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An intraluminal stent facilitates light-activated vascular anastomosis
Prabhu Senthil-Kumar1, Joanna H Ng-Glazier, Mark A Randolph
1From the Wellman Center for Photomedicine (P.S.-K., J.H.N.-G., I.E.K., R.W.R.), Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, Division of Plastic and Reconstructive Surgery, Department of Surgery (P.S.-K., J.H.N.-G., M.A.R., J.M.W.), Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, and Department of Orthopedic Surgery (H.B.-S., O.K.M.), Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
Background:
Photochemical tissue bonding (PTB) is a sutureless, light-activated technique that produces a watertight, microvascular repair with minimal inflammation compared to standard microsurgery. However, it is practically limited by the need for a clinically viable luminal support system. The aim of this study was to evaluate a hollow biocompatible stent to provide adequate luminal support to facilitate vascular anastomosis using the PTB technique.
Methods:
Forty rats underwent unilateral femoral artery transection. Five rats were used to optimize the stent delivery method, and the remaining 35 rats were randomized into three groups: (1) standard suture repair with 10-0 nylon microsuture (SR), (2) standard suture repair over the stent (SR + S), or (3) PTB repair over stent (PTB + S). For the PTB group, a 2-mm overlapping cuff was painted with 0.1% (wt/vol) Rose Bengal then illuminated for 30 seconds on each side (532 nm, 0.5 W/cm, 30 J/cm). Anastomotic leak and vessel patency (immediate, 1 hour, and 1 week postoperatively) were assessed.
Results:
Vessels in all three groups were patent immediately and at 1 hour postoperatively. After 1 week, all animals displayed patency in the SR group, while only 5 of 14 and 2 of 8 surviving animals had patent vessels in the PTB + S and SR + S groups, respectively.
Conclusions:
This study demonstrated successful use of an intraluminal stent for acute microvascular anastomosis using the PTB technique. However, the longer-term presence of the stent at the anastomotic site led to thrombosis in multiple cases. A rapidly dissolvable stent should facilitate a light-activated microvascular anastomosis with excellent long-term patency.