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Cousin T, Aloui W, Van der Giessen J, Mouret F, Kum S, Alimi Y. Clampless 2 Device: Experimental Study of a Lateral Aorto-Prosthetic Anastomosic Device Without Clamping or Suturing. Ann Vasc Surg 2023; 90:27-32. [PMID: 36509370 DOI: 10.1016/j.avsg.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/01/2022] [Accepted: 10/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND To offer an alternative to conventional techniques of lateral prosthetic anastomosis on arteries which require a long training, and impose an extensive open surgery, we are proposing the clampless 2 device (C2D) implanted by a simple arterial puncture and allows a lateral implantation of a polytetrafluoroethylene (PTFE) vascular graft in an artery, without arterial clamping or suture. METHODS C2D is a "T" shaped 25-mm long and 8-mm diameter Nitinol stent with a 6-mm PTFE graft prosthesis mounted laterally on the stent, and implanted in an artery, via a 21-French sheath, and a compliant balloon inflation. In vitro testing of the C2D was first performed on a bench including a segment of a 7-mm internal diameter pig abdominal aorta. A series of 5 consecutive C2D implantation was analyzed with evaluation of the implantation time and the fluid losses at a fluid pressure of 80 and 150 mm Hg. The C2D implantation was finally controlled by angioscopy. An aorto-iliac bypass was then secondly performed on 8 living sows, with a side-to-end C2D implantation in the infrarenal abdominal aorta, followed by a conventional end-to-end prosthetic left iliac trunk anastomosis. The C2D and distal conventional anastomotic times were evaluated, as well as the total operative time and blood loss. A postoperative angiogram was systematically performed. RESULTS The C2D was successfully implanted in all 5 in vitro tests, with an average implantation time of 2'58 (range: 2'25-3'22). The mean value of fluid losses was 84 ml (range: 67-94 ml), with no fluid leakage occurring at 80- and 150-mm Hg pressure. All anastomoses were patent after macroscopic study by angioscopy with a perfect application of the stent in the aortic wall. In 8 living sows (mean weight: 42 kg, 37-50 kg), an aorto-left iliac bypass was successfully implanted in all cases, with a total mean procedure time of 101 min (range: 90-130 min), and an average fluid loss of 77 ml (range:20-120 ml). The mean implantation time was 4'39 (range 3'29-5'52) for C2D and 16 min (range 12-17 min) to perform the conventional distal prosthetic-iliac anastomosis. Systematic arteriographic and angioscopy control showed perfect patency of the C2D implantations. CONCLUSIONS Preliminary in vitro and acute in vivo testing of C2D implantation show good early results, allowing further long-lasting pig experiments on the way to human homologation.
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Affiliation(s)
| | - Wafa Aloui
- Université Aix-Marseille 2 et service de chirurgie vasculaire, Centre Hospitalo-Universitaire Nord Marseille, France
| | | | | | - Steven Kum
- Bypass Solutions, Marseille, France; Vascular Service, Department of Surgery, Changi General Hospital, Singapore
| | - Yves Alimi
- Bypass Solutions, Marseille, France; Université Aix-Marseille 2 et service de chirurgie vasculaire, Centre Hospitalo-Universitaire Nord Marseille, France.
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Moniaci D, Maiorano F, Corrado F. Bilateral Iliac Endobypass Solution in Iliac Artery Rupture during TEVAR Procedure: A Case Report and Review of the Literature. Vasc Specialist Int 2022; 38:35. [PMID: 36582122 PMCID: PMC9806451 DOI: 10.5758/vsi.220042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022] Open
Abstract
Iliac artery rupture is a demanding complication that can occur during endovascular procedures, particularly when large-caliber introducers are required. We present the first case in the literature on the endobypass technique, a quick and effective reconstruction method for the iliofemoral axis. This clinical case highlights that thoracic endovascular aortic repair procedures require large-caliber introducers into the femoral and iliac arteries to allow passage of the delivery system. These arteries may be diseased, representing a high risk of rupture. In our case, placing a 20 Fr introducer, the iliac artery ruptured bilaterally. Therefore, we performed an endobypass deploying Viabahn stent-grafts into the common iliac artery and manually performed distal anastomosis on the femoral bifurcation.
