Sutureless nonocclusive bypass surgery in combination with an expanded polytetrafluoroethylene graft

Laboratory investigation

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  • 1 Rudolf Magnus Institute of Neuroscience, Department of Neurosurgery and
  • 3 Department of Medical Technology, University Medical Center Utrecht, The Netherlands; and
  • 2 Department of Neurosurgery, Inselspital Bern, University of Bern, Switzerland
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Object

Cerebral aneurysms that cannot be treated by clip or coil placement can be treated with high-flow bypass surgery using techniques such as the excimer laser–assisted nonocclusive anastomosis (ELANA). To simplify the technique, a sutureless ELANA (SELANA) was developed in combination with an expanded polytetrafluoroethylene (ePTFE) graft.

Methods

In 18 rabbits a bypass was constructed on the abdominal aorta using the SELANA technique with an ePTFE graft, resulting in 18 bypasses and 36 anastomoses. Short-term effects were analyzed in the first 2 weeks and at 2 and 3 months after the procedure. Patency was evaluated using quantitative ultrasound flowmetry. The anastomotic sites were studied using scanning electron microscopy.

Results

Construction of the bypass using the SELANA technique was easier and faster (15–25 minutes) compared with bypasses made with the ELANA technique (> 90 minutes). At the end of follow-up, 16 of 18 bypasses were patent. Of 36 SELANA anastomoses, 32 could be completed without short temporary occlusion of the recipient vessel. Scanning electron microscopy showed complete coverage of all anastomoses with neointimal repair tissue after 10 days.

Conclusions

The SELANA technique provides further advantages over the conventional ELANA technique in ease of use and shortening of procedure time. The patency rate in this series was 89% and neointima repair tissue at the anastomosis site was complete after 10 days. Further experimental studies of the long-term patency and safety of this technique are necessary before clinical application.

Abbreviations used in this paper:ELANA = excimer laser–assisted nonocclusive anastomosis; ePTFE = expanded polytetrafluoroethylene; SD = standard deviation; SELANA = sutureless ELANA; SEM = scanning electron microscopy.

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Contributor Notes

Address correspondence to: Jochem P. Bremmer, M.D., Department of Neurosurgery, HP Nr. G 03.124, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. email: J.P.Bremmer@umcutrecht.nl.
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