Microvascular Anastomotic Coupler Research Articles

Efficiency and Safety of Microvascular Anastomotic Coupler for Wrist Revascularization in Traumatic Injuries

IntroductionEffective vascular anastomosis is crucial for successful hand surgery, particularly in traumatic injuries where rapid restoration of blood flow is essential. The Synovis microvascular anastomotic coupler system presents a novel approach, potentially offering faster and more reliable outcomes than traditional suturing methods. This study was conducted to assess the effectiveness and safety of the Synovis coupler for microvascular anastomoses in the wrist, evaluating anastomosis time, patency rates, and complication rates. MethodsThis retrospective study examined 25 microvascular anastomoses (22 arteries and 3 veins) in 24 patients at a major trauma center. The primary outcomes measured were anastomosis time and vascular patency, assessed immediately post-operation and at subsequent follow-ups. ResultsThe average time required for anastomosis using the coupler was 7.3 minutes. Immediate postoperative vascular patency was 100%, with a long-term patency rate of 88%. Complications included arterial narrowing at the coupler site in three arteries, and complete occlusion in three arteries, accounting for a 12% long-term complication rate. ConclusionWhile the Synovis coupler demonstrates a significant reduction in anastomosis time and high patency rates, our data suggest that its effectiveness is more pronounced in venous anastomoses. The higher complication rates in arterial anastomoses warrant cautious use in these cases. Further research, including prospective randomized controlled trials, is needed to validate these findings and optimize patient selection criteria for the use of couplers in microvascular surgery.

Evaluation of Anastomosis Efficiency in Arteriovenous Shunts Created by Using Hand-Sewn Microsurgery and Microvascular Anastomotic Coupler Device.

Microsurgery has made great contributions to the advancement of surgery. In parallel with the developments in microsurgery, various techniques have been developed to perfect the technique. Microvascular anastomotic coupler device (MACD) is one of these techniques. The aim of the study was to evaluate the effectiveness of anastomoses created by using hand-sewn microsurgery (HSM) and MACD. Twenty male Sprague-Dawley rats weighing 250 to 300g were divided into 2 groups randomly. Arteriovenous shunt was performed between carotid artery and internal jugular vein with the principles of HSM in the first group (n=10) and by using the 1-mm anastomotic microvascular device in the second group (n=10). Groups were evaluated for anastomose time, success of anastomosis, thrombosis formation, color Doppler ultrasonography, and histopathological features. Anastomotic time was faster with the coupler device compared with HSM technique. Flow rates were found significantly higher in the MACD group. Endothelialization and wall integrity rates were better in MACD group. Microvascular anastomotic coupler device is faster than HSM. High quality and durability of vascularization, insignificant foreign body reactions are histopathological advantages of MACD.

Microvascular anastomotic coupler for venous end-to-side anastomoses in head and neck reconstructive surgery.

The use of coupler devices has become mainstream in microsurgical end-to-end venous anastomoses (EEA) for free flaps in head and neck reconstruction. Reports about end-to-side venous anastomoses (ESA) using a coupler are scarce, though. The surgical technique of end-to-side anastomosis using a coupler device is described. End-to-side anastomoses and end-to-end anastomoses with a vascular coupler are compared with respect to postoperative vascular complications. 124 patients were included, 76 with EEA, 48 with ESA. Postoperative venous complications occurred in 5.3% and 2.1%, respectively. ESA is a valuable alternative to EEA when using a coupler device providing more flexibility to the surgeon.

