NONOCCLUSIVE EXCIMER LASER-ASSISTED END-TO-SIDE ANASTOMOSIS

Background. High-flow extraintracranial bypass operation on the brain is a risky procedure because of the temporary occlusion of the intracr anial portion of the internal carotid artery. We therefore developed a nonocclusive anastomosis technique in the experimental animal laborat ory in 100 chronic and acute experiments in rabbits. Methods. In 40 pa tients we interposed a venous transplant between the external carotid artery or one of its branches and the intracranial portion of the inte rnal carotid artery. During the construction of the distal anastomosis the recipient artery was not occluded. The donor vessel was stitched to the exterior of the recipient vessel and an Excimer laser catheter (Medolas GmbH, Amberg, Germany) was introduced by way of an artificial side branch. The tip of the laser catheter created a hole in the wall of the recipient artery just inside the anastomosis. The cut-out full -thickness portion of recipient vessel wall remained attached to the t ip of the laser catheter by way of high vacuum suction and was removed together with the laser catheter. The artificial side branch was occl uded with a hemostatic clip. No interruption of blood flow in the reci pient artery was induced during the making of the anastomosis. Results . The procedure was well tolerated by the patients and a high patency rate was observed. Conclusions. The nonocclusive Excimer laser-assiste d anastomosis technique is safe and yields a high longterm patency rat e in neurosurgical patients. It cannot be excluded that there are indi cations for this method in coronary bypass surgery. (C) 1997 by The So ciety of Thoracic Surgeons.