Systematic review of microvascular coupling devices for arterial anastomoses in free tissue transfer.

Abstract

BackgroundCoupling devices have become commonplace in performing venous anastomoses during microvascular free tissue transfer (FTT). However, arterial anastomoses are still most commonly performed using traditional microvascular suture techniques.ObjectiveTo describe the safety and feasibility of using microvascular coupling devices for free flap arterial anastomosis.MethodsA systematic review of English language literature was performed for studies that investigated the use of an arterial coupler for microvascular FTT in human patients. A comprehensive search of MEDLINE (January 1948 to August 2018), EMBASE (January 1974 to August 2018), and Web of Science was performed.ResultsFifteen studies were included. All studies were retrospective case series. A combined total of 395 arterial anastomoses were attempted with a coupling device. All studies except for one used the 3M Unilink/Synovis coupling device. One study used a novel absorbable coupling device. The coupling device was aborted and converted to a suture technique in 8.4% of attempted anastomoses. Rupture of the anastomotic device was reported in only 1 patient (0.3%). Thrombosis was also infrequent at 1.9%. The quality assessment showed a high risk of bias in all studies.ConclusionIn selected patients, coupling devices for arterial anastomoses have a good success rate with low rates of thrombosis based on limited quality evidence.