Suitability of the Microvascular Anastomotic Coupler System for Small Spliced Vein Grafts

Suitability of the Microvascular Anastomotic Coupler System for Small Spliced Vein Grafts

In Vivo Preclinical Quantitative Flow Analysis of Arterial Anastomosis Using a Microvascular Anastomotic Coupler and Clinical Application for Extracranial-to-Intracranial Bypass

Although several commercially available sutureless anastomotic techniques are available, they are not routinely used in neurosurgery. We performed an invivo flow analysis of end-to-end anastomosis using a microvascular coupler device in rats. We report our first clinical use of the microvascular anastomotic coupler. Bilateral rat common carotid arteries (CCAs) were exposed, and a microvascular coupler was used to perform 8 anastomoses. A microflow probe provided quantitative measurement of blood-flow volume. Flow augmentation was assessed with end-to-side anastomoses connecting the distal CCA to the jugular vein (JV). A patient with chronic dominant hemisphere atherosclerotic ischemic disease and progressive symptoms refractory to medical management underwent end-to-end cerebral artery bypass using the microvascular coupler. Mean preanastomosis flow in the rat CCA was 3.95 ± 0.45 mL/min; this flow was maintained at 3.99 ± 0.24 mL/min on final measurements 54-96 minutes postanastomosis. Total occlusion time for each rat CCA was 12-19 minutes. After end-to-side anastomosis, with proximal and distal JV patent, CCA flow increased 477% to 22.8 ± 3.70 mL/min (P=0.04, proximal; P= 0.01, distal). After invivo testing, we successfully used the coupler clinically in a superficial temporal artery-to-middle cerebral artery bypass for dominant hemisphere flow augmentation. Invivo quantitative flow analysis demonstrated no flow difference between an unaltered artery and artery with end-to-end anastomosis using a microvascular coupler in rats. A 1-mm coupled anastomosis achieved a 4-fold flow increase with low-resistance venous outflow in rats, simulating increased arterial demand. The coupler was successfully used for extracranial-to-intracranial bypass in a patient.

Applying the Microvascular Anastomotic Coupler Device to End-to-side Venous Anastomosis in Reconstructive Surgery

Background:Microsurgical vascular anastomosis plays an important role in successful free-tissue transfer. The Microvascular Anastomotic Coupler Device (MACD) aims to simplify anastomosis and decrease the time spent on this step, thereby reducing surgeon stress and improving the overall quality of the surgery, especially when venous end-to-side anastomosis is required. Our comparative retrospective cohort study aimed to determine the effect of this widely used device on anastomosis times and complications in head and neck/esophageal reconstruction cases involving venous end-to-side anastomosis using the internal jugular vein as the recipient vessel.Methods:All consecutive patients who underwent head and neck/esophageal reconstruction with hand-sewn or MACD-mediated venous end-to-side anastomosis using the internal jugular vein by three experienced microsurgeons in our tertiary-care hospital in 2012–2020 were identified. Venous anastomosis times and venous trouble cases were recorded.Results:Of the 191 cases, 44 and 147 underwent hand-sewn and MACD-mediated anastomosis respectively. The average venous anastomosis times of these groups were 31 and 11 minutes, respectively. Venous trouble was observed in two hand-sewn (4.5%) and four MACD (2.7%) cases, respectively. Vein twisting and improper coupler placement were the causes in the latter four cases.Conclusions:This study confirmed that MACD simplifies end-to-side venous anastomosis and reduces the time spent on this procedure. Also, for safer anastomosis, it is necessary to pay attention to preventing twisting and improper coupler placement when using MACD. We believe the MACD can improve the quality of reconstructive surgery.

In Vivo Preclinical Quantitative Flow Analysis of Arterial Anastomosis using a Microvascular Anastomotic Coupler and Clinical Application for Extracranial-to-intracranial Bypass

In Vivo Preclinical Quantitative Flow Analysis of Arterial Anastomosis using a Microvascular Anastomotic Coupler and Clinical Application for Extracranial-to-intracranial Bypass

Evaluation of a microvascular anastomotic coupler for end-to-side arterial and venous anastomosis for feline renal transplantation.

