Abstract • Microvascular laser welding can be effectively used in large-diameter artery techniques. The carotid arteries of 12 anesthetized mongrel dogs were exposed. Following heparinization, the carotid arteries were transected, cleaned along their edges, and repaired on the right side by laser and on the left side by suture. The laser-assisted vascular anastomosis (LAVA) required four stay sutures and laser power for welding. Six-week patency for LAVA vs suture anastomosis was 100% vs 92%, respectively. Anastomotic time requirements were less with LAVA (seven vs 25 minutes). Intimal healing for both techniques immediately demonstrated an intraluminal thrombus, which resolved showing complete endothelial repair by four weeks. The laser seal demonstrated little inflammation compared with the giant cell reaction of suture anastomosis. Immediate wall tensions of 6 to 18×105 dynes/cm2 were tolerated after both techniques. Laser-assisted vascular anastomosis of large-diameter arteries is feasible, strong, and associated with minimal inflammation. (Arch Surg 1987;122:673-677) References 1. Quigley MR, Bailes JE, Kwaan HC, et al: Microvascular anastomosis using the milliwatt carbon dioxide laser . Lasers Surg Med 1985;5:357-365.Crossref 2. Serure A, Withers EH, Thomsen S, et al: Comparison of carbon dioxide laser—assisted microvascular anastomosis and conventional microvascular sutured anastomosis . Surg Forum 1983;34:634-636. 3. White JV, Dalsing MC, Yao JST, et al: Tissue fusion effects of the carbon dioxide laser . Surg Forum 1985;36:455-457. 4. Hunter JG, Dixon JA: Lasers in cardiovascular surgery: Current status . West J Med 1985;142:506-510. 5. Krueger RR, Almquist EE: Argon laser coagulation of blood for the anastomosis of small vessels . Lasers Surg Med 1985;5:55-60.Crossref 6. Jain KK, Gorisch W: Repair of small blood vessels with the neodymium-YAG laser: A preliminary report . Surgery 1979;85:684-688. 7. McCarthy WJ, Hartz RS, Yao JST, et al: Vascular anastomoses with laser energy . J Vase Surg 1986;3:32-41.Crossref 8. Ashworth EM, Dalsing MD, Olson JF, et al: Laser-assisted vascular anastomoses of larger arteries. Lasers Surg Med, in press. 9. Strandness DE, Sumner DS: Mechanical properties of the blood vessel wall , in Strandness DE, Sumner DS (eds): Hemodynamics for Surgeons . New York, Grune & Stratton, 1975, pp 161-200. 10. Acland RD, Trachtenberg L: The histopathology of small arteries following experimental microvascular anastomosis . Plast Reconstr Surg 1977;59:868-875.Crossref 11. Nightingale G, Fogdestam I, O'Brien BM, et al: Scanning electron microscope study of experimental microvascular anastomoses in the rabbit . J Plast Surg 1980;33:283-298.Crossref 12. Baxter TJ, O'Brien BM, Henderson PN, et al: The histopathology of small vessels following microvascular repair . Br J Surg 1972;59:617-622.Crossref 13. Maxwell GP, Szabo Z, Buncke HJ: Aneurysms after microvascular anastomoses . Plast Reconstr Surg 1979;63:824-829.Crossref 14. White RA, Abergel RP, Lyons R, et al: Biological effects of laser welding on vascular healing . Lasers Surg Med 1986;6:137-141.Crossref 15. Gomes OM, Macruz R, Armelin E, et al: Vascular anastomosis by argon laser beam . Tex Heart Inst J 1983;10:145-149. 16. Quigley MR, Bailes JE, Kwaan HC, et al: Aneurysm formation after low-power carbon dioxide laser—assisted vascular anastomosis . Neurosurgery 1986;18:292-299.Crossref 17. Pribil S, Powers SK: Microvascular laser anastomosis of rat carotid vessel. Read before the 20th Annual Meeting of the Association for the Advancement of Medical Instrumentation, Boston, May 1985. 18. Acland R: Thrombus formation in microvascular surgery: An experimental study of the effects of surgical trauma . Surgery 1973;73:766-771. 19. Servant JM, Ikuta Y, Harada Y: A scanning electron microscope study of microvascular anastomoses . Plast Reconstr Surg 1976;57:329-334.Crossref 20. Hartz RS, LoCicero J, Shih SR, et al: Mechanical properties of end-to-end laser-assisted and sutured arterial anastomoses under axial loading . Surg Forum 1985;36:457-459.
Archives of Surgery – American Medical Association
Published: Jun 1, 1987