Sh.Sh. Eliava, O.D. Shekhtman, N.L. Martirosyan, A.Yu. Belyaev, I.A. Sazonov, L.V. Shishkina, Yu.A. Zelikova, R.K. Guseinov
(Burdenko Research Institute of Neurosurgery of the Russian Academy of Medical Science, Moscow)
The Study Goal: To test a mechanical device for creation interarterial wide-profile anastomoses.
Materials and Methods. The experimental study was carried out on 20 laboratory rabbits. Operations were performed under general anesthesia. Results of each experiment were registered in a special formalized chart. A fragment of vena saphena magna (10 cm) was used as a vascular transplant. Microvascular end-to-side anastomosis was created with a mechanical device of a cylindrical form. Its length and diameter were up to 25 cm and 0.23 cm, respectively. The device consisted of a system for fixing and sealing a microincision on a recipient vessel and a cylindrical guillotine for cutting out an oval window in a vessel wall after creating microvascular anastomosis. After temporary discontinuation of blood flow in the aorta (up to 2 min), it was dissected linearly along its anterior wall for a distance of 1.5 mm. The device, inserted into the vein fragment lumen in an open state, was then introduced into the aorta via the incision on its wall and fixed hermetically. It was followed by restoration of blood flow within the aorta. The end-to-side anastomosis was created by stitching the vein to the aorta wall. When the transplant end was stitched completely, a cutting part of the device was rotated and pushed down until it reached a fixing plate, which ensured sealing of a microincision. Then a round window in the aorta wall was cut out. The device was removed from the vein lumen together with an excised area of the aorta. It was followed by temporary clipping of the vein in an area, which was distal in relation to anastomosis. An analogous method was used for creation a distal end of anastomosis. End-to-end stitching of anastomosis resulted in forming a bypass. Blood flow in the bypass was estimated under conditions of the excluded abdominal aorta. Its patency was assessed distally and proximally in relation to the transplant, as well as within anastomosis. It was done with the help of contact imtraoperative ultrasound Doppler examination.
Results and Discussion. The above device was used in the series of 20 experiments for creating 29 anastomoses. Intraoperative Doppler revealed functioning of 27 of them (93.1%). An average period of temporary discontinuation of blood flow in the aorta was 2 min. Two (13.3%) out of 15 operated animals died during intervention. Their death was caused by respiratory standstill due to anesthetics overdose (1) and gross stenosis of the aorta and its obstruction (1). Alive animals were divided into 3 groups, depending on outcomes. The first group included 2 rabbits (13.3%), who died in 10-12 hours after operation and had marked symptoms of anastomosis dysfunction. The second one comprised 8 animals (53.3%), whose death occurred in 2-3 days after intervention. These rabbits could move independently in 5-6 hours after operation. It proved, that anastomosis was consistent. Their death was likely to result from systemic disorders, conditioned by anesthesia and operation duration. The third group included 3 rabbits (20%) with two-week and more durable survival.
Thus, experimental data are indicative of theoretical and practical possibility of using our device for creation of non-occlusive arterial wide-profile anastomoses.