Minimally occlusive laser vascular anastomosis (MOLVA): experimental study.
BACKGROUND
Temporary occlusion of an intracranial artery during microvascular anastomosis is a major risk factor in cerebrovascular surgery. A new laser vascular welding technique that minimizes the occlusion time of the recipient vessel has been developed and is described in this report.


METHODS
A new minimally occlusive technique of end-to-side microvascular anastomosis was developed employing a diode laser in association with the application of a chromophore in our experimental model of double end-to-side anastomosis. The implantation of a vein graft on the patent carotid artery was obtained through the application of three interrupted sutures at each anastomotic site; the carotid was then clamped, two arteriotomies were performed, followed by the application of a fourth suture and of the laser welding procedure on each anastomosis. Monitoring of the temperature at the site of the anastomosis was introduced in order to control the welding technique.


RESULTS
The time of the clamping of the carotid artery was 12 min to perform two end-to-side anastomoses (i.e., 6 min for each anastomosis). All bypasses were patent after a follow-up of 90 days and histological study confirmed good preservation of the vascular wall.


CONCLUSIONS
Our laser-assisted technique of vascular anastomosis reduces the duration of the clamping of the recipient artery down to 6 min. This technique can minimize the risk of cerebral ischemia associated with occlusion of a recipient artery in intracranial bypass procedures, promoting an improved vascular healing process with a lower risk of thrombosis and occlusion.
Puca
Alfredo
A
Institute of Neurosurgery, Catholic University, Largo A Gemelli, Rome, Italy.
Esposito
Giuseppe
G
Albanese
Alessio
A
Maira
Giulio
G
Rossi
Francesca
F
Pini
Roberto
R
D000818:Animals; D002339:Carotid Arteries / Q000033:anatomy & histology / Q000601:surgery; D002548:Cerebral Revascularization / Q000295:instrumentation / Q000379:methods*; D007202:Indicators and Reagents / Q000627:therapeutic use; D020767:Intracranial Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods*; D054023:Lasers, Semiconductor / Q000627:therapeutic use; D055806:Microvessels / Q000033:anatomy & histology / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D023421:Models, Animal; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011817:Rabbits; D019737:Transplants; D016896:Treatment Outcome; D014680:Veins / Q000528:radiation effects / Q000637:transplantation
D007202:Indicators and Reagents