Long-term reendothelialization of excimer laser-assisted nonocclusive anastomoses compared with conventionally sutured anastomoses in pigs

In contrast to conventional anastomosis methods, the excimer laser-assisted nonocclusive anastomosis (ELANA) technique involves a platinum ring and intima-adventitia apposition with a rim of medial and adventitial layers exposed to the bloodstream. The authors assessed the reendothelialization of po...

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Published in:	Journal of neurosurgery Vol. 103; no. 2; pp. 328 - 336
Main Authors:	STREEFKERK, Henk Johan N, KLEINVELD, Sanne, KOEDAM, Ester L. G. E, BULDER, Marcel M. M, MEELDUK, Hans D, VERDAASDONK, Ruud M, MANSVELT BECK, Rik J, VAN DER ZWAN, Bart, TULLEKEN, Cornelis A. F
Format:	Journal Article
Language:	English
Published:	Park Ridge, IL American Association of Neurological Surgeons 01-08-2005
Subjects:	Anastomosis, Surgical - methods Animals Biological and medical sciences Blood Vessel Prosthesis Carotid Artery Diseases - surgery Cerebral Revascularization - instrumentation Cerebral Revascularization - methods Female Laser Therapy - instrumentation Laser Therapy - methods Medical sciences Neurosurgery Prosthesis Implantation Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Swine Nervous system diseases Surgical anastomosis Encephalon Pig Vertebrata Mammalia excimer laser-assisted nonocclusive anastomosis technique anastomosis Surgery Laser cerebral revascularization Artiodactyla bypass surgery Ungulata Revascularization
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Summary:	In contrast to conventional anastomosis methods, the excimer laser-assisted nonocclusive anastomosis (ELANA) technique involves a platinum ring and intima-adventitia apposition with a rim of medial and adventitial layers exposed to the bloodstream. The authors assessed the reendothelialization of porcine carotid arteries through ELANA compared with conventional anastomosis by using scanning electron microscopy. In 28 pigs a bypass with one ELANA and one conventional anastomosis was made on the left common carotid artery. All patent anastomoses were evaluated intraoperatively with the aid of an ultrasonographic flowmeter and postoperatively by using scanning electron microscopy at 2 weeks, 2 months, 3 months, and 6 months thereafter. Twenty-four of 28 bypasses (48 of 56 end-to-side anastomoses) were fully patent at the time of evaluation. On scanning electron microscopic evaluation of the bypasses, all 48 patent anastomoses showed complete reendothelialization, including all 24 ELANAs in which the endothelium covered the rim and the laser-ablated edge completely. No endothelial difference was observed between conventional anastomoses and ELANAs, aside from the obvious anatomical differences like the platinum ring, which had been completely covered with endothelium. At 6 months postsurgery, remodeling of the ELANA was observed, leaving the ring covered with a layer of endothelium as the most narrow part of the anastomosis. In long-term experiments, ELANA allows reendothelialization comparable to that achieved with conventional anastomosis. Considering its nonocclusive and high-flow characteristics, the ELANA technique is preferable in cerebral revascularization procedures.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0022-3085
DOI:	10.3171/jns.2005.103.2.0328