The modified excimer laser-assisted high-flow bypass operation.
BACKGROUND
To make high-flow revascularization of the brain possible, we developed an anastomosis technique that obviates temporary occlusion of the recipient artery. After connecting donor and recipient vessels, an Excimer laser catheter, introduced by way of an artificial side branch, creates a hole at the anastomosis site. Because of the inconsistency of the diameter of the hole produced by the closed laser tip, we developed an extensive modification of the procedure.


METHODS
A new type of laser tip was developed, consisting of two layers of 60 mu laser fibers in a circular configuration with a diameter of 2.2 mm. The laser tip is fixed to the vessel wall at the anastomosis site by suction with a high-vacuum suction device, and a round piece of recipient vessel wall inside the anastomosis is cut out.


RESULTS
Using the aorta as the recipient vessel in 30 rabbits, the modified technique was developed and, in the end, produced anastomoses with a high patency rate. In 25 patients, high-flow bypasses for different indications were made using a venous transplant interposed between the external carotid artery or one of its branches and the intracranial internal carotid artery, utilizing the modified Excimer laser technique for the intracranial anastomosis. Complications related to the new anastomosis technique were minimal, and a satisfactory patency rate was obtained.


CONCLUSIONS
The modified Excimer laser-assisted anastomosis technique makes high-flow revascularization of the brain a safe procedure, since temporary occlusion of the recipient proximal brain artery during the making of the anastomosis is obviated.
Tulleken
C A
CA
Department of Neurosurgery, University Hospital, Utrecht, The Netherlands.
Verdaasdonk
R M
RM
Beck
R J
RJ
Mali
W P
WP
D000714:Anastomosis, Surgical / Q000295:instrumentation; D000818:Animals; D001011:Aorta / Q000601:surgery; D002342:Carotid Artery, External / Q000601:surgery; D002343:Carotid Artery, Internal / Q000601:surgery; D002548:Cerebral Revascularization / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D011817:Rabbits; D012501:Saphenous Vein / Q000637:transplantation; D014654:Vascular Patency