Laser vascular tissue fusion: development, current status, and future perspectives

Tissue fusion has a number of vascular applications such as making sutureless blood vessel anastomoses and for securing the end points of endarterectomies and dissection planes. Precision of tissue apposition at the time of fusion has been found to be a critical parameter, affecting the rate of healing and tensile strength of tissue welds. Several laser wavelengths can be used to accomplish vascular and other soft tissue fusions. Potential advantages of laser fusion over suture techniques may include healing without foreign body reaction related to sutures and preserved mechanical properties at anastomoses. While preliminary experimental and clinical data are very promising, additional work is needed. This would include determining the mechanism and optimal laser parameters and wavelengths required for vascular tissue fusion. In addition, the characteristics needed to seal uniformly large-diameter arteries and to fashion welds that withstand systemic arterial pressures must be identified. Follow-ups of approximately three years suggest that strong initial primary seals will eliminate significant adverse effects.