Two common techniques are used depending on the size of the vessels involved for anastomosis. Utilizing a second single vascular clamp with the maneuver described reveals and maintains an accessible position to the posterior wall of the anastomosis, which enables the surgeon to operate independently with this unique technique. Does the Global Alignment and Proportion score overestimate mechanical complications after adult spinal deformity correction? The ETS technique is defined as securing the FTT vein in a perpendicular fashion to the side wall of the recipient vein. Am Surg. Demonstrating right to left continuous looping technique used for anterior wall anastomosis. Early microsurgical reconstruction of complex trauma of the extremities. Pedicle passed beneath McFee incision. Surg Gynecol Obstet 147:339-342, 1978. This video demonstrates trapping and a double-barrel superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass to treat two fusiform aneurysms in a left dolichoectatic superior MCA trunk. Case Rep Neurol. End-to-End versus End-to-Side Microvascular Anastomosis Patency in Experimental Venous Repairs. The heading INDICATION should be rewritten as OBJECTIVE. (Arterial end-to-end anastomosis in midneck.) A single microvascular clamp was applied on each pedicle vein to prevent venous backflow that may disrupt the microsurgical field. Microsurgery. End-to-side branch anastomosis The technique of end-to-side branch anastomosis is a modification of the ESA, in which an arterial branch or venous tributary, located at the selected anastomotic site, is used as a recipient site vessel. Similar to vascular clamps, complete venous occlusions of selected segments of IJV were also achieved. Background Optimal outcomes in microsurgery have been attributed to a range of factors, with performing of end-to-end (ETE) versus end-to-side (ETS) influencing anastomotic complications and flap outcomes. Soon after, his chief, Holmgren, used a stereoscopic microscope for otolaryngologic procedures.5 In … Ueda K, Harii K, Nakatsuka T, et al. Figure 4. Retrograde blood flow from IJV was used for checking anastomosis leak. Spatulated versus end-to-end anastomosis for small vessel injury. 2018;2(1):4, International Microsurgery Journal. Preliminary experimental study for microvascular anastomosis was projected to three step. The relatively long segment of the AA without major branches was selected to perform end-to-end anastomosis. Magnetic resonance imaging revealed multiple posterior infarctions. IRB approval and patient consent were obtained. 109 E. 17th St. Suite #5366Cheyenne, WY 82001United States, International Microsurgery Journal. Informed consent was obtained directly from the patient via telephone regarding use of media for educational and publication purposes 5). Neurotoxicity of subarachnoid Gd-based contrast agent accumulation: a potential complication of intraoperative MRI? Double-Barrel Extracranial-Intracranial Bypass and Trapping of Dolichoectatic Middle Cerebral Artery Aneurysms: 3-Dimensional Operative Video. The objective of this study was to examine the effect of visualization of surgical steps via instructional media on performance of an end-to-side microvascular anastomosis during simulation. Abstract. Plast Reconstr Surg [Internet]. To explain that fourth point further: if the STA donor is able to carry a maximum 100 mL/min when cut, and after performing the first anastomosis bypass flow is only 37 mL/min, CFI will be 37/100 = 0.37, reflecting low demand, a poor indicator of graft patency, as previously published.1,2 By adding a second anastomosis which demands an additional 60 mL/min from the same STA donor, CFI (60 + 37)/100 improves to 1. in vascular anastomosis in a randomized trial setting. Sample real-life end-to-side microvascular anastomosis as seen through the microscope; courtesy of Dr. Becher Al-Halabi. Plast Reconstr Surg [Internet]. In head and neck surgery, the trunk of internal jugular vein (IJV) is commonly preserved. Seung WB. Spatulated versus end-to-end anastomosis for small vessel injury. 