Suturless Method Joins Blood Vessels End-to-End

A new study describes a novel procedure that uses a poloxamer gel and a bioadhesive to join blood vessels in vascular anastomosis.

Researchers at the Stanford University School of Medicine (CA, USA), led by microsurgeon Geoffrey Gurtner, MD, developed the new method of suturless and atraumatic vascular anastomosis based on the properties of a thermo-reversible tri-block poloxamer; the poloxamer becomes solid and elastic when heated above body temperature, but dissolve harmlessly into the bloodstream when cooled. The poloxamer is heated using used a simple halogen lamp, thus distending both openings of a severed blood vessel, allowing the researchers to glue them together precisely using Dermabond, a surgical sealant made by Ethicon (Somerville, NJ, USA).

Using this technique, the researchers were able to perform end-to-end anastomoses five times more rapidly than hand-sewn controls, and vessels that were too small (less than one mm) to sew were successfully reconstructed with the suturless approach. Subsequent imaging of a reconstructed rat aorta confirmed equivalent patency, flow, and burst strength, and histological analysis demonstrated decreased inflammation and fibrosis at up to two years after the procedure. The study was published early online on August 28, 2011, in Nature Medicine.

“When you're bringing together hollow tubes, whether they're large structures, like the colon or the aorta, or a small structure, like a vein in the finger of a child, you're always worried about lining them up directly and effectively sealing them,” said study coauthor Michael Longaker, MD. “The technique that Dr. Gurtner has pioneered could allow surgeons to perform anastomosis more quickly and with improved precision. Coming up with this solution was the result of the classic Stanford model of bringing together researchers from a variety of disciplines.”

A poloxamer is a synthetic block copolymer of ethylene oxide and propylene oxide. They are often used as surfactants, emulsifiers, stabilizers, and food additives.

Related Links:
Stanford University School of Medicine
Ethicon