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A Photochemical Tissue Bonding Approach for Sutureless Microvascular Anastamosis in an Arterial Graf
Joanna H. Ng-Glazier, MD, Neil G. Fairbairn, MD, Amanda M. Meppelink, BS, Hatice Bodugoz-Senturk, PhD, Mark A. Randolph, MS, Orhun K. Muratoglu, PhD, Jonathan M. Winograd, MD, Robert W. Redmond, PhD
Massachusetts General Hospital and Harvard University, Boston, MA

Background: Microvascular repair with suture remains the gold standard, but can lead to inflammation, thrombosis, and is technically difficult. Photochemical tissue bonding (PTB) is a technique that covalently links protein to create an immediate watertight bond with minimal inflammation. We hypothesize that use of PTB with a biocompatible intraluminal stent will result in a watertight microvascular seal with minimal endothelial inflammation.

Methods: 14 rabbits underwent unilateral femoral artery transection with contralateral 1.5cm graft harvest, and were randomized to standard microsurgical repair (SR), stent+SR, or stent+PTB. For PTB, a 1mm overlapping cuff was stained with 0.1% Rose Bengal then illuminated with 532nm green light laser for 60 seconds on each side. One dose of heparin (100U/kg) was administered after clamp removal. Repair time, histology, and vessel patency were assessed immediately, at 1 week, and 4 weeks.

Results: Anastomotic time using PTB was significantly faster compared with SR (p=0.008) and stent+SR (P< 0.0001) groups. SR was 100% patent at all time points. Stent+SR was 100% patent immediately and at 1 week, with 66.6% patency at 4 weeks. PTB was 100% patent immediately, 80% patent at 1 week and 60% patent at 4 weeks. PTB demonstrated less intimal hyperplasia compared with other groups (Figure 1); quantitative analysis is in progress. No hematoma or aneurysm was observed in the groups.

Conclusion: PTB induces minimal endothelial inflammation and creates a rapid, watertight vascular anastomosis, but the use of a non-dissolvable stent induces thrombus formation. Preliminary in-vivo studies using a dissolvable glass stent is in progress.

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