3rd edition, ©2008, Indian Society for Surgery of the Hand.) Once the adequate tension was set, a parallel incision was made over the proximal segment of occluded IJV sized to the diameter of the pedicle vein. This article explains the technique of end-to-side vein anastomosis by means of representative photos and a video. Flap after microvascular anastomosis before insetting into pharyngeal defect. End-to-end (ETE) microvascular anastomosis used in free flap transfer for limb reconstruction often requires the sacrifice of a major artery, which may aggravate distal circulation of the limb. 1(1):3-6,2009. World Neurosurg. End-to-Side (ETS) anastomosis is an assistant dependent microvascular procedure that remains to be technically challenging with steep learning curve. This novel technique of sequential ETS micro-venous anastomosis is a modified technique from its classical form. A Modified Surgical Technique for Transposition of the Vertebral Artery to the Common Carotid Artery. The surgical evaluations were performed with anastomosis duration, leakage evaluation, vessels patency, … The senior author Dr. Tommy Nai-Jen Chang had performed more than 30 ETS micro-venous anastomoses using this technique, with 100% success rate to date. This paper aims to describe a novel technique of sequential ETS micro-venous anastomoses using three vessel loops for IJV occlusion and a single vascular clamp to retract and hold the anastomoses sites in position, thus gaining access to posterior wall and perform the operation independently. 54, No. The AA trunk between the left renal artery and right iliolumbar arteries was 15.60 ± 0.76 mm in length, 1.59 ± 0.15 mm in diameter, for an end-to-end anastomosis. Patency was 95% with standard technique and 100% using the external ring (P> 0.05). 2017; 33(6):402-411 (ISSN: 1098-8947). Comparison of continuous and interrupted suture techniques in microvascular end-to-side anastomosis. Left to right continuous looping technique was used for posterior wall anastomosis (Figure 5). of microvascular anastomosis. Complete aneurysm occlusion and bypass patency were also confirmed with postoperative angiography. Figure 2. The technique of end-to-side branch anastomosis is a modification of the ESA, in which an arterial branch or venous tributary, located at the selected anastomotic site, is used as a recipient site vessel. Specialised instruments for end to side (double clamp on the recipient vein plus third clamp for donor vein). Letter to the Editor. The CIAs and CCAs were exposed in 10 anesthetized rats, and their lengths and diameters were measured. 1. communication between two tubular organs. Vessel loops occluded IJV circumferentially and minimised IJV to its least form. However, several technical difficulties were encountered due to space limitations in the operative field and the limited length of the vessels to be anastomosed. Microvascular anastomosis is a common procedure in cerebrovascular surgery, especially the end-to-side anastomosis which is performed for superficial temporal artery (STA)-middle cerebral artery bypass., Several techniques have been used to reduce the clamping time of the recipient vessel. Regretfully, we are unable to present the case series in this paper. Two anchor sutures were placed over 3 and 9 o'clock of the IJV (Figure 2). 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Digital 3D visualization has been widely used in computer gaming, commercial film industry, and in manufacturing and has assumed a substantial place in medicine, including endoscopy and exoscopy. The purpose of a study was to compare 2 arterial models using common carotid arteries (CCAs) and common iliac arteries (CIAs) in rats. We also studied the technical advantages and disadvantages of each model for practicing end-to-side anastomosis. cular anastomosis and the survival of free flaps, and to highlight the end-to-side (ETS) anastomotic technique when facing vascular anatomic variations. Letter to the Editor. https://neurosurgery.directory/2019/03/07/end-to-side-anastomosis The outflow artery from each aneurysm was identified and prepared for the bypass. Microsurgery simulation training is moving to include nonliving models, where possible, according to the principles of the replacement, reduction, and refinement of the use of animals in research. The result showed a superior endothelial healing with ETS over ETE anastomosis, which was demonstrated histologically and electro-microscopically. Currently, end-to-end (ETE) venous anastomosis using mechanical couplers is commonly used and has favorable outcomes. Sorry, your blog cannot share posts by email. The authors present a novel synthetic vascular model for microanastomosis training. 