To describe the technique and determine the feasibility of an end-to-side (ETS) anastomosis of the renal vein to vena cava and renal artery to aorta using a microvascular anastomotic coupler (MAC) for feline renal transplantation. In vivo experimental study. Six purpose-bred domestic shorthair cats. The left kidney was autotransplanted using a MAC for ETS vascular anastomosis. Outcomes included intraoperative hemorrhage from the anastomosis sites, duration of anastomoses, surgical complications, postoperative renal perfusion (including resistive index (RI)) measured by Doppler ultrasonography and computed tomography angiography, and histopathological examination of the left kidney and anastomosis sites (30 days). Anastomosis was successful in all cats, and intraoperative hemorrhage was negligible. Intraoperative renal perfusion was considered excellent. Venous and arterial anastomoses were completed in 11 minutes 20 seconds (range, 6:38-13:27) and 21 minutes 50 seconds (range, 11:05-30:24), respectively. Vascular occlusion time was 32 minutes (17:43-42:03). One cat was euthanized 5 hours postoperatively because of bleeding from a muscular arterial branch of the dorsal aorta causing hemoabdomen. Renal perfusion and RI of the remaining five cats were within normal range (<0.8) and similar to the contralateral kidney at all time points. Endothelialization of the anastomosis was complete with mild-to-moderate fibrosis surrounding the MAC in all cats. End-to-side anastomosis of the renal vein and artery to the vena cava and aorta, respectively, was consistently achieved in all six cats with the MAC. The use of the MAC may be considered as an alternative to hand suturing for ETS anastomoses for feline renal transplantation.

Lymphaticovenous anastomosis of the caudal thoracic duct to an intercostal vein: A canine cadaver study.

To describe a technique for anastomosis of the thoracic duct (TD) to the 11th or 12th intercostal vein (ICV) using a microvascular anastomotic coupler (MAC) in the dog. Cadaveric study. Eight beagles. A right paracostal laparotomy and 10th intercostal thoracotomy were performed in each dog. Mesenteric contrast lymphography was used to identify the TD and its branches on fluoroscopy. The TD and adjacent 11th or 12th ICV were isolated, double ligated, and divided using a surgical microscope. The caudal TD and proximal ICV were anastomosed in an end-to-end fashion using a 1.5 mm or 2 mm MAC. Mesenteric lymphography was repeated to document patency of the anastomosis. The TD was identified via lymphography in all dogs; five dogs had a single duct, and three dogs had additional branches. The anastomosis was successful in all eight dogs, and flow into the azygos vein without leakage was confirmed via lymphography. End-to-end anastomosis of the TD to an ICV using a MAC was technically feasible in the canine cadaver. Lymphaticovenous anastomosis combined with TD ligation may have application as a treatment for idiopathic chylothorax. By maintaining the flow of chyle from the abdominal lymphatics to the systemic circulation, this procedure may reduce the stimulus for collateral circulation and persistent flow to the cranial mediastinal lymphatics.

The Usefulness of a Versatile Retractor System in Venous Anastomoses with Microvascular Anastomotic Coupler.

The Usefulness of a Versatile Retractor System in Venous Anastomoses with Microvascular Anastomotic Coupler.

Venous Coupler in Pediatric Free Tissue Transfer: Case Series and Literature Review

Background:Venous couplers have gained widespread acceptance as an effective, safe, and time-efficient alternative for hand-sewn anastomosis in microsurgical reconstruction. The literature on venous couplers use in pediatric free tissue transfer is scant. The purpose of this study is to present our experience with coupler-assisted venous anastomosis in young pediatric free flap reconstruction.Methods:This is a retrospective single-center review of all children younger than 10 years old who underwent free flap reconstruction over 36-month period. The primary objective was to assess flap survival rate at 30-day postoperative period. The rate of venous thrombosis, flap take back, flap salvage, and the mean coupling time were also assessed.Results:Four girls and 1 boy with a mean age of 7.3 ± 2.7 years (range 4–10 years) underwent 6 free flap transfers for head and neck, upper limb, and lower limb reconstructions. Microvascular anastomotic coupler system was used for 8 out of 9 performed venous anastomoses with a size ranging from 1.5 to 2.5 mm. Primary flap survival rate was 100%. None of the flaps in our series developed venous thrombosis or required flap take back for microvascular compromise (mean follow-up of 14.4 months). The mean coupling time was 7.1 minutes.Conclusions:In the current study, venous couplers were safe and reliable in free tissue transfer in children younger than 10 years old. Future studies with larger sample size are needed to further examine the safety and efficacy of venous couplers in pediatric microsurgical anastomosis.

