Bioabsorbable device for small‐caliber vessel anastomosis

Although the devices for large‐caliber vessel (>2‐mm diameter) anastomosis are available, there are no devices for performing anastomosis of small‐caliber vessels. We designed a hooked device composed of a bioabsorbable polymer for sutureless anastomosis of small‐caliber vessels. The efficacy of this device was evaluated by in vitro degradation and arterial‐fixation strength tests as well as in vivo transplantation experiments with common carotid arteries of growing SD rats. A nonabsorbable device without hooks served as the control in the fixation strength and animal experiments. The tensile strength of the bioabsorbable device decreased to 27 and 9% of the initial value after 8‐ and 24‐week incubation, respectively. The fixation strength was greater and the anastomotic time was shorter with this device than with the control. The transplantation experiments showed complete endothelial bridging in both devices at 2 weeks after surgery (n = 6). The control device created a considerable protrusion into the arterial lumen at 8 postoperative weeks, whereas the experimental device did not (n = 6). Arterial diameter measurements detected a significant difference between the inner diameters at the respective anastomotic sites (n = 6, P < 0.05) and demonstrated that the control device hindered the vessel growth while the experimental device did not. Therefore, the bioabsorbable hooked device was an effective tool for anastomosis of small‐caliber arteries (ca. 1‐mm diameter). © 2010 Wiley‐Liss, Inc. Microsurgery 30:494–501, 2010.

[1]  E. Kobayashi,et al.  Rat small intestinal transplantation: a comparison of the cuff and hand-suture methods. , 2000, Acta medica Okayama.

[2]  T. Liang,et al.  Novel technique for suprahepatic vena cava reconstruction in rat orthotopic liver transplantation , 2005, Microsurgery.

[3]  S. Uemoto,et al.  A new bioabsorbable material for rat orthotopic liver transplantation. , 1991, European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes.

[4]  D. Lidman,et al.  Are mechanical microvascular anastomoses easier to learn than suture anastomoses? , 2005, Microsurgery.

[5]  R. Daniel,et al.  An Absorbable Anastomotic Device for Microvascular Surgery: Experimental Studies , 1984, Plastic and reconstructive surgery.

[6]  C. Zeebregts,et al.  Non‐suture methods of vascular anastomosis , 2003, The British journal of surgery.

[7]  L. V. von Segesser,et al.  The Vascular Join: a new sutureless anastomotic device to perform end-to-end anastomosis. Preliminary results in an animal model. , 2006, Interactive cardiovascular and thoracic surgery.

[8]  P. Törmälä,et al.  Strength retention of self-reinforced poly-L-lactide screws and plates: anin vivo andin vitro study , 1992 .

[9]  Jie-shou Li,et al.  Improved technique of vascular anastomosis for small intestinal transplantation in rats. , 2000, World journal of gastroenterology.

[10]  E. Kobayashi,et al.  Combined cuff and suture technique for orthotopic whole intestinal transplantation in rats , 2002, Microsurgery.

[11]  T. Bacchella,et al.  Cuff‐glue sutureless microanastomosis , 2007, Microsurgery.

[12]  Y. Ikuta,et al.  Evaluation of an absorbable ring for vascular anastomosis. , 1999, Journal of reconstructive microsurgery.

[13]  E. Owen,et al.  Use of the 3M Precise Microvascular Anastomotic System in Grafting 1-mm Diameter Arteries with Polytetrafluoroethylene Prostheses: A Long-Term Study , 1993, Journal of reconstructive microsurgery.

[14]  D. Zamfirescu,et al.  Training program and learning curve in experimental microsurgery during the residency in plastic surgery , 2007, Microsurgery.

[15]  L. Ostrup,et al.  Mechanical anastomosis of small arteries and veins with the unilink apparatus: a histologic and scanning electron microscopic study. , 1987, Plastic and reconstructive surgery.

[16]  E. Biemer,et al.  Comparison of Experimental Microvascular End-to-End Anastomosis via VCS®-Clips versus Conventional Suture Technique in an Animal Model , 2007, Journal of reconstructive microsurgery.

[17]  C. Zeebregts,et al.  Five years' world experience with nonpenetrating clips for vascular anastomoses. , 2004, American journal of surgery.

[18]  C. Sasaki,et al.  End‐to‐Side Venous Anastomosis With an Anastomotic Coupling Device for Microvascular Free‐Tissue Transfer in Head and Neck Reconstruction , 2008, The Laryngoscope.

[19]  D. Bezuidenhout,et al.  Prosthetic vascular grafts: wrong models, wrong questions and no healing. , 2007, Biomaterials.

[20]  Y. Koyama,et al.  Enhancement of peripheral nerve regeneration using bioabsorbable polymer tubes packed with fibrin gel. , 2007, Artificial organs.

[21]  Y. Ogino,et al.  Orthotopic intestinal transplantation using the cuff method in rats: A histopathological evaluation of the anastomosis , 2001, Microsurgery.

[22]  R. Sodian,et al.  Tissue engineering of small caliber vascular grafts. , 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[23]  Seung‐Woo Cho,et al.  Small-Diameter Blood Vessels Engineered With Bone Marrow–Derived Cells , 2005, Annals of surgery.