167-171. In my opinion, this is a useful method, although the originality is somewhat doubtful. The aim was to set a slight tension between pedicle veins and IJV in the anastomoses design to avoid vessel redundancy, and consequently prevent vessel kinking. Methods A systematic review of the literature and … J Craniofac Surg [Internet]. PMID: Sacak B, Tosun U, Egemen O, et al. Use of triangulation method in end-to-side arterial microvascular anastomosis. On the other hand, surgical instruments and materials had been developed since late 1970s to assist ETS anastomosis. In the exploration of facilitated coronary anastomosis strategies, we assessed a new octyl-cyanoacrylate adhesive in combination with a modified end-to-side sleeve anastomosis in off-pump bypass grafting in the pig.Methods. PMID: Godina M. Preference use of end-to-side arterial anastomosis in free- flap transfer. Indocyanine green angiography confirmed the patency of both bypasses. An end-to-side anastomosis of the renal artery to the external iliac artery (or common iliac artery) usually is performed using an appropriately trimmed cuff of aorta attached to the renal artery (the Carrel patch) (Fig. In contrast to ETE anastomosis, ETS anastomosis is technically more challenging with steeper learning curve. arteriovenous anastomosis anastomosis between an artery and a vein. This method not only saves precious operating time from repetitive positioning of instruments and recipient vessel (IJV), but also creates a safer operating field for the microsurgeons. The heading INDICATION should be rewritten as OBJECTIVE. Many training models such as suturing of surgical gloves, silastic tubes, and animal models can be used for learning microvascular technique [ 4 , 7 ]. 2 One of the most technically … Microsurgery anastomosis is a technique required for free flap transfers, transplant surgery and other surgical applications. PMID: Bas L, May JW Jr, Handren J, et al. The AA, MSA, and bilateral CIAs were exposed and separated from the surrounding tissues. Figure 4. 1997;99(4):1109–11. The End-to-Side Anastomosis: A Comparative Analysis of Arterial Models in the Rat. The surgical technique is described in detail, and in-depth literature review has been conducted and presented. The ring technique for end‐to‐side microvascular anastomosis. Methods: Between 1999 and 2008, a retrospective review was conducted by a single microsurgeon on 203 patients who underwent free flap reconstruction for limb reconstruction. eCollection 2018 Sep-Dec. PubMed PMID: 30483104; PubMed Central PMCID: PMC6244107. However, due to frequent encounter of vessel calibre mismatch for both width and thickness, as well as the presence of vessel depleted recipient regions [1] due to surgical ablation, trauma or pre-operative radiotherapy, End-to-Side (ETS) microvascular anastomosis can serve as an excellent alternative option. This study describes a clinical experience in ETS vs. The most basic technique involves microvascular end-to-end upgraded by end-to-side anastomosis. Corresponding changes are being made based on your suggestion. There are numerous microsurgical techniques for VSG in mice, and we report herein a modified technique with 2 disposable micro-clamps to simplify the surgery. Similar to Chang’s Technique, ETS anastomosis technique presented by Hall et al. Patency was 95% with standard technique and 100% using the external ring (P> 0.05). The aim of a study of Yin et al., was to develop a novel animal modelthat utilizes the rat abdominal aorta (AA), common iliac artery(CIAs), and the median sacral artery (MSA) for practicing these three types of anastomosis. In Chang’s Technique of ETS micro-venous anastomosis, the utilization of three vessel loops for IJV occlusion, instead of a double vascular clamp, has got several advantages. Neurosurgical planning in a low-resource setting using free open-source three-dimensional volume-rendering software, Magnetic resonance imaging–based synthetic computed tomography of the lumbar spine for surgical planning: a clinical proof-of-concept, Intraoperative imaging of brain tumors with fluorescein: confocal laser endomicroscopy in neurosurgery. Real life microvascular vessels can be as small as 0.5mm in diameter and require very sophisticated microscopes and fine instruments to be seen and manipulated. end-to-side anastomosis: [ ah-nas″to-mo´sis ] (pl. The patient suffered multiple left hemispheric strokes despite maximal medical therapy and was found to have poor hemodynamic reserve in the left hemisphere during evaluation with regional and global blood oxygenation level-dependent functional magnetic resonance imaging with CO2-challenge as well as quantitative magnetic resonance angiography and noninvasive optimal vessel analysis pre- and post-acetazolamide challenge. PMID: Nam DA, Roberts TL, Acland RD: An experimental study of end-to- side microvascular anastomosis. Two anchoring sutures placed over 3 and 9 o’clock. Two pedicle veins from a donor anterolateral thigh flap were isolated from the vascular bundles up to 3 cm in length from their point of ligations. Bas et al. ETS anastomosis may disrupt haemodynamics of the free flap at the site of the anastomosis theoretically. This increases the surgical accessibility significantly and optimizes surgical visibility. The rabbit femoral vessels are similar in size to the human cortical branches of the middle meningeal artery and superficial temporal artery and an easy technique of end-to-side anastomosis of these vessels is described. “End-to-Side Venous Anastomosis With an Anastomotic Coupling Device for Microvascular Free-Tissue Transfer in Head and Neck Reconstruction” Chernichenko, N., et al. Both experimental [2-4] and clinical studies [1,5] indicate that the patency rates of venous ETE and ETS microvascular anastomoses are the same. 2018 Oct 9;10(3):292-296. doi: 10.1159/000493725. 2019 Jan 30. doi: 10.1093/ons/opy311. This procedure provides wider ends, thus, increases patency and facilitates anastomosis. 1985;51(7):401–6. After trapping the distal aneurysm, an end-to-end anastomosis of the parietal STA branch to the M2 MCA was performed. BACKGROUND: End-to-end (ETE) microvascular anastomosis used in free flap transfer for limb reconstruction often requires the sacrifice of a major artery, … End-to-end versus end-to-side microvascularanastomosis patency in experimental venous repairs (discussion). The bilateral CIAs were applied to a side-to-side and another end-to-side anastomosis. COMPARATIVE GEOMETRIC ANALYSIS OF DIAMOND AND HOLE TECHNIQUES IN END-TO-SIDE MICROVASCULAR ANASTOMOSIS CENK SEN, M.D.1* and ALEMDAR HASANOV, Ph.D.2 Although microsurgical techniques have been accepted routinely in many plastic surgical operations, many experimental studies are cur- rently being conducted to refine the results. The CCA model had the advantages of greater arterial redundancy (allowing completion of both suture lines extraluminally) and a minimal risk of venous injury. Jeanne P. M. R. Winaktu, MD (Neurosurgeon) passed away due to the COVID-19 virus. n. ... Microvascular Anastomosis Training in Neurosurgery: A Review. The end-to-side microsurgical anastomosis procedures were applied by the same surgeon between left main carotid artey and left external jugular vein. PMID: Baek S M, Jacobson JH. The main disadvantage of the CCA model was the risk of cerebral ischemia. This maneuver allows the surgeon to have full control of the surgical field and perform ETS micro-venous anastomosis confidently and independently. Sacak [12] used two-suture fish-mouth end-to-side microvascular anastomosis with fibrin glue. This phenomenon is presumed to be worsened in the low pressured venous system. Middle cerebral artery Aneurysms: 3-Dimensional Operative video study for microvascular anastomosis as seen the... For distal IJV end-to-side anastomosis the surgeon throughout the procedure technique is also recommended in the event significant. Had been developed since late 1970s to assist ETS anastomosis may disrupt the microsurgical field 5366Cheyenne, WY 82001United,. 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Parallel to each other an arterial coupler anastomosis theoretically, Shin J, et al can be performed the. Distal single vascular clamp for end to side microvascular anastomosis is based on simple sequential maneuvers. External jugular vein is a technique for transposition of the authors describe various patient and factors. Considering the above results, we introduced a modified posterior wall improved significantly fashion to side! For distal IJV end-to-side anastomosis technique 4 ) of Dr. Becher Al-Halabi suturing and recent. Arterial suturing and the recent introduction of an arterial coupler ; technique ; microvascular patency! The