Vascular anastomoses with laser energy

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Presentation transcript:

Vascular anastomoses with laser energy Walter J. McCarthy, M.D., Renee S. Hartz, M.D., James S.T. Yao, M.D., Ph.D., Vikrom S. Sottiurai, M.D., Ph.D., Hau C. Kwaan, M.D., Ph.D., Lawrence L. Michaelis, M.D. Journal of Vascular Surgery Volume 3, Issue 1, Pages 32-41 (January 1986) DOI: 10.1067/mva.1986.avs0030032 Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 CO2 laser is attached to standard two-headed operating microscope. Journal of Vascular Surgery 1986 3, 32-41DOI: (10.1067/mva.1986.avs0030032) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Vessel edges are controlled with four horizontal mattress sutures. CO2 laser beam is directed over edges to achieve fusion; two-armed vessel-approximating clamp facilitates repair. Journal of Vascular Surgery 1986 3, 32-41DOI: (10.1067/mva.1986.avs0030032) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Transmission electron micrograph of transected rabbit artery anastomosis at 24 hours. A, Sutured technique: Cellular debris (CD) consists of degenerating smooth muscle cells and extracellular connective tissue elements, fibrin, and white blood cells. Adjacent to debris, there are leukocytes (L), disoriented smooth muscle cells (SM), and elastic laminae (el). S = suture. (Original magnification, × 1150.) B, Laser-assisted technique: Elastic laminae (el), smooth muscle cells (SM), and extracellular connective tissue matrix are organized in interlaminated pattern. Cellular debris (CD) is more amorphous than in suture anastomosis. Lu = lumen. (Original magnification, × 1150.) Journal of Vascular Surgery 1986 3, 32-41DOI: (10.1067/mva.1986.avs0030032) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Carotid artery anastomosis examined by transmission electron microscopy at 4 weeks. A, Sutured technique: Subendothelial portion of vessel wall consists of luminal cells (LC) with myofilaments (mf), collagen fibers (C), myofibroblasts (MF), and elastic laminae (e). Lu = lumen. (Original magnification, × 6600.) B, Laser-assisted anastomosis: Smooth muscle cells (SM) and myofibroblasts are dominant cellular structures in subendothelial space. Endothelial cell (E) is found interdigitating (arrow) with adjacent cell to line luminal surface. C = collagen fibers. (Original magnification, × 15,620.) Journal of Vascular Surgery 1986 3, 32-41DOI: (10.1067/mva.1986.avs0030032) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Transmission electron micrograph showing luminal cell coverage of rabbit carotid artery anastomosis at 4 weeks. A, Sutured technique (Original magnification, ×2790). B, Laser-assisted anastomosis (Original magnification, ×4640). Lu = lumen; LC = luminal cell; MF = myofibroblast; C = collagen fibers; el = elastic laminae. Multiple elastic laminae are seen in laser anastomosis. Journal of Vascular Surgery 1986 3, 32-41DOI: (10.1067/mva.1986.avs0030032) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 Photomicrograph of laser-assisted carotid artery anastomosis at 8 weeks. In area of anastomosis, there is marked intimal hyperplasia (arrows). Media remains disorganized. Opposite side does not display same degree of hyperplasia. (Hematoxylin-eosin stain; original magnification, ×25.) Journal of Vascular Surgery 1986 3, 32-41DOI: (10.1067/mva.1986.avs0030032) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 Photomicrograph of aser-assisted vena cava anastomosis at 24 hours. There is adventitial and medial necrosis with loss of endothelium. Lu = lumen. (Toluidine blue stain; original magnification, ×50.) Journal of Vascular Surgery 1986 3, 32-41DOI: (10.1067/mva.1986.avs0030032) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 8 Photomicrograph of sutured anastomosis of vena cava at 4 weeks. Two sutures (arrows) can be seen. Luminal space is covered with endothelial-like cells (open arrow). There is minimal intimal hyperplasia. (Toluidine blue stain; original magnification, ×100.) Journal of Vascular Surgery 1986 3, 32-41DOI: (10.1067/mva.1986.avs0030032) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions