Microsurgical anastomosis of rat carotid arteries with the CO2 laser.

In order to further evaluate the role of lasers in microvascular tissue closure, we modified an existing CO2 surgical laser (Xanar XA-20) by adding a partially reflecting mirror to attenuate the beam. This allowed the laser to operate at an output of approximately 100 mW, which was appropriate to achieve microvascular closures. In each of 43 rats, one carotid artery was transected and then anastomosed with standard suture technique with 10 to 12 simple interrupted sutures of size 10-0 Ethilon nylon suture (Ethicon, Inc.). The opposite carotid in each rat was anastomosed by the placement of three stay sutures followed by the application of laser irradiation to the tissue between the stay sutures at 90 to 100 mW, spot size of 0.2 mm, pulse duration 0.2 seconds, approximately 20 to 30 pulses per anastomosis. In vivo test periods were 1 hour, 1 day, 3 days, 7 days, 10 days, 14 days, 28 days, 91 days, and 180 days. All anastomoses were evaluated for patency, and selected samples were utilized for light microscopy, and mechanical testing (intraluminal pressure raised to 300 mmHg). It was determined that similar patency rates and slightly faster time to perform the same procedure could be achieved with the use of the low-powered CO2 laser. However, histologic evidence of significant medial damage raises concern about the long-term risk of a higher aneurysm rate. Vessel damage and the lack of simple intraoperative methods to verify the quality of the laser technique restrict these authors from advocating the clinical introduction of the procedure until further advances are made.(ABSTRACT TRUNCATED AT 250 WORDS)

Ex vivo shunt testing of hydrogel-silicone rubber composite materials.

Hydrogel polymers consisting of HEMA (2-hydroxyethyl methacrylate) alone or co-polymerized with NVP N-(vinyl pyrrolidone) were incorporated into silicone rubber tubing to produce hydrophilic composite materials. Polymerization methods of the interpenetrating network (IPN) and radiation-induced type were used to impregnate the silicone rubber substrates. These methods produced materials with varied wettability (contact angle with water ranged from 57 degrees to 95 degrees) but similar texture. The surface morphology as observed in the scanning electron microscope was the same for all the materials. Four types of composite materials and two sizes of silicone rubber control tubing in a total of 19 dogs were used as ex vivo femoral artery-to-vein (A-V) shunts and were sampled at 5, 15, 30, 45, and 60 min. Data obtained by using scanning electron microscopy (SEM) were used to determine the type and amount of adhering blood cells at the time intervals described. Large platelet aggregates and/or a variable initial response were found to be predictors of shunt failure (occlusion). Most samples showed only varied levels of platelet adhesion, but other cell types were seen in some samples. The adhesion was found to peak in all cases by 30 min and to reach lower levels by 60 min, suggesting that an initial phase of reaction was complete. The course of platelet adhesion for a 60-min period is presented.