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DOI: 10.1055/s-0034-1384812
Intravascular Stenting in Microvascular Anastomoses
Publication History
23 December 2013
09 June 2014
Publication Date:
31 July 2014 (online)
![](https://www.thieme-connect.de/media/jrm/201502/lookinside/thumbnails/10.1055-s-0034-1384812-1.jpg)
Abstract
Background The effect of intravascular stenting (IVaS) on microvascular anastomoses has given adverse results. For experienced microsurgeons the benefit of IVaS is doubtful. We have investigated the potential benefit of the IVaS technique for two groups of inexperienced microsurgeons with different surgical levels of experience (medical students and young residents). Experienced microsurgeons acted as a control group.
Materials and Methods In an experimental crossover study, 139 microsurgical anastomoses were performed on the femoral artery in 70 rats by 10 surgeons. On one side of the rat, the IVaS technique was used. A small piece of 5–0 nylon monofilament was placed in the vessel lumen, acting as a temporary stent during microvascular anastomosis. A conventional technique without the stent was performed on the other side. Patency rates of the vessels in each group were compared as well as the time spent on the anastomosis.
Results No significant difference in patency rates was seen between the stenting and conventional technique in all three groups. The experienced microsurgeons had 100% patency rate with both techniques. The medical students had 20/28 in the IVaS and 19/28 conventional group and the patency rates for the residents were 23/27 using IVaS and 23/28 using the conventional technique. The residents were faster using the IVaS whereas the students and experienced microsurgeons were faster without the stent.
Conclusion The IVaS technique did not seem to benefit either the inexperienced or experienced microsurgeons regardless of their clinical experience. The study also shows that some surgical experience seems to be an advantage in performing microsurgery.
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References
- 1 Tamai S. History of microsurgery. Plast Reconstr Surg 2009; 124 (6, Suppl) e282-e294
- 2 Narushima M, Mihara M, Koshima I , et al. Intravascular stenting (IVaS) method for fingertip replantation. Ann Plast Surg 2009; 62 (1) 38-41
- 3 Narushima M, Mihara M, Yamamoto Y, Iida T, Koshima I, Mundinger GS. The intravascular stenting method for treatment of extremity lymphedema with multiconfiguration lymphaticovenous anastomoses. Plast Reconstr Surg 2010; 125 (3) 935-943
- 4 Sauer MV, Zeffer KB, Bustillo MC, Buster JE. Sterilization reversals performed by fellows in training: what success rates can we reasonably expect?. Microsurgery 1987; 8 (3) 125-127
- 5 Gu JM, Acland RD, Anderson GL, Wyllie F, Barker JH. Poor surgical technique produces more emboli after arterial anastomosis of an island flap. Br J Plast Surg 1991; 44 (2) 126-129
- 6 Wei FC, Mancer K, Zuker RM. The temporary stent technique: an easier method of micro-venous anastomosis. Br J Plast Surg 1982; 35 (1) 92-95
- 7 Narushima M, Koshima I, Mihara M, Uchida G, Gonda K. Intravascular stenting (IVaS) for safe and precise supermicrosurgery. Ann Plast Surg 2008; 60 (1) 41-44
- 8 Miyamoto S, Sakuraba M, Asano T , et al. Optimal technique for microvascular anastomosis of very small vessels: Comparative study of three techniques in a rat superficial inferior epigastric arterial flap model. J Plast Reconstr Aesthet Surg 2010; 63 (7) 1196-1201
- 9 Chaware SM, Bhatnagar S, Singh A. A scanning electron microscopic evaluation of microsurgical anastomosis by conventional end to end and end to end anastomosis using “temporary stent” technique: An experimental study. Indian J Plast Surg 2006; 39 (1) 42-50
- 10 Bossut C, Barbier O. Exploration of the intravascular stenting method for sub 1-mm vessels. J Reconstr Microsurg 2011; 27 (8) 461-468
- 11 Acland R. Signs of patency in small vessel anastomosis. Surgery 1972; 72 (5) 744-748
- 12 Hayhurst JW, O'Brien BM. An experimental study of microvascular technique, patency rates and related factors. Br J Plast Surg 1975; 28 (2) 128-132
- 13 Remie R. The PVC-rat and other alternatives in microsurgical training. Lab Anim (NY) 2001; 30 (9) 48-52