gms | German Medical Science

Suturing microvessels mandates their occlusion during the period of anastomosis. Although ischemia is well tolerated by other tissue types, the brain is quite sensitive to even short ischemic windows. Non-occlusive anastomotic techniques have been developed recently. These are confined to vessels with luminal diameters more than 3 mm. We have evolved a novel technique that can be used with microvessels, as pertinent to STA-MCA bypass. Our Aim is to describe a new technique of suturing microvessels with persistent perfusion via a temporary intraluminal microshunt.

Experiments were conducted in Wistar rats. Abdominal aorta grafts were explanted from donor rats. A soft silicon microcatheter was introduced into the lumen of this graft. The abdominal aorta of a recipient rat was prepared for end-to-side microvascular anastomosis. Acland clamps were applied and a linear arteriotomy was made. One end of the graft-clad microcatheter was introduced into the lumen and occluded with a fenestrated Acland clamp. At a more distal part, a similar arteriotomy was performed and the other end of the microcatheter was introduced into the lumen and clamped with a fenestrated Acland clip. This created a temporary shunt thorough the graft-clad microcatheter. Now the graft was anastomosed to the arteriotomies at both ends, over the microcatheter, in an end-to-side fashion. The microcatheter was explanted from the vessel lumen through an arteriotomy in the middle of the graft. The graft was clipped shortly to close this arteriotomy. The mean total occlusion time before perfusion was reestablished accounted to 3.7 minutes. This experiment was repeated in 12 animals (in 6 with, and in 6 without heparin) without technical complications. As controls conventional anastomoses was made in two animals.

All anastomoses were patent. There were no technical complications.

We have described a new technique for performing microvascular anastomoses over a temporary intraluminal microcatheter shunt.