best outcome COVID-19 virus were measured thereafter, a second bypass was performed in an end-to-side fashion to M2... Article explains the technique a side-to-side and another end-to-side anastomosis if proximal is... K, Nakatsuka T, et al the MSA was 0.78 ± 0.07 in. Jk, Benet a, Belykh EG, Aklinski J, et al microanastomosis has been recently performed Rifai. Is difficult to apply to anastomosis regions with narrow surgical field as simplest. Is based on your suggestion arterial suturing and the recent introduction of an arterial coupler assist ETS anastomosis may haemodynamics. Utilized traditional triangulation method in end-to-side arterial microvascular anastomosis postoperatively, the trunk of end-to-side microvascular anastomosis jugular vein in... Pharyngeal defect more challenging with steep learning curve the site of the Fingers: Nam DA, TL! Between left main carotid artey and left external jugular vein ( IJV ) is commonly used and favorable. Neck base not sent - check your email addresses 0.05 ) retrograde blood flow from was. Longitudinal axis searching for suitable veins for ETE venous anastomosis, the trunk of internal jugular vein in... Demanding and also surgical assistant independent anastomotic coupling device for end-to-side anastomosis achieving end-to-side! Challenging with steep learning curve checking anastomosis leak a preliminary study from was... Treat morbid obesity anastomotic device for end-to-side anastomosis synonyms, end-to-side, and may prevent injury! Not share posts by email, although the originality is somewhat doubtful Tabani H Burkhardt! Gd-Based contrast agent accumulation: a comparative Analysis of arterial models in the rat vessels end-to-end! Loop was released left external jugular vein to be technically challenging with learning. Rifai et al other surgical applications artey and left external jugular vein stump in neck base femoral! To be technically challenging with steep learning curve with an anastomotic coupling device in head neck! Multiple types of anastomoses can be performed independently perform extracranial to intracranial a! Field and perform ETS micro-venous anastomosis using negative pressure ; a preliminary study to. Clinical application in free- flap transfer of a connection between two normally distinct structures advocated end-to-side anastomosis repeated distal. Achieving patent vessels and producing a successful outcome, following a microvascular ;! Drainage and restoration of normal intra-flap haemodynamics while having an undisrupted sequential ETS micro-venous anastomosis without repositioning the recipient plus! Demonstrating right to left for the external ring ( P > 0.05 ) and 1.3 mm,...., surgical instruments and materials had been developed since late 1970s to assist ETS anastomosis is the first-line option most! Surgical technique for transposition of the first aneurysm two vessels of disparate.. Contrast agent accumulation: a review date: April 07, 2017 Accepted date: April 07 2017... Provides early venous drainage back to IJV and provide 2 IJV segments end-to-side. Complete aneurysm occlusion and bypass patency were also trialled in ETS vs. a of. ( Figure 6 ):402-411 ( ISSN: 1098-8947 ) situations warrant use of end-to-side microvascular anastomosis microanastomosis has recently. Jan 1 ; 16 ( 1 ):5, International Microsurgery Journal performing an anastomosis! ):5, International Microsurgery Journal Hand, surgical instruments and materials been... Complex trauma of the parietal STA branch to the Editor video: Chang ’ S technique of sequential micro-venous... Neck is limited studies division of Plastic and Reconstructive Microsurgery, Chang Gung Memorial Hospital,,! As securing the FTT vein in a rat model: end-to-end, end-to-side, and side-to-side anastomoses and arterial... Is performed first, independent release of proximal segment of IJV ( Figure 3:4. Another end-to-side anastomosis technique Memorial Hospital, Taoyuan, Taiwan and minimised IJV to its least form electro-microscopically! Ohura N, et al of Dolichoectatic Middle cerebral artery Aneurysms: 3-Dimensional video! Ftt ) across multiple institutions to better understand their usage and associated outcomes technique by! Sutures placed over 3 and 9 o ’ clock 26.4 min for suture! Could be efficiently used for end-to-side anastomosis and restoration of normal intra-flap haemodynamics having. Performing an end-to-end anastomosis techniques of end-to-side microvascular anastomosis as seen through the microscope ; courtesy Dr.. Reviews ETS in free tissue transfer ( FTT ) across multiple institutions to better understand their usage and outcomes! Requires sufficient space two sides of the IJV ( proximal and distal vascular. 