Diode laser-assisted carotid bypass surgery: An experimental study with morphological and immunohistochemical evaluations

Alfredo Puca, Alessio Albanese, Giuseppe Esposito, Giulio Maira, Barbora Tirpakova, Giacomo Rossi, Alice Mannocci, Roberto Pini

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: Conventional suturing methods of microvascular anastomosis are associated with various degrees of vascular wall damage that can lead to thrombosis and bypass occlusion. An experimental model of double end-to-side venous graft anastomosis on the common carotid artery was set up to compare conventional suturing methods with a low-power diode laser vascular welding technique. METHODS: The experiments were performed on 40 rabbits that underwent implantation of a 15-mm segment of jugular vein on the common carotid artery. The proximal end-to-side suture was performed by eight interrupted stitches; the distal suture, which was done using a laser welding technique, was supported by four stay sutures. The animals were evaluated after 2 days (n = 15), 9 days (n = 15), and 30 days (n = 10). The vascular segments were excised and subjected to histological, immunohistochemical, and ultrastructural evaluation. RESULTS: The average clamping time to perform both anastomoses was 35 minutes. At the end of the follow-up period, one case of complete occlusion was observed after 9 days and one case was observed after 30 days. Surgical observations and pathological evaluation indicated that adoption of the laser welding technique reduced operative time and bleeding. Histologically, a reduction of thrombosis, inflammation, myointimal hyperplasia, and dystrophic calcification was observed in laser-assisted anastomoses. A better preservation of the endothelium was also evident in laser-treated anastomoses. The observed differences were deemed statistically significant (P <0.05). CONCLUSION: Our study demonstrated the efficacy of diode laser welding in improving surgical techniques of high-flow bypass and in reducing the vascular wall damage observed with conventional methods.

Original languageEnglish
Pages (from-to)1286-1294
Number of pages9
JournalNeurosurgery
Volume59
Issue number6
DOIs
Publication statusPublished - Dec 2006

Keywords

  • Cerebral revascularization
  • Diode laser
  • Immunohistochemistry
  • Laser welding
  • Scanning electron microscopy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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