Abstract
BACKGROUND:
The excimer laser-assisted nonocclusive anastomosis (ELANA) technique facilitates the construction of an end-to-side anastomosis between a donor vessel and a recipient artery without the need to temporarily occlude the recipient artery.
OBJECTIVE:
To test whether the surgically difficult ELANA technique can be simplified.
METHODS:
In 42 rabbits, with the aorta as the recipient artery and human saphenous veins as donor grafts, we made 30 conventional ELANAs with 8 microsutures, 90 ELANAs with 4 microsutures (ELANA-4s), 40 ELANAs with 2 microsutures (ELANA-2s), and 90 sutureless ELANAs (SELANAs). SELANA involved a new ring design with 2 pins. ELANA-4, ELANA-2, and SELANA were each combined with 3 different sealants (Bioglue , Tachoseal, and Tisseel ) and compared regarding application time, complications, and burst pressure.
RESULTS:
The conventional ELANA was constructed in a mean of 14.8 ± 2.6 minutes. All experimental anastomoses were constructed significantly faster; the ELANA-4 in a mean of 10.9 ± 1.3 minutes, the ELANA-2 in a mean of 5.4 ± 1.7 minutes, and the SELANA in a mean of 2.5 ± 1.8 minutes. All ELANA and ELANA-4 anastomoses were sufficiently strong with a burst pressure > 200 mm Hg, except for 1 insufficiently sealed ELANA-4 anastomosis. ELANA-2 was sufficiently strong only with Bioglue, showing a burst pressure < 280 mm Hg. SELANA was sufficiently strong with Bioglue or TachoSil, showing a burst pressure < 260 mm Hg.
CONCLUSION:
The ELANA technique can be simplified by reducing or even abandoning microsutures. Of the experimental anastomoses tested, we consider the SELANA technique combined with TachoSil of most potential benefit. Long-term survival studies will be performed in animals before we consider using any of these new techniques in patients.
Time-survival studies for quantifying effects of azlocillin and tobramycin on Pseudomonas aeruginosa.
