Stent-assisted vascular anastomoses

A stent can be used to rapidly create a laminar end-to-end vascular anastomosis. To construct a stent-assisted vascular anastomosis (SAVA), 2 traction sutures 180 degrees apart are used to pull 1 conduit into another so that they overlap. A stent is balloon expanded to create a seal in the area of overlap. A SAVA takes 5 to 15 minutes to create. Essential to the procedure is proper sizing of the graft, stent, and balloon. The SAVA becomes reinforced internally by a neointima and externally by periadventitial scar tissue. No anastomotic leaks or pseudoaneurysms were observed in 13 patients (1 to 2.5 years; mean, 14 months), 6 adult mongrel dogs (6 months), and 5 growing pigs (5.5 months). Three of 9 upper-extremity basilic vein SAVAs (dialysis shunts) occluded (3, 9, and 13 months). Stent deformation was seen in all 3 despite protection by external graft rings. Within our follow-up interval, a balloon-expandable stent is an effective tool to use to rapidly join a vessel to a graft. Because the stent is deformable, a SAVA is not recommended in the extremity.