Background: Microvascular coupling devices are a common tool in the armamentarium of reconstructive microsurgeons, primarily used for venous anastomoses. Coupled anastomoses have several advantages over traditional hand-sewn anastomoses including complete absence of suture material in the lumen, ability to handle size discrepancies and most importantly, significant time savings. For patients with extensive peripheral arterial disease requiring bypass, autologous venous conduits are preferred over synthetic ones such as PTFE or Dacron. In patients who require a “long” or distal bypass, more than one vein segment may be required to provide adequate conduit length. We describe use of the microvascular coupling device to perform veno-venostomies for the creation of appropriate autologous vein bypass graft conduits with greater ease and less time than suture anastomosis of the vessels.
Methods: Three patients were evaluated by the Vascular Surgery service and deemed candidates for femoral-distal arterial bypass. In each case, the patient was a poor candidate for bypass with synthetic material because of history of prior infected bypass graft in the affected limb. To perform these “long” arterial bypasses, autogenous vein conduits were created from a combination of either the basilic, cephalic and/or greater saphenous veins. On a back table, the harvested veins were coupled using the Synovis® device. A standard femoral-distal bypass was then performed using the coupled vein conduits.
Results: The first patient required 3 upper extremity veins to achieve adequate bypass graft length. To create this basilic-to-cephalic-to-cephalic vein conduit, two veno-venostomies were fashioned each with a 4mm Synovis® coupling ring. The second patient received a basilic-to-cephalic vein conduit. This veno-venostomy was performed with a 3.5mm coupling ring. For the final patient, right and left greater saphenous veins were coupled with a 4mm ring. The average time of veno-venostomy (including vessel preparation) was 3.5 minutes. All patients had patent bypass grafts at 2 months post-operatively without symptoms of rest pain or claudication.
Conclusion: We describe a novel use of the microvascular coupling device with applicability outside the typical realm of reconstructive microsurgery. Arterial bypass grafts using autogenous vein with coupled veno-venostomies have proven patent and durable in a short follow-up period. Further long term patency studies are underway.