Experimental Studies in Surgery of Small Blood Vessels

Abstract

ASTOMOSIS by suturing, patching, and shunt ing of small arteries and veins 4 ram. or less in external diameter car ry a high incidence of failure because of constrict ion and thrombosis, as compared to vessels of larger d iameter (5-6 ram. and larger). I t is true t ha t Seidenberg et al. 12 repor ted excellent results by meticulous direct anastomosis of small arteries with sutures, using 7-0 braided silk. 13 However, application of this technique to surgery of intracranial vessels presents additional difficulties, such as: (1) difference in structure of cerebral arteries ~ as compared to extraeerebral vessels, with less adventit ia, reduced media, absent external elastic membrane , ~ and minimal suppor t by surrounding tissues; (~) the presence of perforat ing branches precluding rota t ion; (3) l imitation of t ime of vascular occlusion (even with the use of hypothermia) ; and (4) lack of maneuverabi l ity. With a few exceptions, u,15 patency of the a r te ry has been lost, or could not be reestablished, following such a t t empts in m a n . 8-11,14,15