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Affiliation(s)
- Diego Moniaci
- Service of Vascular and Endovascular Surgery, San Giovanni Bosco Hospital, Turin, Italy
| | - Francesco Maiorano
- Service of Vascular and Endovascular Surgery, San Giovanni Bosco Hospital, Turin, Italy
| | - Federica Corrado
- Service of Vascular and Endovascular Surgery, San Giovanni Bosco Hospital, Turin, Italy
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Mallela DP, Bose S, Shallal CC, Goldsborough E, Xun H, Chen J, Stonko DP, Brandacher G, Sacks J, Kang SH, Hicks CW. A systematic review of sutureless vascular anastomosis technologies. Semin Vasc Surg 2021; 34:247-259. [PMID: 34911631 DOI: 10.1053/j.semvascsurg.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/11/2022]
Abstract
Vascular anastomoses typically involve a handsewn technique requiring significant surgical training, expertise, and time. The aim of our systematic review was to identify and describe sutureless vascular anastomosis techniques. We performed a systematic review of all sutureless vascular anastomosis technologies published in MEDLINE, PubMed, Embase, CINAHL, Cochrane, Web of Science, and Scopus Library databases and a patent review using US Patent and Trade Office Application, US Patent and Trademark Office Patent, Google Patents, Lens, Patent Quality Through Artificial Intelligence, SureChEMBL, and E-Space Net. Data from inclusion studies and patents published between January 1, 1980 and July 15, 2021 were abstracted to describe their category, anastomosis type and configuration, study types, and advantages and disadvantages encountered with each technology. Two hundred eleven original studies and 475 patents describing sutureless vascular anastomosis technologies were identified. In the literature, stents/stent-grafts/grafts (n = 61), lasers (n = 53), and couplers (n = 27) were the predominant device categories. In the patent review, adhesive technologies (n = 103), stents/stent-grafts/grafts (n = 68), and mechanical connectors (n = 61) predominated. The majority of studies involved in vivo animal studies (n = 193); 32.2% (n = 68) of investigations involved human trials; and 17.9% (n = 85) of patent technologies were approved by the US Food and Drug Administration. The main advantages described for sutureless anastomosis technologies included faster procedure time and greater patency rates compared with handsewn anastomoses. The main disadvantages included reduced vessel compliance, stenosis, leakage, and device costs. The appeal of sutureless technology is substantiated by numerous animal trials, but their use in humans remains limited. This may be a reflection of strict regulatory criteria and/or vascular complications associated with currently available technologies.
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Affiliation(s)
- Deepthi P Mallela
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Halsted 668, Baltimore, MD, 21287
| | - Sanuja Bose
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher C Shallal
- Department of Biomedical Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD
| | | | - Helen Xun
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center Boston, MA
| | - Jonlin Chen
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - David P Stonko
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin Sacks
- Division of Plastic and Reconstructive Surgery, Washington University Medical Center, St Louis, MO
| | - Sung H Kang
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Halsted 668, Baltimore, MD, 21287.
