Influences of laser pulse duration and anastomotic disruption on laser-assisted microvascular anastomoses (LAMA).

The success rate of laser-assisted microvascular anastomosis (LAMA) can be influenced by many factors, including the parameters of the laser technique used. This study examined the effects of laser pulse duration and the occurrence of anastomotic disruption immediately following first repair attempts on the incidence of aneurysm formation and the patency rate in LAMA. Fifty transected rat femoral arteries in 25 rats were anastomosed with three stay sutures and welded with a CO2 laser at a power of 80 mW. In each rat, the laser was applied in the form of 45 pulses of 0.2 sec duration to one femoral artery (group 1) and in the form of 15 pulses of 0.6 sec duration to the contralateral femoral artery (group 2). Comparison of group 1 with group 2 showed that overall rates of aneurysm formation (30% vs. 17%) and patency rates (92% vs. 96%) did not differ significantly (P less than 0.05) at 3 weeks postoperatively. However, disrupted vessels in both groups had a significantly higher incidence of subsequent aneurysm formation than nondisrupted vessels (54% vs. 0% in group 1, P less than 0.05; 43% vs. 6% in group 2, P less than 0.06; groups 1 and 2 pooled, P less than 0.001). These findings indicate that changes in laser pulse duration such as those tested do not affect the aneurysm and patency rates of LAMA. The results demonstrate, however, that disruption after laser welding plays a significant role in subsequent aneurysm formation.