Microvascular anastomosis techniques using the medical adhesive VIVO and expandable micro-stents in a rat carotid artery model

BACKGROUND: Sutured anastomosis remains the gold standard in microvascular surgery. The procedure is not free of complications and is a time-consuming operation requiring a high level of experience. The aim of this study was to develop new methods for a stable, faster, and safer anastomosis using a novel biodegradable adhesive, VIVO, and a custom-made microvascular stent.

METHODS: The VIVO medical adhesive was used for a total of 30 anastomoses in rats in the right carotid artery: 15 anastomoses were performed with a temporary intraluminal catheter, VIVO, and reduced sutures (VIVO + TC). A further 15 anastomoses were performed with nitinol stents, VIVO, and reduced sutures (VIVO + SM). Sutured anastomoses served as controls (C) and were performed on the left carotid arteries of the 30 rats. Operation and bleeding times were assessed, and patency was evaluated by Doppler flowmetry and indocyanine green (ICG) angiography. Subsequently, the anastomoses were evaluated histopathological.

RESULTS: The overall patency was recorded as 100% in all groups. No thrombosis or circulatory disturbance was found. Compared to C and VIVO + SM, VIVO + TC proved to be significantly less traumatic, less demanding, and time-saving. The sealing properties of VIVO lead to shorter bleeding times and less oozing. In contrast, VIVO + SM proved to be the most technically demanding and time-consuming procedure.

CONCLUSION: The success of a microvascular sutured anastomosis is determined by a short ischemic interval. Compared to sutured anastomosis, VIVO + TC showed ease of use as well as shorter time taken for anastomosis, less trauma, and lower blood loss. More long-term studies on the functions, biological interactions, and survival rates of glue-based anastomoses need to be initiated.