Vessel Remodeling after Intima-to-Intima Contact Anastomosis

Abstract

BackgroundIntima-to-intima microanastomotic vascular remodeling was explored, utilizing a polylactide-caprolactone absorbable vein coupler model (PAVCM), which was designed to simulate a non-absorbable counterpart system with the sole exception of being absorbable.MethodsSix New Zealand white rabbits were used. After transection of the jugular vein, 2 PAVCMs were placed, 1 at each transected end. The stumps were slipped through the PAVCMs, and the venous wall was everted 90° to achieve intima-to-intima contact. Reanastomosis of the transected jugular vein was performed bilaterally in 3 rabbits. In the other 3 rabbits, the jugular vein (20 mm) harvested from one side was interpositionally grafted to the jugular vein on the opposite side to ease the anastomotic tension. Patency testing, ultrasonography, and histologic assessments were conducted postoperatively at weeks 2, 4, 12, 16, 22, and 26.ResultsAll anastomotic sites were patent, without stenosis, occlusion, or dilatation. In the histologic sections, immature endothelial regeneration was observed at week 2, which was completed by week 4. Regeneration of the tunica media was noted at week 12. Between week 22 and week 26, the tunica media fully regenerated and the coupler dissipated entirely.ConclusionsDespite the absence of a coupler to act as an anastomotic buttress, the structure and function of all the vessels appeared normal, even histologically. These outcomes are true milestones in the development of an absorbable vein coupler.

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

“…Accordingly, the possibility of exposure of the adventitia may be lower with this coupler system than with the conventional sleeve technique and even with end-to-end anastomosis because adventitia invagination occurred due to tight tying or incomplete eversion during suturing. Furthermore, intima-to-intima contact was important because such contact facilitated full remodeling of the tunica media and intima in an experiment involving an absorbable vein coupler 18 . Regarding this technical point of anastomosis using coupler systems, every vascular coupler device, all of which are commercially available, has been applied to venous anastomosis in clinical practice because the coupler system is not easy to apply to arterial anastomoses.…”