PDF(Pubmed)
Abstract：
Sutureless anastomotic devices present several advantages over traditional suture anastomosis, including expanded global access to microvascular surgery, shorter operation and ischemic times, and reduced costs. However, their adaptation for arterial use remains a challenge. This review aims to provide a comprehensive overview of sutureless anastomotic approaches that are either FDA-approved or under investigation. These approaches include extraluminal couplers, intraluminal devices, and methods assisted by lasers or vacuums, with a particular emphasis on tissue adhesives. We analyze these devices for artery compatibility, material composition, potential for intimal damage, risks of thrombosis and restenosis, and complications arising from their deployment and maintenance. Additionally, we discuss the challenges faced in the development and clinical application of sutureless anastomotic techniques. Ideally, a sutureless anastomotic device or technique should eliminate the need for vessel eversion, mitigate thrombosis through either biodegradation or the release of antithrombotic drugs, and be easily deployable for broad use. The transformative potential of sutureless anastomotic approaches in microvascular surgery highlights the necessity for ongoing innovation to expand their applications and maximize their benefits.
摘要：
与传统的缝合吻合相比，无缝合吻合装置具有许多优点。包括扩大微血管手术的全球范围，更短的手术和缺血时间，并降低成本。然而,他们适应动脉使用仍然是一个挑战。这篇综述旨在全面概述FDA批准或正在调查的无缝线吻合方法。这些方法包括管腔外耦合器，管腔内装置,以及由激光或真空辅助的方法，特别强调组织粘合剂。我们分析这些装置的动脉相容性,材料组成,潜在的内膜损伤，血栓形成和再狭窄的风险，以及因其部署和维护而引起的并发症。此外,我们讨论了无缝线吻合技术的发展和临床应用所面临的挑战。理想情况下,无缝线吻合装置或技术应消除血管外翻的需要，通过生物降解或释放抗血栓形成药物来缓解血栓形成，并易于部署广泛使用。无缝合吻合方法在微血管手术中的变革潜力凸显了持续创新的必要性，以扩大其应用并最大化其利益。