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Manolesou DG, Georgiopoulos G, Lazaris AM, Schizas D, Stamatelopoulos KS, Khir AW, Liakakos T, Papaioannou TG. Experimental Devices Versus Hand-Sewn Anastomosis of the Aorta: A Systematic Review and Meta-Analysis. J Surg Res 2020; 258:200-212. [PMID: 33035743 DOI: 10.1016/j.jss.2020.08.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 08/30/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND To minimize complications associated with the construction of the hand-sewn aortic anastomosis, alternative experimental methods have been pursued. This study aimed to evaluate the efficacy of experimental anastomotic devices in relation to time and point of rupture of the anastomosis in comparison to the conventional technique. MATERIALS AND METHODS An electronic search was performed using MEDLINE, Scopus, Science Direct, and Cochrane Library databases by two independent authors. Our exclusion criteria referred to studies reporting results solely from end-to-side anastomosis, results on vessels other than the aorta, studies that did not involve animal experiments, and non-English publications. The last search date was January 1, 2020. RESULTS The meta-analysis included 22 studies with 34 anastomosis samples and a total of 316 animals. The pooled mean automated anastomosis time was 10.38 min, and the mean point of rupture was 32.7 N. In the subgroup analysis of automated anastomosis time by device category, the anastomotic stenting technique reported significantly lower anastomosis time but also showed significantly lower point of rupture. Comparing the efficacy of experimental devices and the hand-sewn technique, our pooled analysis showed that automated devices significantly decrease the time needed to perform the anastomosis (weighted mean difference -7.24 min). On the other hand, the automated anastomosis is also associated with decreased tensile strength (weighted mean difference -20.68 N). CONCLUSIONS Although experimental devices seem to offer a faster anastomosis, they lack endurance when compared with the hand-sewn technique. Further research is needed for the development of an "ideal" anastomotic technique.
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Affiliation(s)
- Danae G Manolesou
- Biomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - George Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London UK
| | - Andreas M Lazaris
- Department of Vascular Surgery, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimon S Stamatelopoulos
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ashraf W Khir
- Brunel Institute for Bioengineering, Brunel University London, London, UK
| | - Theodoros Liakakos
- First Department of Surgery, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore G Papaioannou
- Biomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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A hybrid clampless technique for aortic anastomoses. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 7:137-141. [PMID: 33718685 PMCID: PMC7921192 DOI: 10.1016/j.jvscit.2020.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/26/2020] [Indexed: 11/21/2022]
Abstract
Background and Purpose In various circumstances of aortic repairs (heavy circumferential calcifications or shaggy aorta with extensive thrombus), open and endovascular techniques are at high risk. In addition to a likelihood of emboli, aortic clamping can be complicated by rupture and endovascular techniques may not be successful. We here describe a simple and reproducible hybrid technique that allows performing an aortic anastomosis without clamping in these situations. Methods After a limited exposure of the anterior aortic wall in a healthy segment, a prosthetic graft is sutured without any arteriotomy or clamping (adventitial suture), mimicking the final aspect of an end-to-side anastomosis. The graft and the anastomosis site are punctured using a long needle, allowing a guidewire to be positioned in the aorta under fluoroscopic guidance. Protected covered stenting of the anastomosis site opens the anastomosis without aortic clamping. After tunneling the graft to the target artery, the distal anastomosis is performed in a usual fashion. Results This technique was successfully used in 10 challenging consecutive cases with a sustained patency. Conclusions This hybrid clampless technique for aortic anastomosis represents a useful alternative for challenging lesions unsuitable for a simple open or endovascular treatment.
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Manolesou D, Papaioannou TG, Georgiopoulos G, Schizas D, Lazaris A, Stamatelopoulos K, Dimakakos E, Stergiopulos N, Stefanadis C, Liakakos T, Tousoulis D. Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices. J Vasc Surg 2019; 69:598-613.e7. [PMID: 30683205 DOI: 10.1016/j.jvs.2018.08.