A new sutureless technique for end-to-end and end-to-side arterial and prosthetic anastomosis

Introduction: We report a new sutureless anastomosis with stents and grafts currently used in vascular surgery. Methods and techniques: End-to-end or end-to-side anastomosis using ballon or self-expanding stents were used in 32 sheeps. The graft was places outside the artery and a stent was deployed and fixed with banding silk threads. Clamping time, blood loss and anastomosis patency were studied. Results: In aortic group (10), all the anastomosis were end-to-end and suturless in 5 cases. No thrombosis was observed at time of animal sacrifice. In carotid group (22), bypasses were done with ballon (22) and self-expanding (18) stents. Forty anastomosis were sutureless including 34 end-to-end and 6 end-to-side. Mean clamping time: 13 min (11–16 min) versus 19 min (17–22 min); blood loss: 0 ml versus 57 ml (47–80 ml) respectively for traditional and sutureless anastomosis. All the ballon-expandable stent (22) thrombosed, due to external compression of the neck against the feeding trough. All 6 self-expanding stents were patent. Conclusion: Despite a high rate of thrombosis with ballon-expandable stents, sutureless anastomosis technique is effective with a shorter completion time and less bleeding compared to traditional anastomosis. Further device evaluation and improvements are needed to combine laparoscopic and endovascular techniques.