Sakai Osamu, Nakayama Yasuhide, Nemoto Yasushi, Okamoto Yoshihiro, Watanabe Taiji, Kanda Keiichi, Yaku Hitoshi
Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Artif Organs. 2005;8(2):119-24. doi: 10.1007/s10047-005-0294-z.
A novel sutureless vascular connecting system, an assembly with a delivery rod, an introducing sheath, and a connecting device, was developed for easy implantation of small-caliber vascular grafts less than 2 mm in internal diameter. A microporous stainless tube (length 2 mm, external diameter 1.6 mm, wall thickness 65 microm, pore diameter 400 microm, pore-to-pore distance 500 microm) was designed to serve as a connecting device. The feasibility of the system was tested using two types of preliminary animal experiments. One animal model consisted of graft implantation into the rat abdominal aorta (1.5 mm in diameter). The connecting device was inserted into the proximal and distal ends of the aorta through the introducing sheath by pushing the delivery rod with the connecting device placed over it. Subsequently, the aortic segments were inserted into both ends of model grafts made of segmented polyurethane (1.8 mm in internal diameter) and were fixed with banding silk threads from the exterior. The procedure was completed within 20 min without requiring specialized microsurgery techniques. Blood leakage and obstruction did not occur. The second model consisted of an end-to-end anastomosis between rabbit common carotid arteries (2 mm in diameter), which was performed within several minutes of blood flow interruption. Scanning electron microscopy demonstrated that the luminal surface of the device was fully covered with endothelial cells (ECs) after 1 week as a result of transluminal ingrowth of native ECs through the micropores in the device. This endothelialization may prevent early thrombus-induced occlusion. This simple and "easy-to-learn" technique will promote the development of small-caliber arterial grafts, and furthermore, it may have potential for clinical application.
一种新型无缝合血管连接系统，该组件包括输送杆、导入鞘和连接装置，专为内径小于2毫米的小口径血管移植物的简便植入而开发。设计了一种微孔不锈钢管（长度2毫米，外径1.6毫米，壁厚65微米，孔径400微米，孔间距500微米）作为连接装置。使用两种类型的初步动物实验对该系统的可行性进行了测试。一种动物模型是将移植物植入大鼠腹主动脉（直径1.5毫米）。通过将带有连接装置的输送杆推过导入鞘，将连接装置插入主动脉的近端和远端。随后，将主动脉段插入由分段聚氨酯制成的模型移植物（内径1.8毫米）的两端，并用外部的绑扎丝线固定。该过程在20分钟内完成，无需专门的显微外科技术。未发生血液渗漏和阻塞。第二种模型是兔颈总动脉（直径2毫米）之间的端端吻合，在血流中断几分钟内完成。扫描电子显微镜显示，由于天然内皮细胞通过装置中的微孔腔内向内生长，1周后装置的管腔表面完全被内皮细胞覆盖。这种内皮化可能会防止早期血栓引起的阻塞。这种简单且“易于学习”的技术将促进小口径动脉移植物的发展，此外，它可能具有临床应用潜力。
