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May 14, 2007 Sutureless vascular grafting How can end-to-end anastomosis be done in a minimally

May 14, 2007

Sutureless vascular grafting

How can end-to-end anastomosis be done in a minimally invasive way? What are the requirements in tensile strength, and durability, of the anastomosis for bypass grafting? Can laparoscopic-assisted anastomosis bridge the road to a new innovative mechanical anastomosis?




reports of minimally invasive endoluminal repair of






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endoluminal vascular grafting for the exclusion of aneurysms inspite of the longitudinal displacement and migration issues with the current generation of stent-grafts. In contrast to stent-grafts, the gold standard of sutured graft fixation prevents the loss of fixation, the development of type I and type II endoleaks, and the lack of healing of the aorta to the graft with minimal neointimal hyperplasia. Nevertheless, in order to avoid the main disadvantage of invasive operative exposure with traditional vascular grafting, a permanent minimally invasive anastomosis method is needed that mimics sutured vascular anastomosis in a small confined space. One such attempt is an anastomotic device assembly consisting of a band similar to a cable tie with a one directional locking mechanism. Sharp hook elements are mounted on the surface of a PTFE graft which is drawn over the artery resulting in a sleeve of vessel within the graft. The band is then tightened over an intraluminal delivery device and the anchoring hooks penetrate through the graft into the wall of the artery. However, in many cases the circular penetration of the hooks at precise intervals cannot be accomplished due to calcified deposits in the aortic wall. Besides a rather complicated method of delivery and fastening of the band, complications such as the loss of continuous interface of graft to artery may prevent a leakproof anastomosis and the absence of pseudo-aneurysms or stenosis can no longer be expected. A major challenge in replicating a sutureless method of graft fixation is the difference in tensile strength of the anastomosis was compared with sutured anastomosis. Small retroperitoneal incisions and new laparoscopic port devices have been used to dissect the abdominal aorta laparoscopically. Sewing the graft through these mini incisions with the help of self retaining retractors have resulted in a shorter period of ileus, diminished pulmonary complications, and decreased postoperative length of stay. The anastomosis through these devices appears to be a feasible alternative to endovascular or conventional sutured anastomosis and the laparoscopic-assisted repair method allows the expeditious minimally invasive vascular graft anastomosis. - Further the future ain t what it used to be

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