Laser-sealed arteriotomy: a reliable aneurysm model

Laser-assisted vascular anastomosis (LAVA) is associated with a significant aneurysm problem when it is applied to small arteries. The etiology of this phenomenon was investigated by creating arteriotomies of different lengths and orientation in the rat carotid artery and sealing them with the milliwatt CO2 laser. It was found that increasing the arteriotomy length from 0.5 to 1.0 mm significantly raised aneurysm occurrence (4/17 vs. 25/28, chi-square: p less than 0.001) regardless of orientation. Systemic hypertension (systolic blood pressure greater than or equal to 170 mm Hg) also significantly affected the aneurysm rate among the 0.5-mm arteriotomy group, raising aneurysm occurrence from 23.5% (4/17) to 100% (14/14) (p less than 0.001). Assuming that the stay-sutures used for LAVA's act as rigid supports, the rate of aneurysm occurrence must be related to the distance between sutures. This phenomenon has been exploited to create a reliable aneurysm model.