Dual intravascular stent flipping technique for microvascular anastomosis

The anastomosis of vessels <0.5 mm in diameter is challenging. We developed a supermicrosurgical anastomosis technique, the dual intravascular stent flipping technique with a double or single clip (dual flipping technique, double-clip technique, and single-clip technique). In the dual flipping technique, we used a 7-0 nylon intravascular stent and clipped the vessel along with the nylon. The double-clip technique was performed in 10 rats with 20 saphenous and 15 superficial inferior epigastric arteries. Immediate and 1-week patency rates were assessed. Subsequently, we examined ten epigastric arteries in five rats with the single-clip technique. The clinical application was performed in six cases involving finger/fingertip amputations, two cases involving radial artery superficial palmar branch flap, and one case involving superficial circumflex iliac artery perforator flap. Using the double-clip technique, the immediate patency rate was 90% and 93% in the saphenous and superficial epigastric arteries, respectively, whereas the 1-week patency rate was 81%. With the single-clip technique, the immediate patency rate was 100%. The replantation and flaps were successful. The advantages of the dual flipping technique included easy insertion, rare slipping-out possibility, and spontaneous vessel dilation by the flipped nylon. Additionally, the posterior vessel wall could be sutured more easily than could the anterior wall. By using the elasticity of the thread to invert the blood vessel, the posterior wall can be sutured without the double clip. When forceps tip insertion into the lumen is difficult, the dual flipping technique enables a relatively easy anastomosis if the 7-0 nylon is inserted into the vessel lumen.