J Reconstr Microsurg 2008; 24(1): 039-042
DOI: 10.1055/s-2008-1064926
© Thieme Medical Publishers

Use of a Novel Penetrating, Sutureless Anastomotic Device in Arterial Microvascular Anastomoses

Richard C. Baynosa1 , Ross Stutman1 , Raman C. Mahabir1 , William A. Zamboni1 , Kayvan T. Khiabani1
  • 1Division of Plastic Surgery, University of Nevada School of Medicine, Las Vegas, Nevada
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
12. März 2008 (online)

ABSTRACT

The advent of microsurgery and microvascular anastomosis has helped to alter the treatment of many traumatic defects as well as revolutionize the reconstructive options after extirpative surgery. These procedures, however, continue to be technically demanding and intensive. In addition, increased ischemia and operative times are known to raise complications in microsurgery, particularly in older patients. The nitinol U-clip (Medtronic, Inc., Minneapolis, MN) is a new penetrating clip applied in an interrupted fashion that eliminates knot tying and decreases operative time. This technology holds the potential for rapid, reproducible sutureless microvascular anastomoses. In addition, the surgical technique is very similar to conventional suture microanastomosis, lending itself to comparatively decreased learning curves and suitability for training programs. We present three consecutive cases of successful microsurgical anastomoses using this technology.

