title: Progress in cardiovascular anastomoses: will the vascular join replace Carrel's technique?
abstract: BACKGROUND
  Vascular reconstructions are becoming challenging due to the comorbidity of the aging population and since the introduction of minimally invasive approaches. Many sutureless anastomosis devices have been designed to facilitate the cardiovascular surgeon's work and the vascular join (VJ) is one of these. We designed an animal study to assess its reliability and long-term efficacy.
  
  
  METHODS
  VJ allows the construction of end-to-end and end-to-side anastomoses. It consists of two metallic crowns fixed to the extremity of the two conduits so that vessel edges are joined layer by layer. There is no foreign material exposed to blood. In adult sheep both carotid arteries were prepared and severed. End-to-end anastomoses were performed using the VJ device on one side and the classical running suture technique on the other side. Animals were followed-up with Duplex-scan every 3 months and sacrificed after 12 months. Histopathological analysis was carried out.
  
  
  RESULTS
  In 20 animals all 22 sutureless anastomoses were successfully completed in less than 2 min versus 6 +/- 3 min for running suture. Duplex showed the occlusion of three controls and one sutureless anastomosis. Two controls and one sutureless had stenosis >50%. Histology showed very thin layer of myointimal hyperplasia (50 +/- 10 microm) in the sutureless group versus 300 +/- 27 microm in the control. No significant inflammatory reaction was detected.
  
  
  CONCLUSIONS
  VJ provides edge-to-edge vascular repair that can be considered the most physiological way to restore vessel continuity. For the first time, in healthy sheep, an anastomotic device provided better results than suture technique.
authors.affiliation: Cardiovascular Surgery Department, University of Lausanne, CHUV, Lausanne, Switzerland. Piergiorgio.Tozzi@hospvd.ch
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Tozzi
authors.forename: Enzo
authors.initials: E
authors.lastname: Borghi
authors.forename: Eric
authors.initials: E
authors.lastname: Haesler
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Siniscalchi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Motti
authors.forename: Daniel
authors.initials: D
authors.lastname: Hayoz
authors.forename: Ludwig K
authors.initials: LK
authors.lastname: von Segesser
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D000818:Animals; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000601:surgery; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D004867:Equipment Design; D012039:Regional Blood Flow / Q000502:physiology; D012756:Sheep; D013537:Sutures; D016896:Treatment Outcome; D014463:Ultrasonography