Abstract
Background
Temporary occlusion of an intracranial artery during microvascular anastomosis is a major risk factor in cerebrovascular surgery. A new laser vascular welding technique that minimizes the occlusion time of the recipient vessel has been developed and is described in this report.
Method
A new minimally occlusive technique of end-to-side microvascular anastomosis was developed employing a diode laser in association with the application of a chromophore in our experimental model of double end-to-side anastomosis. The implantation of a vein graft on the patent carotid artery was obtained through the application of three interrupted sutures at each anastomotic site; the carotid was then clamped, two arteriotomies were performed, followed by the application of a fourth suture and of the laser welding procedure on each anastomosis. Monitoring of the temperature at the site of the anastomosis was introduced in order to control the welding technique.
Findings
The time of the clamping of the carotid artery was 12 min to perform two end-to-side anastomoses (i.e., 6 min for each anastomosis). All bypasses were patent after a follow-up of 90 days and histological study confirmed good preservation of the vascular wall.
Conclusions
Our laser-assisted technique of vascular anastomosis reduces the duration of the clamping of the recipient artery down to 6 min. This technique can minimize the risk of cerebral ischemia associated with occlusion of a recipient artery in intracranial bypass procedures, promoting an improved vascular healing process with a lower risk of thrombosis and occlusion.
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Comment
In this interesting, well-planned, effectively executed, and well written in vivo experimental study in a rabbit model of the two-end-to-side anastomoses, the authors continued their interest in using a low-power laser to perform carotid bypass. The goal of the study was to examine the efficacy and safety of the laser-welding technique to establish anastomoses between a jugular vein graft and the carotid artery. The authors found that their technique was not only efficient and safe, but also significantly decreased the time of carotid artery occlusion. The results were presented clearly and convincingly and were supported by properly chosen figures. The discussion was concise and informative. In summary, it is an interesting study that presents a new tool for vascular surgery.
R.M. Pluta
NIH Bethesda, MD, USA
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Puca, A., Esposito, G., Albanese, A. et al. Minimally occlusive laser vascular anastomosis (MOLVA): experimental study. Acta Neurochir 151, 363–368 (2009). https://doi.org/10.1007/s00701-009-0219-3
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DOI: https://doi.org/10.1007/s00701-009-0219-3