title: Side-to-side sutureless vascular anastomosis with magnets.
abstract: OBJECTIVE
  Abbe and Payr introduced vascular techniques and devices to facilitate vessel anastomosis over a century ago. Obora published the idea of a sutureless vascular anastomosis with use of magnetic rings in 1978. The purpose of this study was to assess the performance of a new magnetic device to perform a side-to-side arteriovenous anastomosis in a dog model.
  
  
  METHODS
  Male fox hounds (25 kg) were treated preoperatively and daily postoperatively with clopidogrel bisulfate (Plavix) and aspirin. The femoral artery and vein were exposed unilaterally in 3 dogs and bilaterally in 4 dogs (n = 11 anastomoses). A 4-mm arteriotomy was performed, and 1 oval magnet 0.5 mm thick was inserted into the lumen of the artery and a second magnet was applied external to the artery, compressing and stabilizing the arterial wall to create a magnetic port. An identical venous magnetic port was created with another pair of oval magnets. When the 2 ports were allowed to approach each other, they self-aligned and magnetically coupled to complete the arteriovenous anastomosis. Patency was assessed for the first hour with direct observation, again after 9 weeks with duplex ultrasound scanning, and at 10 weeks under direct open observation. The anastomoses were explanted after 10 weeks. Hydrodynamic resistance was measured ex vivo on the final 8 anastomoses by measuring the pressure drop across an anastomosis with a known flow rate.
  
  
  RESULTS
  After implantation, very high flow created visible turbulence and palpable vibration. All 11 anastomoses were patent under direct observation and palpation. Ten of 11 anastomoses were clearly patent on duplex scans, and patency of 1 anastomosis was questionable. Hydrodynamic resistance averaged 0.73 +/- 0.33 mm Hg min/mL (mean +/- SEM).
  
  
  CONCLUSIONS
  Vascular anastomoses performed with magnets demonstrated feasibility; exhibited 100% patency after 10 weeks in a dog arteriovenous shunt model; lacked apparent aneurysm or other potentially catastrophic failure; demonstrated remodeling of the vessel wall after several weeks to incorporate the magnets, making the magnetic force unnecessary; and warrants further study in vessels with different sizes, flow rates, and locations.
  
  
  CONCLUSIONS
  We present a magnet-based device used to perform side-to-side peripheral vascular anastomoses. Its advantages include the ability to anastomose vessels without requiring circumferential surgical exposure. Vascular anastomosis performed with these magnets demonstrated 100% patency in the dog, lacked apparent aneurysm or other potentially catastrophic failure, and demonstrated remodeling of the vessel wall after several weeks, to incorporate the magnets, making indefinite retention of field strength unnecessary. This technique could enable minimally invasive procedures, such as complex reconstructive and revascularizing surgery, and warrants further study in vessels with different sizes, flow rates, and locations.
authors.affiliation: Kenan Plastic Surgery Research Laboratories, Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Detlev
authors.initials: D
authors.lastname: Erdmann
authors.forename: Ranya
authors.initials: R
authors.lastname: Sweis
authors.forename: Christoph
authors.initials: C
authors.lastname: Heitmann
authors.forename: Koji
authors.initials: K
authors.lastname: Yasui
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Olbrich
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
authors.forename: A Adam
authors.initials: AA
authors.lastname: Sharkawy
authors.forename: Bruce
authors.initials: B
authors.lastname: Klitzman
mesh_terms: D000818:Animals; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation* / Q000379:methods*; D004285:Dogs; D004730:Endothelium, Vascular / Q000648:ultrastructure; D005240:Feasibility Studies; D005263:Femoral Artery / Q000503:physiopathology / Q000601:surgery* / Q000648:ultrastructure; D005268:Femoral Vein / Q000503:physiopathology / Q000601:surgery* / Q000648:ultrastructure; D006097:Granulation Tissue / Q000648:ultrastructure; D008280:Magnetics; D008297:Male; D008422:Materials Testing; D014654:Vascular Patency; D014655:Vascular Resistance