title: Vascular anastomosis using controlled phase transitions in poloxamer gels.
abstract: Vascular anastomosis is the cornerstone of vascular, cardiovascular and transplant surgery. Most anastomoses are performed with sutures, which are technically challenging and can lead to failure from intimal hyperplasia and foreign body reaction. Numerous alternatives to sutures have been proposed, but none has proven superior, particularly in small or atherosclerotic vessels. We have developed a new method of sutureless and atraumatic vascular anastomosis that uses US Food and Drug Administration (FDA)-approved thermoreversible tri-block polymers to temporarily maintain an open lumen for precise approximation with commercially available glues. We performed end-to-end anastomoses five times more rapidly than we performed hand-sewn controls, and vessels that were too small (<1.0 mm) to sew were successfully reconstructed with this sutureless approach. Imaging of reconstructed rat aorta confirmed equivalent patency, flow and burst strength, and histological analysis demonstrated decreased inflammation and fibrosis at up to 2 years after the procedure. This new technology has potential for improving efficiency and outcomes in the surgical treatment of cardiovascular disease.
authors.affiliation: Stanford University School of Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford, California, USA.
authors.forename: Edward I
authors.initials: EI
authors.lastname: Chang
authors.forename: Michael G
authors.initials: MG
authors.lastname: Galvez
authors.forename: Jason P
authors.initials: JP
authors.lastname: Glotzbach
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Hamou
authors.forename: Samyra
authors.initials: S
authors.lastname: El-ftesi
authors.forename: C Travis
authors.initials: CT
authors.lastname: Rappleye
authors.forename: Kristin-Maria
authors.initials: KM
authors.lastname: Sommer
authors.forename: Jayakumar
authors.initials: J
authors.lastname: Rajadas
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Abilez
authors.forename: Gerald G
authors.initials: GG
authors.lastname: Fuller
authors.forename: Michael T
authors.initials: MT
authors.lastname: Longaker
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Gurtner
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D001011:Aorta / Q000601:surgery*; D055119:Elastic Modulus; D007150:Immunohistochemistry; D008297:Male; D008855:Microscopy, Electron, Scanning; D055806:Microvessels / Q000601:surgery*; D044367:Phase Transition; D020442:Poloxamer / Q000627:therapeutic use*; D051381:Rats; D012212:Rheology
chemical_list: D020442:Poloxamer