Sutureless microvascular anastomosis using a neodymium-yag laser.

A technique is described in which a Neodymium-YAG laser is used to anastomose arteries 0.8 to 1.0 mm in diameter. Heat generated by the laser causes fusion of the collagen of the media, making direct handling of the vessel wall unnecessary. Four variations of the technique were performed in 120 rat carotid arteries. Angiographic and scanning electron microscopic studies were carried out immediately after surgery and at intervals of 1 day to 6 months after anastomosis. Patency rates as high as 92.5% were recorded. The technique that produced the most secure anastomosis was considered to be one in which a vascular strut was used as an aid in apposition, followed by the application of a piece of vein wall to the anastomosis with tissue adhesive. The main advantages of the laser technique are speed and consistency. Complications such as disruption and aneurysm formation are considered to be rare.