Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
Oper Neurosurg (Hagerstown). 2020 Nov 16;19(6):E583-E588. doi: 10.1093/ons/opaa231.
The side-to-side in situ microvascular anastomosis is an important tool in the cerebrovascular neurosurgeon's armamentarium. The execution of the side-to-side anastomosis, however, can be limited by the inability to acquire sufficient visualization and approximation of the recipient and donor vessels.
To expedite the transition to the back wall suturing of the donor and recipient vessels during side-to-side in situ microvascular anastomosis.
Incorporation of the first suture throw from the outside to the inside of the vessel lumen with the initial stay suture at the proximal apex of the arteriotomy is described. The apical knot is tied between one limb of the resultant loop and the free end of the suture. The remainder of side-to-side anastomosis can then be completed in a standard fashion starting from the inside of the lumen.
This modification allows for an expedited transition to the back wall suturing of the 2 arterial segments and avoids difficulties associated with taking the first bite from behind the knot at the proximal apex of the arteriotomy or the transfer of the needle between the approximated vessels. This updated technique is illustrated with a case example, illustration, and video.
This technical modification for the side-to-side anastomosis helps optimize microsurgical efficiency by limiting needle, suture, and vessel handling after the initial suture placement, which has classically been a challenge of this bypass.
侧侧原位微血管吻合术是脑血管神经外科医生的重要工具。然而，由于无法充分观察和接近受体和供体血管，侧侧吻合术的执行可能会受到限制。
加快侧侧原位微血管吻合术中转至供体和受体血管后壁缝合的速度。
描述了在动脉切开术近端顶点处的初始暂缝线内，从血管腔外到内进行第一次缝线投掷的方法。顶点结系在所得环的一个分支和缝线的自由端之间。然后可以从管腔内部开始以标准方式完成侧侧吻合术的其余部分。
这种改进允许加快向 2 个动脉段的后壁缝合的过渡，并避免了在动脉切开术近端顶点处从结后面进行第一次缝合或在接近的血管之间转移针头的困难。该更新技术通过案例示例、插图和视频进行说明。
这种侧侧吻合术的技术改进通过限制初始缝线放置后的针、缝线和血管处理，帮助优化了显微手术效率，这一直是该旁路的挑战。