Microvascular anastomotic coupler application learning curve: A curriculum supporting further deliberate practice in ex-vivo simulation models

IntroductionMicrovascular anastomosis with coupler devices has revolutionized microsurgery practice. Couplers are considered easier to apply and offer improved operating time while maintaining success rates. This study aims to map the learning curve, skill acquisition, and decay of novice microsurgeons in performing coupler anastomosis. MethodsNovice microsurgeons performed consecutive coupler applications on a three-layer silastic vessel in two phases. Overall time, total movements, and total path-length were objectively measured and the overall surgical performance was calculated using hand motion analyzer (Dextrous MD, Inition, London, UK). ResultsSixty coupler anastomoses were performed using the synthetic, three-layered silicone vessel by 5 novices, 40 for phase 1, 12 for phase 2 and 8 for phase 3. During the phase 1 and phase 2 learning curves deliberate practice, the novices required an average of 8 (6–9) and 4 (2–6) consecutive repetitions, respectively, before reaching the experts’ performance. There was an average improvement of 69% (p < 0.001) from their baseline performance during phase I and 37% (p < 0.001) during phase II. End-product assessment revealed that 4 out of 40 coupler applications during phase 1 (10%), 3 out of 20 during phase 2 (15%), and 1 out of 8 during exit performance-phase 3 (12.5%). During phase 3 end-product assessment with f-cMP, 7 out of 8 arterial and venous coupler anastomoses demonstrated an adequate range of flow measures. ConclusionThis study demonstrated objectively learning curves and skill decay following a suggested coupler application curriculum and quantified objective thresholds for ethical animal model training and safe supervised clinical sessions in the OR.

The application of microvascular anastomotic coupler in vascular anastomosis of free tissue flap for reconstruction of defect after head and neck cancer resection

Objective: To investigate the application and operation skills in vein anastomosis by microvascular anastomotic coupler (MAC) in reconstruction of defects after head and neck cancer resection. Methods: From August 2015 to July 2016, in Department of Head and Neck Surgery, Sichuan Cancer Hosipital, 17 cases underwent the reconstruction of defects after head and neck cancer resection with free tissue flaps, including forearm flaps in 11 casess, anterolateral flaps in 4 casess and fibula flaps in 2 casess. Totally 17 MAC were used, including 14 MAC for end-to-end anastomosis and 3 MAC for end-to-side anastomosis. SPSS 22.0 software was used to analyze the data. Results: Venous anastomoses in 17 free tissue flaps were successfully completed, with no anastomotic errhysis. All flaps survived well. The time required for vascular anastomoses with MAC varied 2-9 min, with average time of (4.2±2.3) min, which was significantly shorter than that with manually anastomosis (17.4 ± 2.7) min (t=15.1, P<0.01). The followed-up time ranged from 6 to 18 months. The flaps in recipient area healed well. The shape and function of recipient area were satisfying. Conclusions: Microvascular anastomotic coupler can be used for vessel anastomosis in free tissue flap for reconstruction of defect after head and neck cancer resection, which requires for less operation time and shows good results.

Creation of spliced vein conduit using microvascular anastomotic coupler

The single-segment great saphenous vein continues to be a conduit of choice for lower extremity arterial bypass. In patients without an adequate continuous segment of great saphenous vein, a spliced vein graft may be used as an alternative. Creating a spliced vein conduit can be technically challenging and time consuming. We present a technique of creating a spliced vein conduit by using a microvascular anastomotic coupler.

