Long-term reendothelialization of excimer laser-assisted nonocclusive anastomoses compared with conventionally sutured anastomoses in pigs.
OBJECTIVE
In contrast to conventional anastomosis methods, the excimer laser-assisted nonocclusive anastomosis (ELANA) technique involves a platinum ring and intima-adventitia apposition with a rim of medial and adventitial layers exposed to the bloodstream. The authors assessed the reendothelialization of porcine carotid arteries through ELANA compared with conventional anastomosis by using scanning electron microscopy.


METHODS
In 28 pigs a bypass with one ELANA and one conventional anastomosis was made on the left common carotid artery. All patent anastomoses were evaluated intraoperatively with the aid of an ultrasonographic flowmeter and postoperatively by using scanning electron microscopy at 2 weeks, 2 months, 3 months, and 6 months thereafter. Twenty-four of 28 bypasses (48 of 56 end-to-side anastomoses) were fully patent at the time of evaluation. On scanning electron microscopic evaluation of the bypasses, all 48 patent anastomoses showed complete reendothelialization, including all 24 ELANAs in which the endothelium covered the rim and the laser-ablated edge completely. No endothelial difference was observed between conventional anastomoses and ELANAs, aside from the obvious anatomical differences like the platinum ring, which had been completely covered with endothelium. At 6 months postsurgery, remodeling of the ELANA was observed, leaving the ring covered with a layer of endothelium as the most narrow part of the anastomosis.


CONCLUSIONS
In long-term experiments, ELANA allows reendothelialization comparable to that achieved with conventional anastomosis. Considering its nonocclusive and high-flow characteristics, the ELANA technique is preferable in cerebral revascularization procedures.
Streefkerk
Henk Johan N
HJ
Department of Neurosurgery, Brain Division, Rudolf Magnus Institute, Utrecht, The Netherlands. H.J.N.Streefkerk@ELANA-online.org
Kleinveld
Sanne
S
Koedam
Ester L G E
EL
Bulder
Marcel M M
MM
Meelduk
Hans D
HD
Verdaasdonk
Ruud M
RM
Beck
Rik J Mansvelt
RJ
van der Zwan
Bart
B
Tulleken
Cornelis A F
CA
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D001807:Blood Vessel Prosthesis; D002340:Carotid Artery Diseases / Q000601:surgery*; D002548:Cerebral Revascularization / Q000295:instrumentation / Q000379:methods*; D005260:Female; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods*; D019919:Prosthesis Implantation; D013552:Swine