title: Development of sutureless vascular connecting system for easy implantation of small-caliber artificial grafts.
abstract: A novel sutureless vascular connecting system, an assembly with a delivery rod, an introducing sheath, and a connecting device, was developed for easy implantation of small-caliber vascular grafts less than 2 mm in internal diameter. A microporous stainless tube (length 2 mm, external diameter 1.6 mm, wall thickness 65 microm, pore diameter 400 microm, pore-to-pore distance 500 microm) was designed to serve as a connecting device. The feasibility of the system was tested using two types of preliminary animal experiments. One animal model consisted of graft implantation into the rat abdominal aorta (1.5 mm in diameter). The connecting device was inserted into the proximal and distal ends of the aorta through the introducing sheath by pushing the delivery rod with the connecting device placed over it. Subsequently, the aortic segments were inserted into both ends of model grafts made of segmented polyurethane (1.8 mm in internal diameter) and were fixed with banding silk threads from the exterior. The procedure was completed within 20 min without requiring specialized microsurgery techniques. Blood leakage and obstruction did not occur. The second model consisted of an end-to-end anastomosis between rabbit common carotid arteries (2 mm in diameter), which was performed within several minutes of blood flow interruption. Scanning electron microscopy demonstrated that the luminal surface of the device was fully covered with endothelial cells (ECs) after 1 week as a result of transluminal ingrowth of native ECs through the micropores in the device. This endothelialization may prevent early thrombus-induced occlusion. This simple and "easy-to-learn" technique will promote the development of small-caliber arterial grafts, and furthermore, it may have potential for clinical application.
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Sakai
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Nakayama
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nemoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Taiji
authors.initials: T
authors.lastname: Watanabe
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kanda
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yaku
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation*; D000818:Animals; D001012:Aorta, Abdominal / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002339:Carotid Arteries / Q000601:surgery; D042783:Endothelial Cells / Q000378:metabolism; D004730:Endothelium, Vascular / Q000254:growth & development; D005240:Feasibility Studies; D008855:Microscopy, Electron, Scanning; D023421:Models, Animal; D011474:Prosthesis Design; D011817:Rabbits; D051381:Rats; D013536:Suture Techniques; D014656:Vascular Surgical Procedures / Q000295:instrumentation