Minimally occlusive laser vascular anastomosis (MOLVA): experimental study

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• 作者：Alfredo Puca (1)
  Giuseppe Esposito (1)
  Alessio Albanese (1)
  Giulio Maira (1)
  Francesca Rossi (2)
  Roberto Pini (2)
  
• 关键词：Cerebral revascularization ; Diode laser welding ; Anastomosis
• 刊名：Acta Neurochirurgica
• 出版年：2009
• 出版时间：April 2009
• 年：2009
• 卷：151
• 期：4
• 页码：363-368
• 全文大小：205KB
• 参考文献：1. Bass LS, Treat MR (1995) Laser tissue welding: a comprehensive review of current and future clinical applications. Lasers Surg Med 17:315-49. doi:10.1002/lsm.1900170402 CrossRef
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  3. Gelli R, Pini R, Toncelli F, Chiarugi C, Reali UM (1997) Vessel wall recovery after diode laser assisted microvascular anastomosis: Clinical and histological analysis on long term follow-up. J Reconstr Microsurg 13:199-05. doi:10.1055/s-2007-1006405 CrossRef
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  9. Tulleken CAF, Van der Zwan A, Van Rooij WJ, Pareira Ramos LM (1998) High-flow bypass using nonocclusive excimer laser-assisted end-to-side anastomosis of the external carotid artery to the P1 segment of the posterior cerebral artery via the sylvian route. Technical note. J Neurosurg 88:925-27 CrossRef
  10. Zeebregts CJ, Heijmen RH, van den Dungen JJ, van Schilfgaarde R (2003) Non-suture methods of vascular anastomosis. Br J Surg 90:261-71. doi:10.1002/bjs.4063 CrossRef
  
• 作者单位：Alfredo Puca (1)
  Giuseppe Esposito (1)
  Alessio Albanese (1)
  Giulio Maira (1)
  Francesca Rossi (2)
  Roberto Pini (2)
  
  1. Institute of Neurosurgery, Catholic University, Largo A. Gemelli, 8-0168, Rome, Italy
  2. Institute of Applied Physics, National Research Council of Italy, Florence, Italy
  

文摘

Background Temporary occlusion of an intracranial artery during microvascular anastomosis is a major risk factor in cerebrovascular surgery. A new laser vascular welding technique that minimizes the occlusion time of the recipient vessel has been developed and is described in this report. Method A new minimally occlusive technique of end-to-side microvascular anastomosis was developed employing a diode laser in association with the application of a chromophore in our experimental model of double end-to-side anastomosis. The implantation of a vein graft on the patent carotid artery was obtained through the application of three interrupted sutures at each anastomotic site; the carotid was then clamped, two arteriotomies were performed, followed by the application of a fourth suture and of the laser welding procedure on each anastomosis. Monitoring of the temperature at the site of the anastomosis was introduced in order to control the welding technique. Findings The time of the clamping of the carotid artery was 12?min to perform two end-to-side anastomoses (i.e., 6?min for each anastomosis). All bypasses were patent after a follow-up of 90?days and histological study confirmed good preservation of the vascular wall. Conclusions Our laser-assisted technique of vascular anastomosis reduces the duration of the clamping of the recipient artery down to 6?min. This technique can minimize the risk of cerebral ischemia associated with occlusion of a recipient artery in intracranial bypass procedures, promoting an improved vascular healing process with a lower risk of thrombosis and occlusion.