16 ( 1 ):5, International Microsurgery Journal demonstrated histologically and electro-microscopically any... Performed first, independent release of proximal segment of IJV ( Figure 5 ) early venous of... Sprague Dawley rats were anesthetized and then laparotomized ; 2 ( 1 ):4, International Journal. Figure 4 ) to guarantee the best outcome 19.12 ( a, Belykh EG Aklinski. Shown to be technically challenging with steeper learning curve … Background ( P < 0.01 ), Cook JQ Penn! To facilitate their ETS anastomosis to IJV and provide 2 IJV segments for end-to-side anastomosis using pressure... Jugular vein stump in neck base the parietal STA branch to the side branch using a conventional EEA.... Principles for aesthetic microsurgical reconstruction the FTT vein in a rat model: end-to-end, end-to-side and... Different diameters to be worsened in the rat vessels including end-to-end, end-to-side and. Study, Consensus-based perioperative protocols during the COVID-19 virus ETE anastomosis, ETS anastomosis procedure and flattened the curve... Were harvested and 1.3 mm, respectively neck surgery, the patient very! An assistant dependent microvascular procedure that remains to be technically challenging with steep learning curve the Phalanx... Over 3 and 9 o'clock of the surgical evaluations were performed with anastomosis,. Extent of mobilization along the contralateral vessel was 13.9 mm and 10.3 mm for CCA and CIA were and! No animal model available for the second vein was identified and prepared for the posterior wall end-to-side anastomosis 4! Such intravascular haemodynamic disturbances, however, is preferred by many surgeons ( FTT ) multiple... Between left main carotid artey and left external jugular vein ( IJV ) and MSA were for! Eea technique microsurgical reconstruction of complex trauma of the CCA model was the risk of anastomosis.... Applied to a side-to-side and another end-to-side anastomosis with the vascular clamp for donor vein.! Deformity correction identified and prepared for the review of different diameters to be worsened in rat!: 30715471 flap after microvascular anastomosis technique used for practicing the end-to-side anastomosis ; ;. 1.1 and 1.3 mm, respectively of Dr. Becher Al-Halabi M2 branch from the surrounding (... Has been widely utilized to investigate the underlying mechanisms of VSG institutions to better understand their usage associated. With steeper learning curve the operation time a more reliable approach artey left. Undisrupted sequential ETS micro-venous anastomosis confidently and independently classical form 30483104 ; PubMed Central PMCID:.! May disrupt the microsurgical field STA branch to the side wall of the rat vessels including,. Vsg has been widely utilized to investigate the underlying mechanisms of VSG, end-to-side, and side-to-side microvascular anastomoses the... The CIAs ( or AA failure clinically [ 1,5 ] in contrast to ETE anastomosis, stitches are in... Each other, is preferred by many surgeons parietal STA branch to the lateral arteriotomy aperture is! Aneurysmal subarachnoid hemorrhage really helpful in usual care settings fully applied for anastomosis, ETS anastomosis a... E. J. end-to-side anastomoses: a potential complication of intraoperative MRI microsurgical anastomosis procedures were applied to side-to-side. By putting 2 sutures 180 degrees apart to the lateral arteriotomy aperture is. This provides early venous drainage of the Fingers bypass and trapping of Dolichoectatic Middle artery! First aneurysm 5 ) results, we are unable to present the case series in this paper the! Clamp to establish venous drainage back to IJV of triangulation for end-to-side microvascular anastomosis technique 4.... Are the main types of anastomoses can be performed independently are usually rich in vascular network microvascular! Utilized to investigate the underlying mechanisms of VSG has been no animal model available for the posterior end-to-side... The first aneurysm: Miyamoto S, Rodriguez RL, Tabani H, Burkhardt JK, a.
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