Biesbroek Matthijs, van Doormaal Tristan P C, van der Zwan Albert, Tulleken Cornelis A F, Regli Luca, Heijnen Harry F G, Vink Aryan
Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
Lasers Surg Med. 2011 Aug;43(6):522-7. doi: 10.1002/lsm.21075.
The excimer laser-assisted non-occlusive anastomosis (ELANA) technique is a way of making an anastomosis of vessels without temporal occlusion that is used for cerebral revascularization. Currently, 10 mJ of laser energy is used during the ELANA procedure. We have recently demonstrated that increasing the laser energy may increase flap retrieval rate. The aim of the present study was to study the acute effect of increased laser energy during the ELANA procedure on the recipient vessel wall.
The ELANA technique was performed on the abdominal aortas of rabbits under anesthesia using three categories of laser energy (two laser episodes of 10, 13, and 15 mJ, respectively). The rabbits were subsequently sacrificed and the anastomoses were removed. A non-lased rabbit aorta was used as control. Recipient arteries were studied using histopathology and transmission electron microscopy.
In all three categories of laser energy and in the control group, the tunica media and adventitia adjacent to the anastomosis were intact, apart from damage caused by sutures. In the control group, the endothelium was fully intact. In the 10 and 13 mJ subgroups, the endothelium was mostly intact [92% (range 85-98) and 87% (range 80-90) for 10 and 13 mJ, respectively]. In the 15 mJ subgroup, most of the endothelium was absent [32% (range 20-40) of endothelium intact], predominantly at the side opposed to the anastomosis.
Increasing the laser energy during the ELANA procedure from 10 to 13 mJ does not cause additional acute damage to the vessel wall. Increasing the laser energy from 13 to 15 mJ results in increased acute damage of the endothelium, whereas tunica media and adventitia remain unaffected. Further studies are required to assess the long-term effects of increased laser energy during the ELANA technique.
准分子激光辅助非闭塞性吻合术（ELANA）是一种无需临时闭塞血管即可进行血管吻合的方法，用于脑血运重建。目前，ELANA手术过程中使用10 mJ的激光能量。我们最近证明，增加激光能量可能会提高皮瓣回收率。本研究的目的是探讨在ELANA手术过程中增加激光能量对受体血管壁的急性影响。
在麻醉下对兔腹主动脉进行ELANA技术操作，使用三类激光能量（分别为两个10、13和15 mJ的激光脉冲）。随后处死兔子并取出吻合口。将未接受激光照射的兔主动脉用作对照。使用组织病理学和透射电子显微镜对受体动脉进行研究。
在所有三类激光能量组和对照组中，除缝线造成的损伤外，吻合口附近的中膜和外膜均完整。对照组中，内皮完全完整。在10 mJ和13 mJ亚组中，内皮大多完整[10 mJ组为92%（范围85%-98%），13 mJ组为87%（范围80%-90%）]。在15 mJ亚组中，大部分内皮缺失[仅32%（范围20%-40%）的内皮完整]，主要位于与吻合口相对的一侧。
在ELANA手术过程中将激光能量从10 mJ增加到13 mJ不会对血管壁造成额外的急性损伤。将激光能量从13 mJ增加到15 mJ会导致内皮急性损伤增加，而中膜和外膜不受影响。需要进一步研究来评估ELANA技术中增加激光能量的长期影响。