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/09/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE One of the factors contributing to complications related to open repair of the aorta is the construction of a hand-sewn anastomosis. Aortic anastomotic devices (AADs), such as the intraluminal ringed graft (IRG), and the anastomotic stenting technique have been developed to perform a sutureless and less complicated anastomosis. This study performed a systematic review and meta-analysis of the literature reporting clinical use of AADs and aimed to assess, primarily, the effect of each device on 30-day overall and operation-related mortality and aortic cross-clamping time and, secondarily, the rate of successful two-sided application of the IRG device and the operation-related morbidity for each device. METHODS An electronic search was performed using MEDLINE, Scopus, ScienceDirect, and Cochrane Library by two independent authors. Our exclusion criteria included studies incorporating fewer than three patients and studies reporting results solely from animals or in vitro testing, results solely from end-to-side anastomosis, and results solely from endarterectomy procedures. The last search date was February 1, 2018. RESULTS A total of 41 studies were identified that reported outcomes for the use of three different device types: IRG, anastomotic stenting technique, and surgical staplers. The last two types were classified together as the non-IRG group. The meta-analysis included 27 studies with 50 cohorts incorporating 1260 patients. The median age of the incorporated patients was 61.4 years (range, 51-73 years), and 68.9% were male. The operations were performed for the treatment of acute aortic dissection in 82.3%. The pooled overall 30-day mortality rate varied by device type; IRG devices had a mean rate of all-cause mortality of 9.71%, whereas non-IRG devices were associated with a significantly (I2 = 15.78%; P for Cochrane Q test < .19) lower rate of death (1.47%). The pooled mean aortic cross-clamping time was 35.83 minutes. Metaregression showed that the performance of two-sided anastomosis with the IRG device significantly decreased the aortic cross-clamping time. However, a successful two-sided ringed anastomosis was performed in approximately half of the cases. CONCLUSIONS Taking into account that the majority of operations were performed for the treatment of acute aortic dissection, AADs had a relatively low rate of 30-day mortality. Despite the observed heterogeneity in study protocols and the small sample size in the non-IRG group, the non-IRG group presented with the lowest 30-day mortality rate. Specific device-related complications between the different device types need further investigation.
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Affiliation(s)
- Danae Manolesou
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Theodore G Papaioannou
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Georgiopoulos
- Vascular Laboratory, Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimonas Stamatelopoulos
- Vascular Laboratory, Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Dimakakos
- Vascular Unit, 3rd Internal Medicine Clinic, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Biotechnology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Theodoros Liakakos
- First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Anaya-Ayala JE, Davies MG, El-Sayed HF, Peden EK, Naoum JJ. Early Experience With a Novel Hybrid Vascular Graft for Hemodialysis Access Creation in Patients With Disadvantaged Anatomy. J Endovasc Ther 2015; 22:778-85. [DOI: 10.1177/1526602815598754] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To describe the use of the Hybrid vascular graft in disadvantaged anatomy for hemodialysis access creation and compare outcomes to standard-wall polytetrafluoroethylene (PTFE) grafts. Methods: In a retrospective analysis, 25 patients (mean age 65±14 years; 13 men) who received the Hybrid graft were compared with 35 contemporaneous patients (mean age 63±12 years; 20 men) who received a standard PTFE graft for hemodialysis access over a 2-year period. Criteria for Hybrid graft placement were (1) exhausted or inadequate peripheral veins for arteriovenous fistula (AVF) creation and concomitant small target veins that precluded conventional PTFE graft placement, (2) previous graft anastomosis or a stent in the venous target at the level of the axilla, or (3) failed brachial-basilic or brachial-brachial upper arm transposition AVF with a small target vein at the axilla. Efficacy, anatomic and clinical considerations, and technique were reviewed; patency rates, complications, and reinterventions were examined. Results: Technical success was achieved in all cases, and all grafts were usable for hemodialysis. Seven of 25 Hybrid patients required stent-graft extensions and 3 patients required angioplasty to improve venous outflow at the time of Hybrid graft insertion. Three of 35 standard PTFE graft patients required angioplasty to improve venous outflow at the time of graft insertion. There was no perioperative mortality or procedure-related morbidity in either group. Median follow-up was 21 months. The patient survival estimate was 66% at 2 years. Estimated primary patency (24% vs 18%, p>0.05), assisted primary patency (34% vs 28%; p>0.05), and secondary patency rates (40% vs 38%, p≥0.05) at 24 months were equivalent for Hybrid vs PTFE grafts, respectively. Venous hypertension was not a complication following Hybrid graft implantation but was seen in 2 patients with the standard PTFE graft. Conclusion: The Hybrid graft offers a safe, technically effective alternative for patients with disadvantaged anatomy requiring hemodialysis access and has comparable outcomes to standard PTFE grafts. Further clinical experience and long-term data are required for determining the proper utility of this device in chronic dialysis-dependent patients.
