Vascular Anastomosis Techniques Research Articles

Modèle animal d'entraînement à l'anastomose temporosylvienne

Background and purpose Microsurgical training in neurosurgery is essential, the aim being to practise surgery with the microscope and to learn vascular and nervous anastomosis techniques. The objective of this project was to create a model simulating the human anatomy and surgical conditions. Technique Rats were operated on using a plaster model mimicking a human hemicranium. The technique performed was an end to side anastomosis of the distal free end of the left carotid to the right carotid arteriotomy, using eight interrupted 10/0 sutures, at a depth of 5 cm. Early and delayed patency tests were performed. Discussion Various models and techniques for training to microsurgical arterial anastomosis are described in the literature. The determining factor is the skill of the operator, which is in turn dependent on the level of training. This model allows the surgeon to gain significant technical experience with the EC-IC bypass, which is applicable to human neurosurgical practice and is indispensable for the prospective neurovascular surgeon.

Complicaciones quirúrgicas post-trasplante renal. Estudio en 185 casos

ObjectiveTo analyze the incidence of surgical complications its diagnosis and treatment after renal transplantation. MethodsA retrospective study measuring the incidence of surgical complications and reviewing its diagnosis and treatment in 185 renal single transplants. Results185 transplants, 27% had surgical complications. Only one patient lost the graft due to surgical complications and there was no associated mortality. Cold ischemia time 20 hours. Double J stenting in 19%, under surgeon’s opinion. Vascular complications 3,2% (all of them renal artery stenosis). Urological complications 6,4%. Perinephric haematoma 7%. Lymphocele 4,9%. Peritoneum related complications 4%. Other 4%. The diagnosis was clinical and radiological in most of cases. 14% needed any kind of intervention. ConclusionsOur results are similar to those reported in other recent series. Only one surgical team involved and the same technique for vascular and vesico-ureteric anastomosis probably makes lower our complications rate. Early postoperative abdominal ultrasonography contributes to the diagnosis of surgical complications. The initial treatment approach is the endoscopic-conservative one, with exceptions.

Bipolar anastomosis technique with removable instruments: an easy, fast, and reliable technique for vascular anastomosis.

The interrupted suture technique is most commonly used for microsurgical vascular anastomosis. For several reasons (e.g., exposure of suture material to blood, time needed), many attempts have been made to find other solutions. This article describes a new means of performing a microsurgical vascular anastomosis. The aim of this study was to show the feasibility and possible advantages of this new technique. The basic components at work here are a modified cuff and electrically generated heat used to unite the vessel walls. In this way, both endothelial layers are adapted without manipulating the inside of the vessel or leaving behind foreign matter. Various energy/coagulation time settings were used to perform arterial anastomoses (n = 42) in an isogeneic abdominal aorta interposition model in the rat. The quality of anastomosis was evaluated at days 1, 10, 21, and 120. Immediately after the welding process all anastomoses (n = 42) were patent. No stenosis was found at any observation time. Anastomosis time ranged from 3 to 18 minutes (average, 11 minutes). This new technique permits a vascular anastomosis to be performed easily and reliably with a high patency rate. With this technique, the authors are convinced that a skilled surgeon can create a high-quality anastomosis in a fraction of the time needed to sew an anastomosis.

Minimally Invasive Vascular Surgery and the Evolution of Vascular Anastomosis Techniques

The evolution of vascular surgery toward minimally invasive approaches appears to be inevitable. Thus, innovative and reliable minimally invasive anastomosis techniques are needed to facilitate minimally invasive vascular surgery. Current endovascular anastomosis techniques are limited by their reliance on suitable arteries for access and attachment. Their dependency on the fate of the arterial attachment sites is greater than for the conventionally sutured anastomosis. These limitations will be difficult to over come. Videoscopic anastomosis techniques may offer both the advantages of endovascular surgery in terms of rapid postoperative recovery and reliability of open-sutured anastomosis. With improved training and instrumentation, such as robots, semiautomatic or automatic anastomotic devices, the video scopic approaches will likely become technically easier. The chief disadvan tage of current open-sutured anastomoses is the invasive exposure required, elevated morbidity and mortality, and associated p...

Aortic aneurysm operations: past, present, and future

Effective methods to treat aortic aneurysms are now available, although these lesions still challenge the cardiovascular surgeon. Attempts at treatment began in earnest in the 1800s, with the introduction of indirect and direct methods of repair. A major breakthrough occurred in the late 1800s, when Dr Rudolph Matas devised a method for internal repair of aneurysms in which continuity of blood flow was restored by excising the diseased portion of the lesion and creating a tunnel through the remaining normal portion. Matas named this technique reconstructive endoaneurysmorrhaphy. Until that time, surgeons had treated aneurysms by ligating the parent vessel with a Hunterian ligature or introducing foreign material to promote coagulation. Ligating the aneurysm rendered the extremities vulnerable to ischemic damage, however, and results were unpredictable with the use of various foreign materials. Around the turn of the century, Carrel began experimenting with different techniques for vascular anastomoses. The work of these early pioneers formed the basis for much of the modern treatment of aneurysms of the thoracic aorta. My experience began in 1950, when I excised a large aortic aneurysm in one of Dr Alfred Blalock’s patients. The patient survived and was cured. After that experience, I knew that aortic aneurysms could be treated successfully by aggressive surgical means. Treatment has changed, however, from the early emphasis on excising the lesion to the present practice of restoring circulatory continuity with a suitable graft, ie, endoaneurysmorrhaphy. The development of reliable synthetic grafts has been one of the most important advances in the treatment of aneurysms. The surgical technique used today depends on the anatomic location of the aneurysm, which can occur anywhere from the aortic annulus and aortic valve to the distal thoracic aorta and visceral vessels in the abdomen.

