Intravascular stenting in microvascular anastomoses.

Abstract

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. 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. 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. 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.