Clinical Efficacy of Microvascular Anastomotic Coupler in Upper Limb Replantation

Objective: Microvascular anastomotic coupler has gained popularity in anastomosis surgery over the last 2 decades. However, evaluation of its impact on patency rate in upper limb replantation is barely reported. In this study, we aim to access clinical efficacy of microvascular anastomotic coupler in the application of upper limb replantation. Methods: From March 2013 to August 2015, a retrospective study was conducted in 6 consecutive patients with amputated upper limbs who underwent replantation. Among these patients, replantation was performed in 2 patients with middle upper arm amputation, 1 patient with elbow amputation, 2 with forearm amputation, and 1 with wrist disarticulation. Twenty-seven microvascular anastomotic couplers were applied in anastomosis of 2 brachial arteries, 4 ulnar arteries, 3 radial arteries, 6 cephalic veins, 4 basilic veins, 4 venae comitantes of brachial arteries, and 4 venae comitantes of ulnar arteries. Revascularization time, patency rate, complications, and viability of limbs were evaluated. Results: Patency rate of vessels in all 6 patients was 100%, and average duration of operation was 5 hours, whereas the mean time for anastomoses was 4 minutes, without postoperative vascular crisis. All replanted limbs survived after an average follow-up of 2 to 12 months; blood flow was patent and no thrombosis occurred over the site of anastomosis by Doppler vascular ultrasound. Conclusion: The microvascular anastomotic coupler serves as a powerful instrument in upper limb replantation by achieving high patency rate, high viability, and low complication rate.

The Use of Venous Coupler Device in Free Tissue Transfers for Oral and Maxillofacial Reconstruction

Microvascular anastomosis remains the most challenging and important technique affecting the success of free tissue transfers. A microvascular anastomotic coupling device is often used. This study is a retrospective review of the use of a venous coupler for head and neck reconstruction during a 2-year period at the Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University (Zhengzhou, China). Sixty-nine consecutive cases of microvascular free flaps from December 2012 through December 2014 were retrospectively reviewed. Patients' demographic information (age and gender), defect location, flap type, recipient vein, anastomotic time, coupler size, microvascular complications, and flap survival rate were collected and analyzed. Sixty-nine anastomotic coupler devices were used for 69 flaps. Of the 69 flaps performed, there were 26 anterior lateral thigh flaps (37.68%), 25 radial forearm flaps (36.23%), 17 fibula flaps (24.64%), and 1 deep inferior epigastric perforator flap (1.45%). The branch of the internal jugular vein was the most common recipient vein (n= 29; 40.03%), followed by the facial vein (n= 25; 36.23%) and the external jugular vein (n= 15; 21.74%). Coupler sizes ranged from 1.5 to 3.5mm, with most being 2.5mm (n= 41; 59.42%), followed by 3.0mm (n= 19; 27.54%), 2.0mm (n= 7; 10.14%), 1.5mm (n= 1; 1.45%), and 3.5mm (n= 1; 1.45%). The average operation time was 3 to 11minutes for venous anastomosis (∼6minutes on average). Postoperative complications were seen in 7 of 69 flaps (10.14%), and no complications led to complete flap loss. The overall flap success rate was 100%. Total coupler venous thrombosis rate was 4.35% (3 of 69). The microvascular coupler shows reliability for venous anatomosis in head and neck reconstruction free tissue transfers. Use of a microvascular anastomotic coupler could simplify vascular anatomosis, considerably shorten operative time, and achieve excellent vessel patency and flap success rate.

The microvascular anastomotic coupler for venous anastomoses in free flap breast reconstruction improves outcomes.

