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. 2014 Oct 21:5:153.
doi: 10.4103/2152-7806.143366. eCollection 2014.

Usefulness of continuous suture using short-thread double-armed micro-suture for cerebral vascular anastomosis

Sei Haga  1 , Shinji Nagata  1
Affiliations

Usefulness of continuous suture using short-thread double-armed micro-suture for cerebral vascular anastomosis

Sei Haga et al. Surg Neurol Int. .

Abstract

Background: When microvascular anastomosis is performed in a deep, narrow operating field, securing space to throw knots is difficult. To simplify the procedure and avoid obstruction of the anastomosis, we use a continuous suturing with short-thread double-armed micro-suture.

Methods: Sixty-four patients (38 cerebral revasculazation, 16 moyamoya disease, and 10 aneurysm surgery) undergoing microvaucular anastomosis were included. During anastomosis, a continuous suture was placed with short-thread double-armed micro-suture.

Results: During 64 microanastomosis procedures, 64 consecutive continuous sutures were performed with 1-year follow up. All patients showed patency of anastomosis with long-term follow up.

Conclusions: This technique is especially useful for anastomosis in a deep, narrow surgical field, such as in superior cerebellar artery anastomosis.

Keywords: Anastomosis; continuous suture; double-armed micro-suture.

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Figures

Figure 1
Figure 1
Photograph of short-thread double-armed microsuture (6 cm 10-0 nylon with a needle at both ends)
Figure 2
Figure 2
Intraoperative photographs of superficial temporal artery-middle cerebral artery anastomosis and schemas showing microanastomosis with short-thread double-armed microsuture. (a) Microsuture insertion. Out-in for donor artery, In-out for recipient artery. (b) Mattress sutures are placed for anchoring. This technique causes eversion of the vessel ends for attachment of recipient endothelium to the donor artery. (c) Running suture is placed without the “purse string” and puckering effects. (d) Vessel ends are visualized with pyoctanin (crystal violet) for attachment of endothelium. (e) Patency of anastomosis is confirmed by indocyanine green videoangiography
Figure 3
Figure 3
Illustrative Case: External carotid artery-superior cerebellar artery bypass with a saphenous vein graft (ECA-SV-SCA bypass). (a) Preoperative three-dimensional computed tomographic angiography. (b) Preoperative angiography of vertebral artery, right. (c) Intraoperative photographs of ECA-SV-SCA bypass. (d) ECA-SV-SCA with indocyanine green videoangiography. (e) Postoperative angiography of vertebral artery, right
See this image and copyright information in PMC

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