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Initial human evaluation of argon laser—assisted vascular anastomoses

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1 Initial human evaluation of argon laser—assisted vascular anastomoses
Rodney A. White, MD, Geoffrey H. White, MD, Roy M. Fujitani, MD, Jerry W. Vlasak, MD, Carlos E. Donayre, MD, George E. Kopchok, BS, Ski-Kaung Peng, MD  Journal of Vascular Surgery  Volume 9, Issue 4, Pages (April 1989) DOI: / (89) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

2 Fig. 1 Technique for performing laser fusion of the artery-vein anastomoses. A, Aligning sutures placed at apexes of incision and at middle of posterior wall. B, After fusion of posterior wall, anterior surface opposed by a traction suture for laser delivery. Journal of Vascular Surgery 1989 9, DOI: ( / (89) ) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

3 Fig. 2 Magnetic resonance imaging scan of laser-fused arteriovenous fistula at 5 months postoperatively. Arrow shows site of anastomosis. Journal of Vascular Surgery 1989 9, DOI: ( / (89) ) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

4 Fig. 3 Duplex scan in longitudinal (A) and cross-section (B) projections of a laser-fused fistula at 1 year postoperatively. White line marks line of anastomosis. Journal of Vascular Surgery 1989 9, DOI: ( / (89) ) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

5 Fig. 4 External (A) and intraluminal (B) appearance of an excised arteriovenous fistula at 5 months postoperatively (from patient 5, Table I). Arrows identify areas of laser fusion. Journal of Vascular Surgery 1989 9, DOI: ( / (89) ) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

6 Fig. 5 Verhoeff-van Gieson stain of a laser-fused arteriovenous fistula excised at 5 months postoperatively (from patient 5, Table I). A, Laser-fused segments show regular orientation of vascular wall architecture and normal repair with no inflammation. B, Sutured segments show foreign body reaction and tortuosity and disorientation of elastin, collagen, and wall constituents. Arrows mark site of anastomosis at luminal surface; S, sutures. (Original magnification × 40.) Journal of Vascular Surgery 1989 9, DOI: ( / (89) ) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

7 Fig. 6 Electron microscopy of region of transition from vein to artery in laser-fused anastomosis showing compacted elastin (e), and disrupted internal elastic fibers (f) of the artery bound to collagen (c) of the vein. Arrow marks site of transition from artery to vein. (Original magnification ×2000; final magnification ×5000; scale: 2 μm.) Journal of Vascular Surgery 1989 9, DOI: ( / (89) ) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

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