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Conventional microvascular anastomosis with sutures is the most preferred technique. However, it has several disadvantages (1). Many alternative techniques have been reported to overcome these problems, but none has proven superior. Among these techniques, tissue adhesives requires anchoring sutures and it has a risk for adhesives leakage into the lumen, so this method still needs ongoing research for refinement. Poloxamer 407 (P407) is a thermoreversible polymer that is used as a delivery vehicle for drugs (2-4). P 407 turns into gel phase at the transient temperature and its gel phase can maintain open vessel lumen during anastomosis (5).
We aim to demonstrate that P407, loaded with heparin, can be used as an intraluminal stent for suturless microvascular anastomosis, and so it can not only increase patency rate but also decrease anastomosis time.
Rat abdominal aorta model was preferred. Sixty Sprague- Dawley rats were used and divided into three groups. In the first group, end-to-end anastomoses were performed with suture conventionally, while 2-octyl cyanoacrylate was used for sutureless anastomosis in the poloxamer groups. As an intraluminal stent, P407 was used in the second group, heparin loaded P407 was used in the third group (Picture 1).
Anastomosis time was measured. Lumen width, vessel wall thickness, inflammatory cells and multinuclear giant cells were assessed histologically at first and sixth weeks. Velocity flow rates were measured with Doppler ultrasound, and vessel diameters were measured with Doppler ultrasound and CT angiography at sixth week. Burst strengths were measured at sixth week. The results were evaluated statistically and p<0.05 was accepted as a significant difference.
The anastomoses were performed more rapidly in the poloxamer groups. Lumen width was found narrow and vessel walls were found thicker in the suture group. At first week vessel walls were found thinner in the heparin loaded P 407 group than in the P407 group. Inflammatory cells were found more in the suture group. We didn't found any statistical differences between the groups about imaging and burst strength results.
P407, loaded with heparin, can be used as an intraluminal stent for sutureless microvascular anastomosis with tissue adhesives. It can not only decrease anastomosis time but also increase patency rate.
Picture 1: Sutureless microvascular anastomosis with using heparin loaded P407.