Bremmer Jochem P, Verweij Bon H, Van der Zwan Albert, Reinert Michael M, Beck Hendricus J Mansvelt, Tulleken Cornelis A F
Rudolf Magnus Institute of Neuroscience, Department of Neurosurgery, University Medical Center Utrecht, The Netherlands.
J Neurosurg. 2007 Dec;107(6):1190-7. doi: 10.3171/JNS-07/12/1190.
Cerebral aneurysms that cannot be treated by clip or coil placement can be treated with high-flow bypass surgery using techniques such as the excimer laser-assisted nonocclusive anastomosis (ELANA). To simplify the technique, a sutureless ELANA (SELANA) was developed in combination with an expanded polytetrafluoroethylene (ePTFE) graft.
In 18 rabbits a bypass was constructed on the abdominal aorta using the SELANA technique with an ePTFE graft, resulting in 18 bypasses and 36 anastomoses. Short-term effects were analyzed in the first 2 weeks and at 2 and 3 months after the procedure. Patency was evaluated using quantitative ultrasound flowmetry. The anastomotic sites were studied using scanning electron microscopy.
Construction of the bypass using the SELANA technique was easier and faster (15-25 minutes) compared with bypasses made with the ELANA technique (> 90 minutes). At the end of follow-up, 16 of 18 bypasses were patent. Of 36 SELANA anastomoses, 32 could be completed without short temporary occlusion of the recipient vessel. Scanning electron microscopy showed complete coverage of all anastomoses with neointimal repair tissue after 10 days.
The SELANA technique provides further advantages over the conventional ELANA technique in ease of use and shortening of procedure time. The patency rate in this series was 89% and neointima repair tissue at the anastomosis site was complete after 10 days. Further experimental studies of the long-term patency and safety of this technique are necessary before clinical application.
无法通过夹闭或栓塞治疗的脑动脉瘤可采用准分子激光辅助非闭塞性吻合术（ELANA）等高流量搭桥手术进行治疗。为简化该技术，开发了一种与膨体聚四氟乙烯（ePTFE）移植物相结合的无缝合ELANA（SELANA）。
在18只兔子身上使用SELANA技术和ePTFE移植物在腹主动脉上构建搭桥，共形成18个搭桥和36个吻合口。在术后前2周以及术后2个月和3个月分析短期效果。使用定量超声血流仪评估通畅情况。使用扫描电子显微镜研究吻合部位。
与使用ELANA技术构建搭桥（>90分钟）相比，使用SELANA技术构建搭桥更容易、更快（15 - 25分钟）。随访结束时，18个搭桥中有16个通畅。在36个SELANA吻合口中，32个可以在不短暂临时阻断受体血管的情况下完成。扫描电子显微镜显示10天后所有吻合口均被新生内膜修复组织完全覆盖。
SELANA技术在易用性和缩短手术时间方面比传统ELANA技术具有更多优势。本系列中的通畅率为89%，吻合部位的新生内膜修复组织在10天后完全形成。在临床应用之前，有必要对该技术的长期通畅性和安全性进行进一步的实验研究。
