Microvascular anastomosis using histoacryl glue and an intravascular soluble stent

The purpose of this study was to assess a new technique for microvascular anastomosis on small arteries using Histoacryl glue and an intravascular soluble stent.

Sprague-Dawley rats were randomly assigned to either of two experimental groups or one control group. The first author (DL, a postgraduate year 4 resident) performed 12 end-to-end anastomoses on rat carotid arteries (1-mm vessel) (group A) using the experimental technique with Histoacryl glue and an intravascular stent. Thirteen microsuture carotid anastomoses performed by the senior author (DD), an experienced microsurgeon, served as control (group C). Permeability was assessed at 1 week for half of the animals and at 6 weeks for the others. Pathologic examination was done on both groups. To evaluate the influence of vessel size on the experimental technique, eight end-to-end anastomoses on rat abdominal aorta (2 mm) (group B) were also done by the first author. Permeability was assessed at 24 to 48 hours for this group.

In the experimental groups (A and B), two predictable failures (both in group A) were observed. Median anastomosis times were 11 minutes and 7 minutes, respectively. The control group had no failure and a median time of 17 minutes. Pathologic examination revealed more inflammation in group A than in group C. Coagulative necrosis of the arterial wall was observed exclusively in group A.

This new technique is easy to learn and readily accessible to less experienced microsurgeons. The technique is fast and efficient. The calibre of the vessel has a great influence on ease and speed of the technique. However, histotoxicity of Histoacryl glue was observed. This technique can be valuable for free-tissue transfer in head and neck reconstruction. A less toxic glue would be useful.