Sutureless Microvascular Anastomosis using Intravascular Stenting and Cyanoacrylate Adhesive

Abstract

Background Microvascular anastomosis using cyanoacrylate adhesive has a reputation among researchers as an alternative to conventional sutures. However, a degree of ingenuity is required to avoid the collapse of the vascular lumen for the duration of the anastomosis. The aim of this study was to determine the feasibility of intravascular stenting (IVaS) as a temporary stent during sutureless microvascular anastomosis with cyanoacrylate adhesive.

Methods Sixty male Fisher 344 rats were evenly divided into two groups. The right superficial femoral arteries (RSFAs) were transected in each group. Microvascular anastomoses were then performed with the sutureless (SL) method in one group and conventional sutures (CS) in the other group. The diameter of the RSFA, duration of microvascular anastomosis, and the patency of the RSFA were evaluated immediately after anastomosis and 7 days after the surgery. Tissue samples were obtained for pathological consideration.

Results There was no significant difference in the diameter of the RSFAs between the SL and the CS groups. There was no significant difference in the patency rates of the groups. The anastomosis time of the SL group was significantly shorter than that of the CS group, regardless of the experience of the surgeons. A histological analysis showed a comparable level of foreign body reactions in each group.

Conclusion IVaS plays a supportive role in sutureless microvascular anastomosis with cyanoacrylate adhesive. The short-term safety of this technique has now been confirmed at the experimental stage.

Keywords

intravascular stenting (IVaS) - 2-octylcyanocrylate - surgical adhesive

• References

• 1 Lemaire D, Mongeau J, Dorion D. Microvascular anastomosis using histoacryl glue and an intravascular soluble stent. J Otolaryngol 2000; 29 (04) 199-205
• 2 Kamiji T, Maeda M, Matsumoto K, Nishioka K. Microvascular anastomosis using polyethylene glycol 4000 and fibrin glue. Br J Plast Surg 1989; 42 (01) 54-58
• 3 Khorgami Z, Shoar S, Aminian A, Nasiri S, Mahmoodzadeh H. Stent-and-glue sutureless vascular anastomosis. Med Hypotheses 2011; 77 (01) 94-96
• 4 Wei FC, Mancer K, Zuker RM. The temporary stent technique: an easier method of micro-venous anastomosis. Br J Plast Surg 1982; 35 (01) 92-95
• 5 Yamagata S, Carter LP, Handa H. , et al. Experimental studies in nonsuture end-to-side microvascular anastomosis. Neurol Med Chir (Tokyo) 1981; 21 (07) 701-708
• 6 Zhong C, Tang NX, Zheng CF, Xu YW, Wang TD. Experimental study on microvascular anastomosis using a dissolvable stent support in the lumen. Microsurgery 1991; 12 (02) 67-71
• 7 Narushima M, Koshima I, Mihara M, Uchida G, Gonda K. Intravascular stenting (IVaS) for safe and precise supermicrosurgery. Ann Plast Surg 2008; 60 (01) 41-44
• 8 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 (03) 935-943
• 9 Narushima M, Mihara M, Koshima I. , et al. Intravascular stenting (IVaS) method for fingertip replantation. Ann Plast Surg 2009; 62 (01) 38-41
• 10 Galvão FH, Bacchella T, Machado MC. Cuff-glue sutureless microanastomosis. Microsurgery 2007; 27 (04) 271-276
• 11 Schwaiger N, Wu J, Wright B, Morrissey L, Harris M, Rohanizadeh R. BioWeld(®) Tube and surgical glue for experimental sutureless venous microanastomosis. Br J Surg 2010; 97 (12) 1825-1830
• 12 Chang EI, Galvez MG, Glotzbach JP. , et al. Vascular anastomosis using controlled phase transitions in poloxamer gels. Nat Med 2011; 17 (09) 1147-1152
• 13 Qassemyar Q, Michel G. A new method of sutureless microvascular anastomoses using a thermosensitive poloxamer and cyanoacrylate: an experimental study. Microsurgery 2015; 35 (04) 315-319
• 14 Assersen K, Sørensen J. Intravascular stenting in microvascular anastomoses. J Reconstr Microsurg 2015; 31 (02) 113-118
• 15 Jacobson II JH, Moody RA, Kusserow BK, Reich T, Wang MC. The tissue response to a plastic adhesive used in combination with microsurgical technique in reconstruction of small arteries. Surgery 1966; 60 (02) 379-385
• 16 Weissberg D, Schwartz P, Goetz RH. Nonsuture end-to-side anastomoses of small blood vessels. Surg Gynecol Obstet 1966; 123 (02) 341-346
• 17 Souther SG, Levitsky S, Roberts WC. Bucrylate tissue adhesive for microvascular anastomosis. Technique, results, and histologic evaluation. Arch Surg 1971; 103 (04) 496-499
• 18 Green AR, Milling MA, Green AR. Butylcyanoacrylate adhesives in microvascular surgery: an experimental pilot study. J Reconstr Microsurg 1986; 2 (02) 103-105
• 19 Casanova R, Herrera GA, Vàsconez Engels B, Velasquez C, Grotting JC. Microarterial sutureless sleeve anastomosis using a polymeric adhesive: an experimental study. J Reconstr Microsurg 1987; 3 (03) 201-207 ; 209–210
• 20 Ang ES, Tan KC, Tan LH, Ng RT, Song IC. 2-octylcyanoacrylate-assisted microvascular anastomosis: comparison with a conventional suture technique in rat femoral arteries. J Reconstr Microsurg 2001; 17 (03) 193-201
• 21 Hall WW, Wrye SW, Banducci DR, Ehrlich P. Microvascular anastomosis using 2-octyl cyanoacrylate in the rat femoral artery. Ann Plast Surg 2000; 44 (05) 508-511
• 22 Kim BY, Choi BH, Huh JY, Lee SH, Zhu SJ, Cho BP. Microvascular anastomosis using cyanoacrylate adhesives. J Reconstr Microsurg 2004; 20 (04) 317-321
• 23 Ong YS, Yap K, Ang ES, Tan KC, Ng RT, Song IC. 2-Octylcynanoacrylate-assisted microvascular anastomosis in a rat model: long-term biomechanical properties and histological changes. Microsurgery 2004; 24 (04) 304-308
• 24 Qu L, Jing Z, Wang Y. Sutureless anastomoses of small and medium sized vessels by medical adhesive. Eur J Vasc Endovasc Surg 2004; 28 (05) 526-533
• 25 Abenavoli FM. Using Dermabond. Plast Reconstr Surg 2001; 108 (01) 269
• 26 Zhu Y, Wei W, Li Y. 2-Octylcyanoacrylate-assisted microvascular anastomosis in rat orthotopic small bowel transplantation. J Reconstr Microsurg 2011; 27 (03) 151-156