Affiliation:
1. Department of Surgery, University Hospital Groningen, Groningen, The Netherlands
2. Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
Abstract
Abstract
Background
The main aim of performing a vascular anastomosis is to achieve maximal patency rates. An important factor to achieve that goal is to minimize damage to the vessel walls. Sutures inevitably induce vascular wall damage, which influences the healing of the anastomosis. Over time, several alternatives to sutures have become available.
Methods
A Medline literature search was performed to locate English, German and French language articles pertinent to non-suture methods of vascular anastomosis. Manual cross-referencing was also performed and many historical articles were included.
Results and conclusion
The non-suture techniques can be categorized into five groups based on the materials used: rings, clips, adhesives, stents and laser welding. With all these techniques a faster and less traumatic anastomosis can be made compared with sutures. However, each device is associated with technique-related complications. As a consequence, suturing continues to be the standard approach. The disadvantages of the non-suture techniques include: rigidity and a non-compliant anastomosis with rings; toxicity, leakage and aneurysm formation with adhesives; early occlusion with stents; cost, reduced strength in larger-sized vessels and demand for surgical skills with laser welding. Further refinement is needed before widespread adoption of these techniques can occur. Clips, however, may be particularly promising but long-term evaluation is required.
Publisher
Oxford University Press (OUP)
Reference105 articles.
1. La technique opératoire des anastomoses vasculaires et la transplantation des viscères;Carrel;Lyon Med,1902
2. Scanning electron micrographic study of vascular lesions caused by microvascular needles and suture;Pagnanelli;J Neurosurg,1980
3. The normal healing process of microvascular anastomoses;Lidman;Scand J Plast Surg,1981
4. Arterial repair after microvascular anastomosis. Scanning and transmission electron microscopy study;Macchiarelli;Acta Anat,1991
5. Nonpenetrating vascular clips for small-caliber anastomosis;Zeebregts;Microsurgery,2000
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