Experimental simplification of the excimer laser-assisted nonocclusive anastomosis (ELANA) technique.
BACKGROUND
The excimer laser-assisted nonocclusive anastomosis (ELANA) technique facilitates the construction of an end-to-side anastomosis between a donor vessel and a recipient artery without the need to temporarily occlude the recipient artery.


OBJECTIVE
To test whether the surgically difficult ELANA technique can be simplified.


METHODS
In 42 rabbits, with the aorta as the recipient artery and human saphenous veins as donor grafts, we made 30 conventional ELANAs with 8 microsutures, 90 ELANAs with 4 microsutures (ELANA-4s), 40 ELANAs with 2 microsutures (ELANA-2s), and 90 sutureless ELANAs (SELANAs). SELANA involved a new ring design with 2 pins. ELANA-4, ELANA-2, and SELANA were each combined with 3 different sealants (Bioglue, Tachoseal, and Tisseel) and compared regarding application time, complications, and burst pressure.


RESULTS
The conventional ELANA was constructed in a mean of 14.8 +/- 2.6 minutes. All experimental anastomoses were constructed significantly faster; the ELANA-4 in a mean of 10.9 +/- 1.3 minutes, the ELANA-2 in a mean of 5.4 +/- 1.7 minutes, and the SELANA in a mean of 2.5 +/- 1.8 minutes. All ELANA and ELANA-4 anastomoses were sufficiently strong with a burst pressure > 200 mm Hg, except for 1 insufficiently sealed ELANA-4 anastomosis. ELANA-2 was sufficiently strong only with Bioglue, showing a burst pressure > 280 mm Hg. SELANA was sufficiently strong with Bioglue or TachoSil, showing a burst pressure > 260 mm Hg.


CONCLUSIONS
The ELANA technique can be simplified by reducing or even abandoning microsutures. Of the experimental anastomoses tested, we consider the SELANA technique combined with TachoSil of most potential benefit. Long-term survival studies will be performed in animals before we consider using any of these new techniques in patients.
van Doormaal
Tristan P C
TP
Rudolf Magnus Institute of Neuroscience, Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands. T.vandoormaal@gmail.com
van der Zwan
Albert
A
Verweij
Bon H
BH
Biesbroek
Matthijs
M
Regli
Luca
L
Tulleken
Cornelius A F
CA
D000714:Anastomosis, Surgical / Q000379:methods; D000771:Anesthesia, Intravenous / Q000379:methods; D000818:Animals; D001012:Aorta, Abdominal / Q000601:surgery*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D054018:Lasers, Excimer; D011817:Rabbits; D012501:Saphenous Vein / Q000637:transplantation; D013536:Suture Techniques