Venous couplers are ubiquitous around the world and are a useful tool for the reconstructive microsurgeon. A systematic review of coupler performance studies demonstrated a thrombosis rate range of 0% to 3%, whilst the average time of using the device is 5 minutes. There is sparse published data on cost analysis and the impact of operator experience on the anastomotic coupler device success. Improvements in outcomes other than time benefits have also not been shown. This study aims to address these deficiencies in the literature. A retrospective clinical study was undertaken, aiming to compare equivalent groups of patients that had free flap surgery with venous micro-anastomoses with those that had sutured anastomoses. The cohort comprised all patients undergoing microsurgical breast reconstruction at the St Andrew's Centre for Plastic Surgery & Burns from January 2009 to December 2014. Between January 2010 to December 2014, 1,064 patients underwent 1,206 free flap breast reconstructions. The average age of patients was 50 years. Seventy percent of patients underwent mastectomy and immediate reconstruction during this period with the remaining 30% having a delayed reconstruction. The 1,206 free flaps comprised of 83 transverse myocutaneous gracilis (TMG) flaps, and 1,123 deep inferior epigastric artery perforator (DIEP) flaps. In total the coupler was used in 319 flaps, 26% of the cohort. There was a statistically significant clinical benefit in using the anastomotic coupler for venous anastomosis. Overall, the return to theatre rate was 12.69% whilst the overall flap loss rate was 0.75%. The overall coupler failure rate was significantly less at 1.4% whilst sutured vein failure rate was 3.57% (P=0.001). The anastomotic coupler for venous anastomosis in free flap surgery is associated with reduced operating times, reduced take-backs to theatre and cost benefits. This is the first study to demonstrate clear clinical benefits to anastomotic couplers, and suggests that these may be the gold standard for venous microanastomosis. With increasing experience with their use and technological advances, these outcomes may continue to improve.

Innovative Sutureless Microvascular Anastomotic Device With Embedded Doppler Flow Monitor1

Innovative Sutureless Microvascular Anastomotic Device With Embedded Doppler Flow Monitor1

Application of microvascular anastomotic device in vascular injury of upper limb

Objective To investigate the clinical outcomes of arteriovenous anastomosis by microvascular anastomotic coupler device.Methods From January 2013 to November 2013,23 cases of microvascular anastomotic coupler device were applied in 18 patients with vascular injury of upper limb,and anastomosis time and patency rate was observed.Results In 18 patients,the brachial artery injury in 2 cases,the radial artery injury in 11 cases,the ulnar artery injury in 8 cases,the cephalic vein injury in 1 case,and basilic vein injury in 1 case.23 microvascular anastomotic coupler devices were applied in vascular injury.The post procedure vascular patency rate was 100％ and the average time of anastomosis was 3min 59s.Conclusion Microvascular anastomotic coupler device is charactered by higher patency rate and faster operation.It can not only be used in venous anastomosis of tissue graft,and also has a certain value in the repair of arteriovenous injury. Key words: Vascular anastomosis; Upper limb; Microvascular anastomotic device; Thrombus

Microvascular Anastomotic Coupler Assessment in Head and Neck Reconstruction

To assess the advantages of using mechanical anastomotic systems in head and neck free tissue transfer. Case series with chart review. A university-based tertiary care center. A retrospective review of mechanical venous coupler devices in head and neck reconstruction performed between October 2004 and December 2006. A total of 261 venous anastomoses were performed in 234 consecutive patients. Five types of flaps were performed: radial forearm (66%), anterior lateral thigh (12%), fibula (9%), rectus abdominis (8%), and latissimus dorsi (2%). Demographic data were collected, and the outcomes measured were flap survival and microvascular complications. The size of the venous anastomosis ranged from 1.5 to 4.0 mm, with most being 3.0 mm (56%) followed by 3.5 mm (23%). The most common recipient vein used was a stump off the internal jugular vein (76%) followed by the external jugular vein (17%). Microvascular complications occurred in <5% (n = 11) of patients, with >50% of those being arterial insufficiency (n = 7). Total failures occurred in 3% (n = 7) of patients: 1.5% (n = 4) acute failures (<5 days) and 1.5% (n = 3) late failures. Of the acute failures, causes included venous congestion (n = 1) and arterial insufficiencies (n = 3). The venous coupler used in the failures was 3.0 mm in diameter. Free flap failures resulting from arterial insufficiency involved coupling to the external jugular vein, while the remaining free flap failures (n = 4) used the internal jugular vein. With an early venous failure rate of 0.38%, mechanical anastomosis is an adequate alternative to hand-sewn techniques.