title: Microvascular anastomosis using modified micro-stents: a pilot in vivo study.
abstract: BACKGROUND
  Microvascular sutured anastomosis remains the gold standard in microvascular flap surgery but is technically challenging, time-consuming, and sometimes unreliable. The goal of our study has been to develop a microvascular stenting system that can be used for microvascular anastomosis, even without the use of a microscope.
  
  
  METHODS
  Custom-made stainless-steel stents were used to re-establish vessel continuity after the severance of the abdominal aortic vessel in nine rats. At 30 min after re-opening the blood flow, Doppler flowmetry and indocyanine green (ICG) angiography were used to assess vessel patency, and vessels were inspected microscopically for signs of thrombosis.
  
  
  RESULTS
  Eight of the nine animals survived the procedure. In one case, the abdominal aorta was torn during balloon dilation of the stent. Four out of the nine stent anastomoses showed an excellent fit. In the remaining four cases, a collagen membrane and fibrin glue were successfully used to stop vascular leakage. However, these additional steps might have had a negative impact on vessel patency, and thrombus formation impaired blood flow completely in one case.
  
  
  CONCLUSIONS
  Microvascular stent anastomosis is feasible and might in some cases be superior to standard sutured anastomosis. However, a number of technical difficulties remain to be addressed, and long-term results are not yet available.
authors.affiliation: Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Electronic address: florian.jm.bauer@tum.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Bauer
authors.affiliation: Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Fichter
authors.affiliation: Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Denys J
authors.initials: DJ
authors.lastname: Loeffelbein
authors.affiliation: Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.affiliation: Private Practice, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Schütz
authors.affiliation: Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mücke
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation* / Q000379:methods; D057868:Anastomotic Leak / Q000601:surgery; D000792:Angiography / Q000379:methods; D000818:Animals; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery; D003094:Collagen; D004396:Coloring Agents; D004867:Equipment Design; D005240:Feasibility Studies; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D007208:Indocyanine Green; D017078:Laser-Doppler Flowmetry / Q000379:methods; D008567:Membranes, Artificial; D008833:Microcirculation; D008866:Microsurgery / Q000295:instrumentation* / Q000379:methods; D008904:Miniaturization; D010865:Pilot Projects; D051381:Rats; D017208:Rats, Wistar; D012039:Regional Blood Flow / Q000502:physiology; D013193:Stainless Steel / Q000737:chemistry; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging; D014014:Tissue Adhesives / Q000627:therapeutic use; D014654:Vascular Patency / Q000502:physiology
chemical_list: D004396:Coloring Agents; D015718:Fibrin Tissue Adhesive; D008567:Membranes, Artificial; D014014:Tissue Adhesives; D013193:Stainless Steel; D003094:Collagen; D007208:Indocyanine Green
keywords: Anastomosis; Microsurgery; Minimally invasive; Stents