title: The acute effect of increased laser energy during the excimer laser-assisted non-occlusive anastomosis procedure on the vessel wall of the recipient artery: a histopathological study.
abstract: OBJECTIVE
  The excimer laser-assisted non-occlusive anastomosis (ELANA) technique is a way of making an anastomosis of vessels without temporal occlusion that is used for cerebral revascularization. Currently, 10 mJ of laser energy is used during the ELANA procedure. We have recently demonstrated that increasing the laser energy may increase flap retrieval rate. The aim of the present study was to study the acute effect of increased laser energy during the ELANA procedure on the recipient vessel wall.
  
  
  METHODS
  The ELANA technique was performed on the abdominal aortas of rabbits under anesthesia using three categories of laser energy (two laser episodes of 10, 13, and 15 mJ, respectively). The rabbits were subsequently sacrificed and the anastomoses were removed. A non-lased rabbit aorta was used as control. Recipient arteries were studied using histopathology and transmission electron microscopy.
  
  
  RESULTS
  In all three categories of laser energy and in the control group, the tunica media and adventitia adjacent to the anastomosis were intact, apart from damage caused by sutures. In the control group, the endothelium was fully intact. In the 10 and 13 mJ subgroups, the endothelium was mostly intact [92% (range 85-98) and 87% (range 80-90) for 10 and 13 mJ, respectively]. In the 15 mJ subgroup, most of the endothelium was absent [32% (range 20-40) of endothelium intact], predominantly at the side opposed to the anastomosis.
  
  
  CONCLUSIONS
  Increasing the laser energy during the ELANA procedure from 10 to 13 mJ does not cause additional acute damage to the vessel wall. Increasing the laser energy from 13 to 15 mJ results in increased acute damage of the endothelium, whereas tunica media and adventitia remain unaffected. Further studies are required to assess the long-term effects of increased laser energy during the ELANA technique.
authors.affiliation: Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Matthijs
authors.initials: M
authors.lastname: Biesbroek
authors.forename: Tristan P C
authors.initials: TP
authors.lastname: van Doormaal
authors.forename: Albert
authors.initials: A
authors.lastname: van der Zwan
authors.forename: Cornelis A F
authors.initials: CA
authors.lastname: Tulleken
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
authors.forename: Harry F G
authors.initials: HF
authors.lastname: Heijnen
authors.forename: Aryan
authors.initials: A
authors.lastname: Vink
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery; D001158:Arteries / Q000473:pathology* / Q000601:surgery*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D011817:Rabbits; D014656:Vascular Surgical Procedures / Q000379:methods*