Microvascular Anastomosis Devices: A Scoping Review

Performing a hand-sewn microvascular anastomosis is a technically challenging and potentially time-consuming task, the results of which can dramatically impact prolonged ischemia time and clinical outcomes. This scoping review aims to examine and synthesize the landscape of microvascular anastomotic devices with the ultimate goal of evaluating their practical utility in comparison to traditional suture-only methods. Emphasis was placed on efficiency, outcomes, and potential limitations as a means of identifying areas for innovation.A scoping review of the PubMed, Scopus, Cochrane Library, and Web of Science databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Search terms related to microsurgery, anastomoses, and devices (e.g., couplers, staplers, clips, stents, glue, laser). Eligible studies included primary research, excluding meeting abstracts, reviews, commentaries, non-English studies, and research on robotic technology or venous couplers for end-to-end anastomoses. Data were extracted on study design, anastomosis completion outcomes (e.g., patency rates, time to completion), and complication rates (e.g., flap loss, anastomotic thrombosis).4875 unique studies underwent title/abstract screening and full-text review. Seventy-three English-language articles met the inclusion criteria. Device distribution included: couplers (36.1%), clip appliers (25.0%), lasers (8.0%), glue (6.2%), and intravascular stents (2.6%). Most included studies were prospective cohorts (43.1%), followed by preclinical studies (23.6%), retrospective review studies (22.2%), case series (5.6%), prospective comparative studies (2.8%), and randomized controlled trials (2.8%). The majority of studies evaluating devices replacing traditional hand-sewn suture, such as clips, staplers, and couplers, reported significantly reduced anastomotic times with comparable or improved vessel patency and/or flap survival, with one study reporting an average anastomotic time of less than 5 minutes. Adjunctive anastomosis devices such as laser, stents, and glue were also shown to be useful in a majority of studies. Intravascular stents were reported to have similar results to the conventional technique; however, some studies noted concerns about long-term vessel patency and compromised perfusion. Glue was shown to reduce the number of required sutures, though few studies noted reactive inflammation and significantly increased thrombosis.This scoping review demonstrates that these microvascular anastomotic devices, either as a replacement for conventional suture or as an adjunct, demonstrate favorable efficiency and safety profiles. Certain limitations were identified, such as vessel characteristics (diameter, thickness, friability), increased risk of thrombosis, or reactive inflammation. These devices also exist in a greater context of practicality, such as cost feasibility, ease of use, and initial learning curve. Further high-quality, large-scale trials are required to confirm these findings in both human and preclinical settings.