CO2-welded venous anastomosis: enhancement of weld strength with heterologous fibrin glue.
The milliwatt CO2 laser was used to perform end-to-end anastomoses in canine jugular veins. There was a high disruption rate (50%) in laser-welded veins (n = 10). Fibrin glue (n = 17), formed from human fresh-frozen plasma, enhanced the weld strength decreasing the disruption rate (18%), resulting in an 82% patency which nearly equaled the contralateral sutured vein patency (93%). The bursting strength was improved with fibrin glue. Transmural necrosis was present initially in all groups but extended for a longer distance in the vessel wall in laser-welded anastomoses. Sutured anastomoses exhibited a greater inflammatory response. In laser-welded anastomoses endothelial cells were not as confluent as in sutured anastomoses by six weeks. Carbon dioxide laser-welded end-to-end vein anastomoses appear to be impractical because they disrupt too easily. However, the addition of heterologous fibrin glue to the weld results in a reasonably strong anastomosis with histologic properties that may be beneficial in vein bypass grafts.
Cikrit
D F
DF
Department of Surgery, Indiana University Medical Center, Indianapolis 46202.
Dalsing
M C
MC
Weinstein
T S
TS
Palmer
K
K
Lalka
S G
SG
Unthank
J L
JL
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D004285:Dogs; D004730:Endothelium, Vascular / Q000473:pathology; D015718:Fibrin Tissue Adhesive; D007601:Jugular Veins / Q000473:pathology / Q000601:surgery; D007834:Lasers; D009336:Necrosis; D013536:Suture Techniques; D013718:Tensile Strength; D014654:Vascular Patency / Q000502:physiology; D014680:Veins / Q000601:surgery*
D015718:Fibrin Tissue Adhesive