Comparison of indium III oxine-labeled platelet aggregation between sutured and argon laser-assisted vascular anastomoses

Abstract

The thrombogenicity of argon laser-assisted vascular anastomoses (LAVAs) was compared with that of sutured vascular anastomoses (SVAs) by measurement of platelet aggregation at the site of repair in a canine model. Sequential 1 cm longitudinal carotid and femoral arteriotomies (n = 80) or jugular and femoral phlebotomies (n = 80) were performed, with each vessel having two tandem, randomly positioned arteriotomies or phlebotomies separated by a 4 cm length of intact vessel. One incision was repaired by SVA with continuous 6-0 polypropylene sutures and the other by argon LAVA. For the laser fusions, argon laser energy was applied to the adventitial surface of the vessel with a 300 μm fiberoptic probe with 0.5 W power, 1100 joules per square centimeter energy fluence, and 150 second exposure per 1 cm length. The arterial and venous segments of SVAs and LAVAs and an equivalent length of normal vessel were harvested at 48 hours (n = 16, 16, 16), 2 weeks (n = 12, 12, 12), and 4 weeks (n = 12, 12, 12). Autologous indium 111 oxine-labeled platelets were injected intravenously 48 hours before removal of the vascular repairs and the radioactivity of the specimens was determined on removal with a NaI (T1) well-type scintillation counter. Anastomotic platelet adherence index (APAI) was calculated as the ratio of emissions of SVA or LAVA to normal reference vessel. Argon arterial LAVAs had significantly less platelet deposition when compared with SVAs in the canine model at 48 hours (APAI = 161 ± 76 and 93 ± 41, respectively; p < 0.01), whereas no significant differences were shown between the arterial repairs at 2 or 4 weeks or between venous repairs at either 48 hours, 2 weeks, or 4 weeks. This study demonstrates that argon LAVA, with energy applied to the adventitial surface of medium-sized arteries, induces less or comparable platelet aggregation than sutured repairs and may have a favorable effect on initial patency.