NATIVE PERIPHERAL VASCULAR DISEASE CONTRIBUTES TO RENAL TRANSPLANT RENOVASCULAR DISEASE

288 Renal transplant artery stenosis (RTAS) is a relatively rare complication of renal transplantation, especially with the current techniques for vascular anastomoses. However, older patients (pts) prone to peripheral vascular disease (PVD), are more frequently being considered as candidates for renal transplantation. PVD involving the iliac system in this context can mimic RTAS(pseudoRTAS) and detrimentally affect graft function. We retrospectively analyzed 819 pts who underwent primary and non-primary kidney transplantation alone between 1993 and 1997 to determine the extent of pseudoRTAS. The population consisted of 506 M and 313 F. 92 pts (11.2%), suspected of having RTAS with new onset lower extremity edema and an increase in serum creatinine(Cr) underwent angiography (Agram) or magnetic resonance angiography (MRA). 4 pts underwent Agram or MRA involving the transplant renal artery for other reasons. RTAS or pseudoRTAS was defined as one or more hemodynamically significant lesions in the renal transplant artery or iliac system diagnosed by Agram or MRA. PseudoRTAS or RTAS was evident in 44 pts (5.4%), including 5 pts with pseudoRTAS and RTAS, 15 with pseudoRTAS, and 24 with RTAS. The recipient factor most significantly associated with RTAS and pseudoRTAS was increased weight at time of transplant (p < 0.0009). Other recipient factors that were associated with RTAS or pseudoRTAS included:TableThere was no significant association between RTAS or pseudoRTAS and race, pre-transplant dialysis modality, use of cyclosporine, FK506 or MMF, CMV infection, PRA, or HLA matching. In evaluating donor variables, available for 491 cadaveric transplants in this group, only older donor age was significantly associated with RTAS or pseudoRTAS (p < 0.0005). These data suggest that ischemic renal disease in renal transplant recipients may be increasing in incidence, taking on a new guise encompassing RTAS and pre-existing PVD that acts as pseudoRTAS.

A new anastomotic technique in renal transplants reduces warm ischemia time

The cause of allograft dysfunction following renal transplantation has not yet been fully determined. However, one of the principal factors known to cause dysfunction in renal transplantation is warm. ischemia. A new vascular anastomosis technique that reduces anastomotic time and the amount of warm ischemia time during the implantation phase was tested. A retrospective review compared 21 consecutive sutureless renal transplants with 31 consecutive suture transplants using a new technique performed by the same surgeon in the previous 12 months. The results showed the warm ischemia time was reduced by 51% (from 42.4 min to 24.04 min) with the new anastomotic technique, and with few complications. Initial experience with the new anastomotic technique is favorable. Further experience is needed to fully evaluate the complications and long‐term outcomes using this technique.

The Jejunal Free Flap In Oral Cavity And Pharyngeal Reconstruction

The jejunal free flap is comprehensively reviewed in this article. Information on the historical development, the anatomy and physiology of the jejunum flap, and the particular suitability of this donor site for creation of free-tissue units is described. The correct abdominal harvest and vascular anastomosis techniques are also reviewed. A detailed description of how jejunal free flaps are placed into the oral cavity and oropharynx is then provided with particular reference to the split jejunal flap and its disposition in these recipient sites. It is concluded that this flap continues to maintain an already well developed place in the armamentarium of the head and neck reconstructive surgeon.

A Technique for Rapid Non-Suture Vascular Anastomosis

In an attempt to overcome some of the difficulties inherent in vascular anastomosis using standard suture methods, we have developed a technique that allows for rapid non-suture anastomosis of blood vessels. The technique has been used in over 400 anastomoses, including interposition vein grafts in rat, rabbit and dog vessels ranging in size from 0.7 mm to 3 mm in diameter. Animals have been followed for over 1 year postoperatively with serial angiography and histological evaluation including scanning electron microscopy. Stress studies have compared the biomechanical properties of both non-suture and suture anastomosis. The overall patency rate in non-suture end-to-end anastomoses using an interposition vein graft was 85% at 1 year follow up. Histological evaluation revealed a healing pattern that was temporally similar to that of the suture technique. Stress tests revealed no significant difference between suture and non-suture technique. These studies reveal that the non-suture technique compares favourably with the suture technique, and demonstrate the feasibility of applying this technique to man.

Evaluation and Treatment of Priapism

We herein review the last 29 patients with priapism treated at our hospitals with respect to the physiology and pathophysiology of erection and priapism, respectively, and present a rational approach to the management of priapism. Emphasis is given to the corpus cavernosum to corpus spongiosum shunt with a vascular anastomosis technique.

An Improved Technique for Coronary Vascular Anastomosis

A vein holder is described that is used for anastomosis of both ends of aortocoronary bypass grafts. It minimizes handling of the graft, ensures precision in placing sutures with excellent visualization, and provides maximum patency at the anastomotic sites.