Alfieri Alex, Reinert Michael
Department of Neurosurgery, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany.
Eur Surg Res. 2011;46(1):32-7. doi: 10.1159/000321699. Epub 2010 Dec 7.
BACKGROUND/AIMS: The excimer laser-assisted nonocclusive anastomosis (ELANA) technique has been developed as a clinical effective technique to perform intracranial high-flow bypass without temporary occlusion of cerebral vessels in otherwise untreatable or high-risk cerebrovascular diseases. We experimentally tested the application of a nonabsorbable cyanoacrylate-based sealant with the ELANA technique.
Three technical in vitro variations of the ELANA anastomosis technique using Omnex(©) glue and expanded polytetrafluoroethylene tube were compared with conventional sutured ELANA bypasses, resulting in 36 bypasses and 72 anastomoses. After that, the best resulting type was tested in 10 rabbits.
The ELANA bypass using Omnex and the expanded polytetrafluoroethylene tube technique offers better results in vitro in the retrieval of the arterial wall flap after arteriotomy, is faster, and the tensile strength of the bypasses performed with Omnex is comparable with those performed with conventional sutures. However, in 2 cases, we observed thrombosis of the vessel and considerable stiffness.
The combining of the ELANA technique with 2-octyl cyanoacrylate and butyl lactoyl cyanoacrylate experimentally provides some advantages over the conventional ELANA technique. Further experimental studies should be performed in order to improve the safety and applicability of this technique.
背景/目的：准分子激光辅助非闭塞性吻合术（ELANA）已发展成为一种临床有效的技术，用于在其他难以治疗或高风险的脑血管疾病中进行颅内高流量搭桥手术，而无需临时闭塞脑血管。我们通过实验测试了一种不可吸收的氰基丙烯酸酯基密封剂与ELANA技术的联合应用。
将使用Omnex(©)胶水和膨体聚四氟乙烯管的ELANA吻合技术的三种体外技术变体与传统缝合的ELANA搭桥术进行比较，共进行了36次搭桥和72次吻合。之后，在10只兔子身上测试了效果最佳的类型。
使用Omnex和膨体聚四氟乙烯管技术的ELANA搭桥术在体外动脉切开术后动脉壁皮瓣的恢复方面效果更好，速度更快，并且使用Omnex进行的搭桥术的拉伸强度与使用传统缝线进行的相当。然而，在2例中，我们观察到血管血栓形成和明显的僵硬。
将ELANA技术与2-辛基氰基丙烯酸酯和丁基乳酰氰基丙烯酸酯联合应用在实验中比传统的ELANA技术具有一些优势。应进行进一步的实验研究以提高该技术的安全性和适用性。
