J Reconstr Microsurg 2007; 23(1): 045-050
DOI: 10.1055/s-2006-958702
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of Experimental Microvascular End-to-End Anastomosis via VCS®-Clips versus Conventional Suture Technique in an Animal Model

M. Klöppel1 , C. Tudor1 , L. Kovacs1 , N.A. Papadopulos1 , C. Höhnke1 , I. Himsl1 , N.T. Hoang1 , E. Biemer1
  • 1Department of Plastic and Reconstructive Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
Further Information

Publication History

Accepted: August 4, 2006

Publication Date:
17 January 2007 (online)

ABSTRACT

In this experimental study on 96 CD rats, microvascular end-to-end anastomoses created via suture or alternatively by means of a VCS®-Clip-Application-System, were compared. The aorta abdominalis of the animals, with a diameter of 1.5 ± 0.2 mm, was experimentally dissected, and the free ends of the vessel then anastomosed. The results were evaluated using sonography, microangiography, histologic examination, and vascular imprints. Postoperative examination was carried out after 1, 3, 7, 14, or 30 days. Major advantages of the VCS®-Clip technique over suturing were that it was easy to learn, significantly faster to perform (execution of anastomosis 10.9 ± 2.6 min versus 19.4 ± 5.0 min), and produced significantly more favorable histologic results in terms of less inflammatory response, foreign body reaction, necrosis of the tunica media, hyperplasia of the intima, and thrombosis of the vessel lumen. The main disadvantage of the clip technique was a significantly higher rate of stenoses (15.8 ± 6.0 versus 4.1 ± 6.6 percent).

REFERENCES

  • 1 Boeckx W D, Darius O, van den Hof B, van Holder C. Scanning electron microscopic analysis of the stapled microvascular anastomosis in the rabbit.  Ann Thorac Surg. 1997;  63 128-134
  • 2 Ducasse E, Basseau F, Puppinck P, Baquey C. Can minimal arterial aggressions using non-penetrating mechanical clip suture prevent myo-intimal hyperplasia? Preliminary results.  J Mal Vasc. 2001;  26 50-54
  • 3 Gerbault O, Arrouvel C, Servant J M, Revol M, Banzet P. VCS microclip anastomosis on blood vessels of less than 2 millimeters in diameter. Preliminary experimental study in the rat.  Ann Chir Plast Esthet. 1998;  43 27-39
  • 4 Pauli S. Lauwers P: Stapled versus hand-sewn vascular anastomoses. An experimental study in the rabbit.  Eur Surg Res. 2000;  32 39-42
  • 5 Östrup L T, Fredrickson J M. Microvascular surgery.  Scand J Plast Reconstr Surg. 1976;  10 18-28
  • 6 Biemer E, Duspiva W. Rekonstruktive Mikrogefäßchirurgie. Berlin, Heidelberg: Springer Verlag 1982: 3-142
  • 7 Liebermann-Meffert D MI, Meier R, Siewert R J. Vascular anatomy of the gastric tube used for esophageal reconstruction.  Ann Thorac Surg. 1992;  54 1110-1115
  • 8 Zeebregts C J, Kirsch W M, Reijnen M M, Zhu Y H, van den Dungen J J. Expanding use of nonpenetrating clips in various surgical specialities.  Surg Technol Int. 2005;  14 85-95
  • 9 Birth M, Geberding J, Markert U, Wohlschlager C, Brugmans F, Bruch H P. Biliary end-to-end anastomosis with extramucosal titanium clips. Initial results with a new technique.  Zentralbl Chir. 2000;  125 990-996
  • 10 Findlay J M, Megyesi J F. Carotid arteriotomy using a vascular clip system.  Neurosurgery. 1998;  42 550-553
  • 11 Yamamoto N, Nakai H, Satoh Y, Oshima Y. Clinical application of a nonpenetrating microvascular stapling device for vascularized free tissue transfer.  Ann Plast Surg. 1999;  42 49-55

Laszlo KovacsM.D. 

Department of Plastic and Reconstructive Surgery, Klinikum rechts der Isar, Technical University Munich

Ismaninger Str. 22, 81675 Munich, Germany

    >