Evaluation of the long-term results of vascular anastomosis using polyurethane adhesive and shape-memory stent in the rat carotid artery model

Marius Heitzer, Mark Ooms, Marie Sophie Katz, Florian Peters, Konrad Kilic, René Tolba, Stefan Jockenhoevel, Benita Hermanns-Sachweh, Frank Hölzle, Ali Modabber

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

INTRODUCTION: In free flaps, 5%-10% of complications are related to failure of sutured vascular anastomoses. Adhesive-based microvascular anastomoses are potential alternatives but are associated with failure rates of 70% in research studies. VIVO is a new adhesive with slow biodegradation within 6 months that has shown a 100% patency rate in research studies over 2 h observation time but long-term patency has not been evaluated. The authors hypothesize that VIVO will enable a reliable microvascular procedure comparable to sutured anastomoses over a 28-day period.

MATERIALS AND METHODS: The right common carotid artery of 60 male Sprague Dawley rats, ~450 g, were used for microvascular end-to-end anastomosis. VIVO was applied with reduced sutures with a temporary catheter in one group and in the other with a custom-shaped memory stent. Anastomoses with eight interrupted sutures served as control. All groups were n = 20. Anastomosis time and bleeding were recorded for each procedure. Doppler flowmetry was performed 20 min, 1, 10, and 28 days postoperatively. Postmortem toluidine staining was used for semi-quantitative analysis of stenosis, thrombosis, necrosis, and aneurysm formation by histologic evaluation.

RESULTS: No occlusion was detected 20 min and 1 day postoperative, and after 28 days of observation in all anastomoses. The anastomosis time of the VIVO with catheter group was about 32% significantly faster than the VIVO with stent group. In the VIVO group with stent, the bleeding time was ~80% shorter than in the control group with 2.1 ± 0.3 and VIVO with catheter 2.0 ± 0.5 (p ≤ .001 each). Minor and nonsignificant stent-associated thrombus formation and stent-typical intraluminal stenosis were detected exclusively in the VIVO with stent group.

CONCLUSION: Within the limitations of a rat study, the use of VIVO in anastomosis showed promising results. VIVO with catheter was found to be advantageous.

Original languageEnglish
Pages (from-to)480-489
Number of pages10
JournalMicrosurgery
Volume42
Issue number5
Early online date7 Jun 2022
DOIs
Publication statusPublished - Jul 2022

Keywords

  • CYANOACRYLATE
  • FIBRIN GLUE
  • FREE-FLAP RECONSTRUCTIONS
  • HEAD
  • HISTOACRYL GLUE
  • MEDICAL ADHESIVE
  • MICROVASCULAR ANASTOMOSIS
  • NECK REGION
  • POLOXAMER
  • SUTURE

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