A comparison of CO2 laser-assisted venous anastomoses and conventional suture techniques: patency, aneurysm formation, and histologic differences.
The expected patency and the potential complications of CO2 laser-welded end-to-end venous anastomoses have not been well established despite increasing clinical interest in the subject. To further study this relatively new technique we used the internal jugular veins (1.0 to 1.4 mm diameter) of 15 New Zealand White rabbits weighing 2.5 to 3.5 kg. On one randomly selected side, a laser-welded end-to-end anastomosis was performed in all animals by placing three equidistant stay sutures followed by welding the vein edges with a CO2 laser (spot size of 0.27 mm, power of 100 mW, and power density of 175 W/cm2). On the contralateral side, the vein was anastomosed with interrupted 10-0 nylon sutures in 10 animals, and in the remaining five animals a continuous 10-0 nylon suture technique was used. All anastomoses were surgically assessed at 30 days after operation. A significantly lower 30-day patency rate (p less than 0.05, Fisher's Exact Test) was found in anastomoses constructed by use of the continuous technique (20%) compared with either interrupted (90%) or the laser-assisted technique (87%). No significant difference was observed in 30-day patency between laser-assisted and conventional interrupted anastomoses. Anastomoses performed with the continuous and the laser-assisted technique required 12.5 +/- 1.3 and 12.9 +/- 3.0 minutes, respectively, whereas those constructed with interrupted technique required 19.1 +/- 4.5 minutes (p less than 0.05, Student-Neuman-Keuls' Test). No evidence of false or true aneurysm was noted in any of the animals. Histologic evaluation of laser-assisted anastomoses demonstrated early full-thickness coagulation necrosis of the wall with reendothelialization by 7 days and complete healing by 30 days after the procedure. Conventional anastomoses showed reendothelialization and minimal necrosis near the sutures at 7 days, but healing was complete by 30 days after the procedure. The patency rate of vein anastomoses performed with the CO2 laser is excellent and superior to the one obtained with continuous sutures, and except for less operating time, the former technique does not appear to offer any significant advantage over the conventional interrupted suture technique for small vein anastomosis in this animal model up to 1 month of follow-up.
Division of Vascular Surgery, Maimonides Medical Center-State University of New York, Brooklyn 11219.
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M
Gennaro
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E
Ascer
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C
Mohan
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S
Wang
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000783:Aneurysm / Q000209:etiology; D000818:Animals; D004730:Endothelium, Vascular / Q000648:ultrastructure; D005500:Follow-Up Studies; D007601:Jugular Veins / Q000473:pathology / Q000601:surgery; D053685:Laser Therapy / Q000009:adverse effects; D008855:Microscopy, Electron, Scanning; D011817:Rabbits; D013536:Suture Techniques; D014654:Vascular Patency; D014680:Veins / Q000601:surgery*