Microvascular Anastomosis Using Cyanoacrylate Adhesives

This paper describes a new technique for microvascular anastomosis, which involves the overlapping of the adventitias of the two ends of a severed blood vessel, and then painting a cyanoacrylate adhesive on the outer surface of the vessel around the anastomosed part. Sixteen anastomoses were performed in both radial arteries and cephalic veins in eight dogs. All vessels were patent without thrombus. The described method of anastomosis was faster and easier to perform than the conventional suture anastomosis. Histologic studies revealed that the adhesive did not flow into the lumen, and that normal healing of the endothelium and of the internal elastic lamina occurred across the anastomotic site, even though the adhesive remained on the adventitial side of the vessel at 4 weeks. This technique deserves to be considered as an alternative to conventional suture anastomosis.

KEYWORDS

Microvascular anastomosis - tissue adhesive - cyanoacrylate

REFERENCES

• 1 Salemark L. International survey of current microvascular practices in free tissue transfer and replantation surgery.  Microsurgery. 1991;  12 308-311
• 2 Chow S P. The histopathology of microvascular anastomosis: a study of the incidence of various tissue changes.  Microsurgery. 1983;  4 5-9
• 3 Han S K, Kim S W, Kim W K. Microvascular anastomosis with minimal suture and fibrin glue: experimental and clinical study.  Microsurgery. 1998;  18 306-311
• 4 Zang L, Kolker A R, Choe E I et al.. Venous microanastomosis with the Unilink system, sleeve, and suture techniques: a comparative study in the rat.  J Reconstr Microsurg. 1997;  13 257-261
• 5 Daniel R K, Olding M. An absorbable anastomotic device for microvascular surgery: clinical application.  Plast Reconstr Surg. 1984;  74 337
• 6 Gelli R, Pini R, Toncelli F et al.. Vessel-wall recovery after diode laser-assisted microvascular anastomosis: clinical and histologic analysis on long-term follow-up.  J Reconstr Microsurg. 1997;  13 199-205
• 7 Bowen C V, Leach D H, Crosby N L, Reynolds R. Microvascular anastomoses: a comparative study of fibrinogen adhesive and interrupted suture techniques.  Plast Reconstr Surg. 1996;  97 792-800
• 8 Padubidri A N, Browne E, Kononov A. Fibrin glue-assisted end-to-side anastomosis of rat femoral vessels: comparison with conventional suture method.  Ann Plast Surg. 1996;  37 41-47
• 9 Casanova R, Herrera G A, Vasconez L et al.. Microarterial sutureless sleeve anastomosis using a polymeric adhesive: an experimental study.  J Reconstr Microsurg. 1987;  3 201-207
• 10 Takenaka H. Sutureless anastomosis of blood vessels using cyanoacrylate adhesives.  Japn J Surg. 1992;  22 46-54
• 11 Middleton W G, Mattews W, Chiasson D A. Histoacryl glue in microvascular surgery.  J Otolaryngology. 1991;  20 363-366
• 12 Ang E S, Tan K C, Tan L H, Ng R T, Song I C. 2-octylcyanoacrylate-assisted microvascular anastomosis: comparison with a conventional suture technique in rat femoral arteries.  J Reconstr Microsurg. 2001;  17 193-201
• 13 Hall W W, Wrye S W, Banducci D R, Ehrlich P. Microvascular anastomosis using 2-octyl cyanoacrylate in the rat femoral artery.  Ann Plast Surg. 2000;  44 508-511
• 14 Souther S G, Levitsky S, Roberts W C. Bucrylate tissue adhesive for microvascular anastomosis: technique, results, and histologic evaluation.  Arch Surg. 1972;  103 496-499
• 15 Tschopp H M. Small artery anastomosis, using a cuff of dura mater and a tissue adhesive.  Plast Reconstr Surg. 1975;  55 606-611
• 16 Gottlob R. The toxic action of alkylcyanoacrylate adhesives on vessels. Comparative studies.  J Surg Res. 1967;  7 363-367
• 17 Jacobson J H, Moody R A, Kusserow B K, Reich T, Wang M C. The tissue response to a plastic adhesive used in combination with microsurgical technique in reconstruction of small arteries.  Surgery. 1966;  60 379-385
• 18 Weissberg D, Schwartz P, Goetz R H. Nonsuture end-to-side anastomosis of small blood vessels.  Surg Gyn Obstet. 1966;  123 341-346