Sutureless microvascular anastomosis assisted by an expandable shape-memory alloy stent.

Noriko Saegusa,Kazuo Kishi,Masatoshi Kusuhara,Kunihiro Ohta,Masahiro Nakagawa,Yasuto Akiyama,Mitsuhiro Watanabe,Shunji Sarukawa,Takashi Sugino,Kensuke Takamatsu,Keita Inoue,Jun Yu

doi:10.1371/journal.pone.0181520

Noriko Saegusa, Kazuo Kishi + Show 10 more

Open Access

https://doi.org/10.1371/journal.pone.0181520

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Abstract

Vascular anastomosis is the highlight of cardiovascular, transplant, and reconstructive surgery, which has long been performed by hand using a needle and suture. However, anastomotic thrombosis occurs in approximately 0.5–10% of cases, which can cause serious complications. To improve the surgical outcomes, attempts to develop devices for vascular anastomosis have been made, but they have had limitations in handling, cost, patency rate, and strength at the anastomotic site. Recently, indwelling metal stents have been greatly improved with precise laser metalwork through programming technology. In the present study, we designed a bare metal stent, Microstent, that was constructed by laser machining of a shape-memory alloy, NiTi. An end-to-end microvascular anastomosis was performed in SD rats by placing the Microstent at the anastomotic site and gluing the junction. The operation time for the anastomosis was significantly shortened using Microstent. Thrombus formation, patency rate, and blood vessel strength in the Microstent anastomosis were superior or comparable to hand-sewn anastomosis. The results demonstrated the safety and effectiveness, as well as the operability, of the new method, suggesting its great benefit for surgeons by simplifying the technique for microvascular anastomosis.

Highlights

Successful vascular anastomosis is the highlight of cardiovascular and transplant surgery, which is currently performed by hand using a needle and suture
We developed a bare-metal stents (BMSs), termed Microstent, constructed with NiTi, a shape-memory alloy (SMA), with a design and size that do not interfere with blood flow such that it can be placed in the microvascular lumen
Blood flow stagnation was large at the junction between the branches, and because a markedly greater decrease in the area where stagnation occurs was observed with a thickness of 100 μm than with 150 μm (S1 Fig), a NiTi tube with a thickness of 100 μm was used

Summary

Introduction

Successful vascular anastomosis is the highlight of cardiovascular and transplant surgery, which is currently performed by hand using a needle and suture The history of this technique is surprisingly long, going all the way back to 1902, when Alexis Carrel first reported it as a practical way to approximate vessel ends, minimizing the gap between their lumens [1]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funder provided support in the form of salaries for authors N.S., S.S., K.O., K.T., M.N., and K.I., but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section

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