet) and required operative management. Conclusion Venous couplers remain an equivalent alternative to conventional hand-sewn anastomosis. However, venous coupler extrusion and palpability in the late postoperative period is a complication unique to anastomotic couplers, particularly in radiated head and neck, feet and hand free flaps. Removing extruded venous couplers is safe after tissue integration 3 weeks postoperatively. Coupler palpability and extrusion should be integrated into preoperative patient counseling and assessed in follow-up examinations.

The False Positive Rate of Transcutaneous Tissue Oximetry Alarms in Microvascular Breast Reconstruction Rises after 24 Hours

“…While there are recognized preoperative patient-related factors that can affect flap outcomes, tissue oximetry monitoring can decrease free flap loss and improve salvage rate in the postoperative setting. 4,[11][12][13] A survey found that microsurgeons were more likely to immediately return to the operating room for a concerning tissue oximetry reading than an abnormal Doppler signal. 3 Other investigators have shown benefits of incorporating tissue oximetry in flap monitoring protocols as well.…”

Adverse Events Associated with Implantable Dopplers during Microvascular Surgery

“…Unique complications associated with these couplers have been systematically reviewed; however, the focus was only on the postoperative setting. 29 Additionally, in a direct comparison of ID couplers and venous anastomotic couplers, the only intraoperative complication discussed was vessel thrombosis and there was not a significant difference in the rate of this complication. 30 Reports of coupler ring detachment, the second most commonly reported device malfunction, had four associated adverse events.…”

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

“…Stanix et al 22 reported that the rates of complications and flap failure were similar between reconstructions performed using a venous coupler and those performed using hand-sewn venous anastomosis in lower extremity reconstructions, which have the highest reported rates of complications and flap failure among all anatomical regions. Conversely, in a systematic review of venous anastomotic couplers by Wu et al, 23 unique complications, such as coupler extrusion and palpability, were reported in cases with previous radiation exposure or thin, soft tissues (eg, head and neck, hands, and feet). Methods such as the use of metal stents completely buried in the target blood vessels may prevent such complications.…”