The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 57-62, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
End-to-side and end-to-end vascular anastomoses with a carbon dioxide laser
S Nakata, CD Campbell, R Pick and RL Replogle
Department of Surgery, Michael Reese Hospital and Medical Center, University of Chicago, Ill.
This study was designed to compare anastomoses performed with a carbon
dioxide laser and conventional anastomoses performed with 7-0 polypropylene
suture. In each of 80 rabbits, the divided left carotid artery was
anastomosed by a continuous suture technique and the right carotid was
anastomosed with a carbon dioxide laser. In each of 40 additional rabbits,
both end-to-end and end-to-side laser anastomoses were performed on the
same carotid artery. The laser technique involved the placement of three
stay sutures (end-to-end technique) or four stay sutures (end-to-side
technique) of 7-0 polypropylene and an everting laser seal at a power level
of 65 mW. The 1-year overall patency rate was 98% (78/80) in laser
anastomoses, 79% (63/80) in suture anastomoses, and 95% (38/40) in combined
end-to-end and end-to-side laser anastomoses. Microscopic findings in laser
anastomoses demonstrated degeneration of collagen and protein in the
adventitia and media, but much less intimal injury than in suture
anastomoses, with reendothelialization beginning earlier (within 7 days
after anastomosis as compared with 2 to 4 weeks). The tissue tensile
strength at 1 hour was less in laser anastomoses than in suture
anastomoses, but the laser anastomoses still withstood an intraluminal
pressure load of 380 mm Hg. Laser anastomosis improved the microscopic and
histologic appearance of the intimal layer, allowing for rapid early
reendothelialization and resulting in excellent patency rates.
