Microvascular Coupler–Induced Intimal Crimping Causing Venous Thrombosis

Utilization of the microvascular coupler (GEM Coupler, Synovis Micro Companies Alliance, Birmingham, AL)[1] for venous anastomosis in free tissue transfer has become the standard practice for many surgeons with success rates reaching 98.5%.[2] The risk of venous thrombosis increases with the use of couplers smaller than 2.0 mm.[3] The benefits of use include ease of application, speed of anastomosis, and possible stenting of the venous anastomotic site open for reliability. The coupler is indicated for vessels ranging in diameter from 0.8 to 4.5 mm, with a wall thickness of up to 0.5 mm.

We describe two cases wherein the venous coupler was applied and subsequent microvascular thrombosis of the anastomotic site was seen, and attributed primarily to the crimping of the intima causing clot and ensuing venous collapse.

• References

• 1 Synovis Micro Companies Alliance.. Birmingham, AL: GEM Microvascular Anastomotic COUPLER Device and System. 2012
• 2 Ardehali B, Morritt AN, Jain A. Systematic review: anastomotic microvascular device. J Plast Reconstr Aesthet Surg 2014; 67 (6) 752-755
• 3 Broer PN, Weichman KE, Tanna N , et al. Venous coupler size in autologous breast reconstruction-does it matter?. Microsurgery 2013; . doi: 10.1002/micr.22169
• 4 Dorafshar AH, Januszyk M, Song DH. Anatomical and technical tips for use of the superficial inferior epigastric artery (SIEA) flap in breast reconstructive surgery. J Reconstr Microsurg 2010; 26 (6) 381-389