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A Photochemical Tissue Bonding Approach for Sutureless Microvascular Anastamosis in an Arterial Graft Model
Joanna H. Ng-Glazier, M.D., Neil G. Fairbairn, M.D., Amanda M. Meppelink, B.S., Hatice Bodugoz-Senturk, Ph.D., Mark A. Randolph, M.S., Orhun K. Muratoglu, Ph.D., Jonathan M. Winograd, M.D., Robert W. Redmond, Ph.D..
Massachusetts General Hospital, Boston, MA, USA.
PURPOSE: Microvascular repair with suture remains the gold standard, but can lead to inflammation and thrombosis, especially in small peripheral vessels. Use of clips, couplers, and rings can assist with technical difficulties but do not minimize risk of thrombosis or endothelial damage. Photochemical tissue bonding (PTB) is a technique that covalently links protein to create an immediate watertight bond, and has been employed by our group for wound closure in several tissues including cornea, skin, tendon, and peripheral nerve. We hypothesize that use of PTB in conjunction with a biocompatible intraluminal stent would result in a watertight seal with minimal endothelial inflammation.
METHODS: 14 New Zealand white rabbits underwent unilateral femoral artery transection with contralateral 1.5cm graft harvest, and were randomized to standard microsurgical repair with 10-0 nylon (SR) (n=6), SR+stent (n=3), or PTB+stent (n=6). For the PTB group, a 1mm overlapping cuff was stained with 0.1% Rose Bengal then illuminated with 532nm green light laser for 60 seconds on each side. One dose of heparin (100U/kg) was administered after vessel clamp removal in all animals. Repair time and vessel patency (immediate, 1 week, 4 weeks) were assessed by milk test and transcutaneous Doppler. Histology was performed at 4 weeks to assess for endothelial damage, intimal hyperplasia, and thrombus formation. Statistics were performed using one-way ANOVA with Bonferroni’s comparison test.
RESULTS: Time to complete microvascular anastomosis in the PTB group was significantly faster compared with the SR (p=0.008) and the SR+stent groups (p< 0.0001), Figure 1. The SR and SR+stent groups were patent immediately and at 1 week. The PTB group was 100% patent immediately, with 80% patency rate at 1 week. At 4 weeks, the SR group was 100% patent, the SR+stent group was 66.6% patent, and the PTB group was 60% patent, Table 1. Histologic analysis revealed qualitatively less intimal hyperplasia in the PTB group compared with other groups (Figure 2); quantitative measurements are currently in progress. There was grossly no hematoma or aneurysm formation at 4 weeks in any of the groups.
CONCLUSIONS: PTB induces minimal endothelial inflammation and creates a rapid, watertight and sutureless vascular anastomosis compared with standard microsurgical repair, but the use of a non-dissolvable intraluminal stent induces thrombus formation. Preliminary in-vivo studies (n=2) using a readily soluble biocompatible glass stent in a rodent model are currently in progress.
Comparison of Patency Rates
|Group||Immediate||1 week||4 weeks|
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