Li Huizhong, Gale Bruce K, Sant Himanshu, Shea Jill, David Bell E, Agarwal Jay
Department of Mechanical Engineering, University of Utah, 50 S Central Campus Drive Rm 2110, Salt Lake City, UT, 84112, USA.
Department of Surgery, School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
Cardiovasc Eng Technol. 2015 Sep;6(3):294-302. doi: 10.1007/s13239-015-0220-3. Epub 2015 Feb 28.
Vascular anastomosis is common during reconstructive surgeries. Traditional hand-suturing techniques are time consuming, subject to human error, and require high technical expertise and complex instruments. Prior attempts to replace hand-suturing technique, including staples, ring-pin devices, cuffing devices, and clips, are either more cumbersome, are unable to maintain a tight seal, or do not work for both arteries and veins. To provide a more efficient and reliable vessel anastomosis, a metal-free vascular coupling system that can be used for both arteries and veins was designed, fabricated and tested. A set of corresponding instruments were developed to facilitate the anastomosis process. Evaluation of the anastomosis by scanning electron microscopy and magnetic resonance imaging, demonstrated that the installation process does not cause damage to the vessel intima and the vascular coupling system is not exposed to the vessel lumen. Mechanical testing results showed that vessels reconnected with the vascular coupling system could withstand 12.7 ± 2.2 N tensile force and have superior leak profiles (0.049 ± 0.015, 0.078 ± 0.016, 0.089 ± 0.008 mL/s at 160, 260, 360 mmHg, respectively) compared to hand sutured vessels (0.310 ± 0.014, 1.123 ± 0.033, 2.092 ± 0.072 mL/s at 160, 260, 360 mmHg, respectively). The anastomotic process was successfully demonstrated on both arteries and veins in cadaver pigs.
血管吻合术在重建手术中很常见。传统的手工缝合技术耗时、易受人为误差影响，并且需要高技术专长和复杂的器械。先前尝试替代手工缝合技术，包括吻合钉、环针装置、套扎装置和夹子，要么更繁琐，无法保持紧密密封，要么不适用于动脉和静脉。为了提供更高效可靠的血管吻合，设计、制造并测试了一种可用于动脉和静脉的无金属血管耦合系统。开发了一套相应的器械以促进吻合过程。通过扫描电子显微镜和磁共振成像对吻合情况进行评估，结果表明安装过程不会对血管内膜造成损伤，且血管耦合系统不暴露于血管腔内。力学测试结果显示，与手工缝合的血管（在160、260、360 mmHg时分别为0.310±0.014、1.123±0.033、2.092±0.072 mL/s）相比，用血管耦合系统重新连接的血管能够承受12.7±2.2 N的拉力，并且具有更好的渗漏情况（在160、260、360 mmHg时分别为0.049±0.015、0.078±0.016、0.089±0.008 mL/s）。在猪尸体的动脉和静脉上均成功演示了吻合过程。
