Temporary Luminal Arteriotomy Seal for Bypass Grafting

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Temporary Luminal Arteriotomy Seal for Bypass Grafting Robin H. Heijmen, Cornelius Borst, Rob van Dalen, Paul F. Gründeman, Cees W.J. Verlaan The Annals of Thoracic Surgery Volume 65, Issue 4, Pages 1093-1099 (April 1998) DOI: 10.1016/S0003-4975(98)00118-0

Fig. 1 Schematic representation of the temporary luminal arteriotomy seal and its application. The temporary luminal arteriotomy seal was made from a polyurethane balloon skin material (A). The seal was prefolded in a small cannula segment (B) and inserted into the artery (C), where it unfolded owing to the flexibility of the material (D). The suture loop at the toe side was used to position the temporary luminal arteriotomy seal correctly inside the artery (E), after which blood flow was restored. During suturing, the flimsy seal gave way when a needle was inserted between the seal and the arterial wall, without producing a leak (F). After the suturing was finished, the temporary luminal arteriotomy seal was taken hold of, slid toward the heel (see D), and withdrawn in the axial direction from the artery past the suture (G), which subsequently was tightened to complete the anastomosis. The Annals of Thoracic Surgery 1998 65, 1093-1099DOI: (10.1016/S0003-4975(98)00118-0)

Fig. 2 Percentage circumference of recipient artery not covered by endothelium. The schematic drawing shows the temporary luminal arteriotomy seal (TLAS) (light gray) inside the recipient artery. The arteriotomy (dark gray) measures 2 mm in width. Data are presented as mean ± standard deviation. (∗One anastomosis sectioned in the longitudinal plane and excluded from analysis; †estimated circumferential coverage [%] by the TLAS. ‡Constriction of the artery because of the ligature close to the proximal anastomosis and excluded from analysis.) The Annals of Thoracic Surgery 1998 65, 1093-1099DOI: (10.1016/S0003-4975(98)00118-0)

Fig. 3 Percentage of medial smooth muscle cell nuclei, relative to a proximal reference. Data are presented as mean ± standard deviation. (CONV = conventional anastomoses; TLAS = temporary luminal arteriotomy seal anastomoses. (∗one anastomosis sectioned in the longitudinal plane and excluded from analysis; †constriction of the artery due to the ligature close to the proximal anastomosis and excluded from analysis.) The Annals of Thoracic Surgery 1998 65, 1093-1099DOI: (10.1016/S0003-4975(98)00118-0)

Fig. 4 Representative recording from a pig carotid artery during insertion of the temporary luminal arteriotomy seal. The intraluminal seal did not change phasic and mean blood flow. The Annals of Thoracic Surgery 1998 65, 1093-1099DOI: (10.1016/S0003-4975(98)00118-0)

Fig. 5 Transverse cross-section of the media of the recipient artery located at the toe of the anastomosis that was covered by the temporary luminal arteriotomy seal, 2 days postoperatively. Note the absence of endothelial cells without disruption of the internal elastic lamina (arrows). Note the undisturbed medial smooth muscle cell nuclei. (Hematoxylin and eosin stain; bar = 50 μm.) The Annals of Thoracic Surgery 1998 65, 1093-1099DOI: (10.1016/S0003-4975(98)00118-0)

Fig. 6 Longitudinal cross-section of the heel of a temporary luminal arteriotomy seal anastomosis (A) and a conventionally sutured anastomosis (B), 4 weeks postoperatively. There was no significant difference in anastomotic intimal hyperplasia area between both groups. (IH = intimal hyperplasia.) (Elastin van Gieson stain; bar = 100 μm.) The Annals of Thoracic Surgery 1998 65, 1093-1099DOI: (10.1016/S0003-4975(98)00118-0)

Fig. 7 Three-dimensional representation of the carotid artery with a temporary luminal arteriotomy seal in place. In 1 additional pig, the left carotid artery in which the arteriotomy was sealed with a temporary luminal arteriotomy seal was pressure-fixated at 80 mm Hg and sectioned transversely each 200 μm. In each cross-section, the lumen area was determined. Because of the relative expansion of the artery at the arteriotomy combined with the low profile of the seal, the lumen of the recipient artery, and hence the blood flow, is virtually unchanged. The Annals of Thoracic Surgery 1998 65, 1093-1099DOI: (10.1016/S0003-4975(98)00118-0)