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Affiliation(s)
- Javier E. Anaya-Ayala
- Department of Cardiovascular Surgery and Houston Methodist Hospital Research Institute, The Methodist Hospital, Houston, TX, USA
| | - Mark G. Davies
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, TX, USA
| | - Hosam F. El-Sayed
- Division of Vascular Diseases and Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Eric K. Peden
- Department of Cardiovascular Surgery and Houston Methodist Hospital Research Institute, The Methodist Hospital, Houston, TX, USA
| | - Joseph J. Naoum
- Department of Cardiovascular Surgery and Houston Methodist Hospital Research Institute, The Methodist Hospital, Houston, TX, USA
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Jose RR, Raja WK, Ibrahim AMS, Koolen PGL, Kim K, Abdurrob A, Kluge JA, Lin SJ, Beamer G, Kaplan DL. Rapid prototyped sutureless anastomosis device from self-curing silk bio-ink. J Biomed Mater Res B Appl Biomater 2014; 103:1333-43. [PMID: 25385518 DOI: 10.1002/jbm.b.33312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/28/2014] [Accepted: 10/10/2014] [Indexed: 01/03/2023]
Abstract
Sutureless anastomosis devices are designed to reduce surgical time and difficulty, which may lead to quicker and less invasive cardiovascular anastomosis. The implant uses a barb-and-seat compression fitting composed of one male and two female components. The implant body is resorbable and capable of eluting heparin. Custom robotic deposition equipment was designed to fabricate the implants from a self-curing silk solution. Curing did not require deleterious processing steps but devices demonstrated high crush resistance, retention strength, and leak resistance. Radial crush resistance is in the range of metal vascular implants. Insertion force and retention strength of the anastomosis was dependent on fit sizing of the male and female components and subsequent vessel wall compression. Anastomotic burst strength was dependent on the amount of vessel wall compression, and capable of maintaining higher than physiological pressures. In initial screening using a porcine implant, the devices remained intact for 28 days (the length of study). Histological sections revealed cellular infiltration within the laminar structure of the male component, as well as at the interface between the male and female components. Initial degradation and absorption of the implant wall were observed. The speed per anastomosis using this new device was much faster than current systems, providing significant clinical improvement.
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Affiliation(s)
- Rod R Jose
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
| | - Waseem K Raja
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
| | - Ahmed M S Ibrahim
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215
| | - Pieter G L Koolen
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215
| | - Kuylhee Kim
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215
| | - Abdurrahman Abdurrob
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
| | - Jonathan A Kluge
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, 02215
| | - Gillian Beamer
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts Clinical and Translational Science Institute, Tufts University, Grafton, MA 01536
| | - David L Kaplan
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts, 02155
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A new vascular coupling device: Assessment of MRI issues at 3-tesla. Magn Reson Imaging 2014; 32:585-9. [DOI: 10.1016/j.mri.2014.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 12/23/2013] [Accepted: 01/14/2014] [Indexed: 11/22/2022]
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Tossios P, Triantafillopoulou K, Sianos G, Karapanayiotides T, Foroulis CN. Magnetic connectors for coronary surgery: What do we know a decade later? MINIM INVASIV THER 2014; 23:313-6. [DOI: 10.3109/13645706.2014.908925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yevzlin AS, Valliant AM. Interventional nephrology: Novel devices that will one day change our practice. Clin J Am Soc Nephrol 2013; 8:1244-51. [PMID: 23620442 DOI: 10.2215/cjn.01580213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
There is increasing awareness of vascular access dysfunction as a significant contributor to the morbidity associated with chronic hemodialysis. Over the last several years, interventional nephrologists, in conjunction with our colleagues in vascular surgery, have led the way in the creation of novel devices that are designed to help solve the vascular access problem. The purpose of this review is to describe novel devices in the precommercial stage of development that have the potential to revolutionize the field of dialysis vascular access. These devices include bioengineered blood vessels, access monitoring technology, and advanced anastomotic connectors.
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Affiliation(s)
- Alexander S Yevzlin
- Nephrology Division, University of Wisconsin, Madison, Wisconsin 53705-2281, USA
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Nonsuture anastomosis of arteries and veins using the magnetic pinned-ring device: a histologic and scanning electron microscopic study. Ann Vasc Surg 2012; 26:985-95. [PMID: 22835565 DOI: 10.1016/j.avsg.2012.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 03/21/2012] [Accepted: 04/23/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND The goal of this study was to evaluate the performance of the magnetic pinned-ring device for nonsuture vascular anastomosis. METHODS The magnetic pinned-ring device consists of paired magnetic rings that are coated with titanium nitride and embedded in a polypropylene shell; the rings are equipped with alternately spaced holes and titanium pins. The vascular anastomosis procedure using the novel magnetic pinned-ring device was performed on 14 mongrel dogs, and the traditional hand-sewing technique was used on 14 additional dogs. In situ end-to-end anastomoses were performed in the femoral artery and the inferior vena cava. Patency was confirmed through ultrasonographic scans at different time points as late as 24 weeks after surgery. Gross observation, histological staining, and scanning electron microscopy were used to evaluate the results at 24 weeks postoperatively. RESULTS The time required to perform the vascular anastomosis was significantly shorter for the magnetic device than for hand sewing. A continuity of re-endothelialization was confirmed in all anastomotic stomas after 24 weeks, and neither formation of aneurysms nor thickening of the vascular wall was noted. The re-endothelialization was smooth at the anastomotic site of the magnetic device, whereas hand sewing resulted in rough and uneven re-endothelialization and the presence of visible sutures. Moreover, the endothelial cells were regularly arranged at the anastomotic site of the magnetic device, whereas different-sized and irregularly aligned endothelial cells were present at the hand-sewn anastomotic site. Use of the magnetic device was associated with significantly decreased deposition of fibrotic collagen and depressed infiltration of inflammatory cells compared with use of the hand-sewing technique. CONCLUSIONS The magnetic pinned-ring device offers a simple, fast, reliable, and efficacious technique for nonsuture vascular anastomosis. Use of this device shortens operation time, maintains a high patency rate, and improves the healing of vascular tissue.
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Piazza M, Bonvini S, Ferretto L, Menegolo M, Frigatti P, Ricotta JJ, Grego F. Modification of the Viabahn Padova sutureless technique for challenging anastomosis between a prosthetic graft and a circumferentially calcified target artery. J Endovasc Ther 2012; 19:457-60. [PMID: 22788901 DOI: 10.1583/12-3827mr.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To describe modification of the Viabahn Padova Sutureless (ViPS) technique for challenging anastomosis between a prosthetic graft and a circumferentially calcified target artery. TECHNIQUE The technique is demonstrated in a 75-year-old man with complete superficial femoral artery (SFA) occlusion and reconstitution of a circumferentially calcified above-knee popliteal artery. A 7-mm Viabahn endoprosthesis with its constraining string was withdrawn from its delivery system; the string at the proximal edge of the stent was gently cut with a scalpel, causing the proximal part of the stent to deploy, while the undeployed distal tip with its smooth profile retained its commercial orientation. The proximal end was subsequently sutured to a 7-mm polytetrafluoroethylene (PTFE) graft. After surgical exposure, the popliteal artery was transected, and the undeployed distal portion of the Viabahn was inserted into the distal segment, supported by a stiff guidewire. By pulling the constraining string, the stent was deployed in a "non-reversed" fashion and subsequently dilated to achieve optimal apposition. Finally, the proximal end of the PTFE graft was tunneled under the sartorius muscle and sutured to the common femoral artery. CONCLUSION This modification to the ViPS technique using a "non-reversed" method of Viabahn stent preparation allows a safer and more accurate deployment of the endoprosthesis in the calcified target artery.
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Affiliation(s)
- Michele Piazza
- Clinic of Vascular and Endovascular Surgery, Padova University School of Medicine, Italy.
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