Microvascular anastomosis with minimal suture and Arista: an experimental study.

Background: The conventional technique of microvascular anastomosis may cause trauma to the vessel wall. In addition, the technique is difficult for beginners and is time consuming. The duration of ischemia is an important limiting factor for muscle transfer. In the case of multiple-digit replantations, fatigue developed in the surgeon may also result in suboptimal results. This study was performed to establish an easier and shorter method of microvascular anastomosis using the Arista hemostatic agent.

Methods: In this study, 20 carotid arteries obtained from rats were equally divided into two groups. The arteries were then divided and repaired using three simple interrupted stay sutures with Arista powder. Evaluations were performed using the following three methods: (1) clamping time during the vessel anastomosis, (2) patency test (after 1 hour, 24 hours, and 28 days), and (3) light microscopic findings.

Results: The clamping time in the conventional suture anastomosis group was 21+/-4 minutes, whereas that of the minimal suture in the Arista group was 12+/-2 minutes; the difference between the two groups was statistically significant (P<.001). There was no significant difference between the patency rates of the two groups (P= .474). It was observed that the Arista group showed qualitatively less perivascular foreign-body giant cell reaction than the control group. There was no evidence of vascular mural fibrinoid necrosis, indicating that Arista was nontoxic for the vessel walls.

Conclusions: The Arista-assisted microvascular anastomosis is an alternative to the conventional suture-only method because it reduces the anastomosis time significantly and does not cause narrowing of the vessel wall. We believe that this technique has the potential for improving the performance of microvascular anastomosis in clinical practice.