Vascular anastomosis using controlled phase transitions in poloxamer gels

• Published in: Nature medicine Vol. 17; no. 9; pp. 1147 - 1152
• Main Authors: Chang, Edward I, Galvez, Michael G, Glotzbach, Jason P, Hamou, Cynthia D, El-ftesi, Samyra, Rappleye, C Travis, Sommer, Kristin-Maria, Rajadas, Jayakumar, Abilez, Oscar J, Fuller, Gerald G, Longaker, Michael T, Gurtner, Geoffrey C
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-09-2011; Nature Publishing Group
• Subjects: 639/301/54/990; 692/699/75/593; 692/700/565/545/576/402; Anastomosis; Anastomosis, Surgical - methods; Animals; Aorta - surgery; Biomedical and Life Sciences; Biomedical materials; Biomedicine; Blood vessels; Cancer Research; Cardiovascular diseases; Care and treatment; Diagnosis; Elastic Modulus; Immunohistochemistry; Infectious Diseases; Male; Metabolic Diseases; Methods; Microscopy, Electron, Scanning; Microvessels - surgery; Molecular Medicine; Neurosciences; Phase Transition; Phase transitions; Poloxamer - therapeutic use; Polymers; Rats; Rheology; Surgery; Surgical anastomosis; Surgical techniques; technical-report; United States
• ISSN: 1078-8956; 1546-170X
• DOI: 10.1038/nm.2424

By exploiting the thermoreversible properties of the US Food and Drug Administration–approved poloxamer 407 (triblock polymer) and 2-octylcyanoacrylate bioadhesive, Edward Chang
et al
. have developed a new method of sutureless vascular anastomosis, even in vessels with a diameter of less than 1.0 mm. This nonmechanical, sutureless approach compared favorably to the standard hand-sewn approach in long-term (two-year) rat studies.
Vascular anastomosis is the cornerstone of vascular, cardiovascular and transplant surgery. Most anastomoses are performed with sutures, which are technically challenging and can lead to failure from intimal hyperplasia and foreign body reaction. Numerous alternatives to sutures have been proposed, but none has proven superior, particularly in small or atherosclerotic vessels. We have developed a new method of sutureless and atraumatic vascular anastomosis that uses US Food and Drug Administration (FDA)-approved thermoreversible tri-block polymers to temporarily maintain an open lumen for precise approximation with commercially available glues. We performed end-to-end anastomoses five times more rapidly than we performed hand-sewn controls, and vessels that were too small (<1.0 mm) to sew were successfully reconstructed with this sutureless approach. Imaging of reconstructed rat aorta confirmed equivalent patency, flow and burst strength, and histological analysis demonstrated decreased inflammation and fibrosis at up to 2 years after the procedure. This new technology has potential for improving efficiency and outcomes in the surgical treatment of cardiovascular disease.