REFERENCES

  • 1 Smith J M, Hawes J, Engel A M. Replacement of the descending aorta using the da Vinci surgical system in a sheep model: comparison of anastomosis techniques.  Heart Surg Forum. 2005;  8 E212-215
  • 2 Serletti J M, Higgins J P, Moran S et al.. Factors affecting outcome in free-tissue transfer in the elderly.  Plast Reconstr Surg. 2000;  106 66-70
  • 3 Carroll W R, Esclamado R M. Ischemia/reperfusion injury in microvascular surgery.  Head Neck. 2000;  22 700-713
  • 4 Singh B, Cordeiro P G, Santamaria E et al.. Factors associated with complications in microvascular reconstruction of head and neck defects.  Plast Reconstr Surg. 1999;  103 403-411
  • 5 Wheatley M J, Mathes S J, Hassett C. Comparison of continuous and interrupted suture techniques in microvascular end-to-side anastomosis.  J Reconstr Microsurg. 1986;  2 93-96
  • 6 Guity A, Young P H, Fischer V W. In search of the “perfect” anastomosis.  Microsurgery. 1990;  11 5-11
  • 7 Chen Y X, Chen L E, Seaber A V et al.. Comparison of continuous and interrupted suture techniques in microvascular anastomosis.  J Hand Surg [Am]. 2001;  26 530-539
  • 8 Schlechter B, Guyuron B. A comparison of different suture techniques for microvascular anastomosis.  Ann Plast Surg. 1994;  33 28-31
  • 9 Hattori H, Killen D A, Green J W. Influence of suture materials and technique on patency of anastomosed arteries of less than 1.5mm diameter.  Am Surg. 1970;  36 352-354
  • 10 Cobbett J R. Microvascular surgery.  Surg Clin N Am. 1967;  47 521-542
  • 11 Baumgartner N, Dobrin P B, Morasch M et al.. Influence of suture technique and suture material selection on the mechanics of end-to-end and end-to-side anastomoses.  J Thorac Cardiovasc Surg. 1996;  111 1063-1072
  • 12 Hasson J E, Megerman J, Abbott W M. Suture technique and para-anastomotic compliance.  J Vasc Surg. 1986;  3 591-598
  • 13 Lee B Y, Brancato R, Shaw W W et al.. Effect of suture technique on blood velocity waveforms in the microvascular anastomosis of autogenous vein graft.  Microsurgery. 1983;  4 151-156
  • 14 Tozzi P, Hayoz D, Ruchat P et al.. Animal model to compare the effects of suture technique on cross-sectional compliance on end-to-side anastomoses.  Eur J Cardiothorac Surg. 2001;  19 477-481
  • 15 Baguneid M S, Goldner S, Fulford P E et al.. A comparison of para-anastomotic compliance profiles after vascular anastomosis: nonpenetrating clips versus standard sutures.  J Vasc Surg. 2001;  33 812
  • 16 Memry Corporation .“Nitinol FAQ”. http://www.memry.com/nitinolfaq/nitinolfaq.html
  • 17 Katariya K, Yassin S, Tehrani H Y et al.. Initial experience with sutureless proximal anastomoses performed with a mechanical connector leading to clampless off-pump coronary artery bypass surgery.  Ann Thorac Surg. 2004;  77 563-567
  • 18 Hill A C, Maroney T P, Virmani R. Facilitated coronary anastomosis using a nitinol U-clip device: bovine model.  J Thorac Cardiovasc Surg. 2001;  121 859-870
  • 19 Demaria R G, Fortier S, Malo O et al.. Interrupted coalescent nitinol clip versus continuous suture coronary anastomosis: a comparative endothelial function study.  Heart Surg Forum. 2003;  6 72-76
  • 20 Ross J R. Creation of native arteriovenous fistulas with interrupted anastomoses using a self-closing clip device-one clinic's experience.  J Vasc Access. 2002;  3 140-146
  • 21 Lin P H, Bush R L, Nelson J C et al.. A prospective evaluation of interrupted nitinol surgical clips in arteriovenous fistula for hemodialysis.  Am J Surg. 2003;  186 625-630
  • 22 Berdat P A, Kipfer B, Immer F F et al.. Facilitated vascular interrupted anastomosis in cardiovascular surgery with a new clip device.  J Thorac Cardiovasc Surg. 2002;  124 1256-1258
  • 23 Hamman B L, White C H. Angiographic confirmation of graft patency after coronary artery bypass graft surgery using interrupted nitinol clips.  BUMC Proceed. 2003;  16 399-400
  • 24 Caskey M P, Kirshner M S, Alderman E L et al.. Six-month angiographic evaluation of beating-heart coronary arterial graft interrupted anatomoses using the coalescent U-clip anastomotic device: a prospective clinical study.  Heart Surg Forum. 2002;  5 319-326
  • 25 Wolf R K, Alderman E L, Caskey M P et al.. Clinical and six-month angiographic evaluation of coronary arterial graft interrupted anastomoses by use of a self-closing clip device: a multicenter prospective clinical trial.  J Thorac Cardiovasc Surg. 2003;  126 168-177
  • 26 Zeebregts C J, Kirsch W M, Reijnen M M et al.. Expanding use of nonpenetrating clips in various surgical specialties.  Surg Technol Int. 2005;  14 85-95
  • 27 Shindo M L, Costantino P D, Nalbone V P et al.. Use of a mechanical microvascular anastomotic device in head and neck free tissue transfer.  Arch Otolaryngol Head Neck Surg. 1996;  122 529-532
  • 28 Zeebregts C, Acosta R, Bolander L et al.. Clinical experience with non-penetrating vascular clips in free-flap reconstructions.  Br J Plast Surg. 2002;  55 105-110
  • 29 Cope C, Lee K, Stern H et al.. Use of the vascular closure staple clip applier for microvascular anastomosis in free-flap surgery.  Plast Reconstr Surg. 2000;  106 107-110
  • 30 Ahn C Y, Shaw W W, Berns S et al.. Clinical experience with the 3M microvascular coupling anastomotic device in 100 free-tissue transfers.  Plast Reconstr Surg. 1994;  93 1481-1484
  • 31 Ostrup L T, Berggren A. The UNILINK instrument system for fast and safe microvascular anastomosis.  Ann Plast Surg. 1986;  17 521-525
  • 32 Daniel R K, Lidman D, Olding M et al.. An anastomotic device for microvascular surgery: evolution.  Ann Plast Surg. 1984;  13 402-411
  • 33 Kirsch W M, Zhu Y H, Hardesty R A et al.. A new method for microvascular anastomosis: report of experimental and clinical research.  Am Surg. 1992;  58 722-727

Kayvan T KhiabaniM.D. F.R.C.S.C. 

c/o Division of Plastic Surgery

2040 West Charleston Boulevard, Suite 302 Las Vegas, NV 89102

    >