DIFFERENT TYPES OF SLEEVE ANASTOMOSIS

Microvascular techniques are important in making routine anastomoses q uicker and difficult anastomoses easier. The authors have developed th ree types of sleeve anastomoses for different size vessels: a three-st itch sleeve anastomosis, four-stitch sleeve anastomosis, and sidecut s leeve anastomosis. Arteriography, in vivo observation, pulsed ultrasou nd Doppler hemodynamic study, histology, and ultrastructural examinati on with scanning electron microscopy at 2 to 90 days demonstrated that all three groups of sleeve anastomoses do not stenose, do not show he modynamically significant vasospasm, and are not complicated by aneury sm formation by 90 days. The hemodynamics were comparable to control s utured anastomoses at 2 to 4 hr postoperatively. The sleeve anastomose s left no suture material within the vessel lumen. Reendothelializatio n was comparable with controls at 14 days, and the long-term patency r ates were similar (p > 0.05). The operative times for all three types of sleeve anastomoses were significantly shorter than sutured control anastomoses (p < 0.001). Although limited by available vessel length a nd diameter, the sleeve anastomosis is a useful technique for the micr osurgeon.