title: Diode laser-assisted carotid bypass surgery: an experimental study with morphological and immunohistochemical evaluations.
abstract: OBJECTIVE
  Conventional suturing methods of microvascular anastomosis are associated with various degrees of vascular wall damage that can lead to thrombosis and bypass occlusion. An experimental model of double end-to-side venous graft anastomosis on the common carotid artery was set up to compare conventional suturing methods with a low-power diode laser vascular welding technique.
  
  
  METHODS
  The experiments were performed on 40 rabbits that underwent implantation of a 15-mm segment of jugular vein on the common carotid artery. The proximal end-to-side suture was performed by eight interrupted stitches; the distal suture, which was done using a laser welding technique, was supported by four stay sutures. The animals were evaluated after 2 days (n = 15), 9 days (n = 15), and 30 days (n = 10). The vascular segments were excised and subjected to histological, immunohistochemical, and ultrastructural evaluation.
  
  
  RESULTS
  The average clamping time to perform both anastomoses was 35 minutes. At the end of the follow-up period, one case of complete occlusion was observed after 9 days and one case was observed after 30 days. Surgical observations and pathological evaluation indicated that adoption of the laser welding technique reduced operative time and bleeding. Histologically, a reduction of thrombosis, inflammation, myointimal hyperplasia, and dystrophic calcification was observed in laser-assisted anastomoses. A better preservation of the endothelium was also evident in laser-treated anastomoses. The observed differences were deemed statistically significant (P < 0.05).
  
  
  CONCLUSIONS
  Our study demonstrated the efficacy of diode laser welding in improving surgical techniques of high-flow bypass and in reducing the vascular wall damage observed with conventional methods.
authors.affiliation: Institute of Neurosurgery, Catholic University, Rome, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Puca
authors.forename: Alessio
authors.initials: A
authors.lastname: Albanese
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Esposito
authors.forename: Giulio
authors.initials: G
authors.lastname: Maira
authors.forename: Barbora
authors.initials: B
authors.lastname: Tirpakova
authors.forename: Giacomo
authors.initials: G
authors.lastname: Rossi
authors.forename: Alice
authors.initials: A
authors.lastname: Mannocci
authors.forename: Roberto
authors.initials: R
authors.lastname: Pini
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D017536:Carotid Artery, Common / Q000473:pathology* / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D007601:Jugular Veins / Q000637:transplantation*; D053685:Laser Therapy / Q000379:methods*; D011817:Rabbits; D016896:Treatment Outcome