Sutureless vascular anastomotic approaches and their potential impacts

• Published in: Bioactive materials Vol. 38; pp. 73 - 94
• Main Authors: Ribaudo, Joseph G., He, Kevin, Madira, Sarah, Young, Emma R., Martin, Cameron, Lu, Tingying, Sacks, Justin M., Li, Xiaowei
• Format: Journal Article
• Language: English
• Published: China Elsevier B.V 01.08.2024; KeAi Publishing Communications Ltd; KeAi Publishing; KeAi Communications Co., Ltd
• Subjects: Anastomosis; Anastomotic device; Biodegradation; Coronary vessels; Cost reduction; Drug delivery; Elasticity; FDA approval; Ischemia; Microsurgery; Microvasculature; OUTLINE; Patency; Reconstructive surgery; Restenosis; Review; Smooth muscle; Success; Surgeons; Surgery; Sutureless; Sutures; Thrombosis; Tissue adhesive; Trouble shooting; Vascular; Veins & arteries; Patency; OUTLINE; Vascular; Tissue adhesive; Sutureless; Anastomotic device
• ISSN: 2452-199X; 2097-1192; 2452-199X
• DOI: 10.1016/j.bioactmat.2024.04.003

Sutureless anastomotic devices present several advantages over traditional suture anastomosis, including expanded global access to microvascular surgery, shorter operation and ischemic times, and reduced costs. However, their adaptation for arterial use remains a challenge. This review aims to provide a comprehensive overview of sutureless anastomotic approaches that are either FDA-approved or under investigation. These approaches include extraluminal couplers, intraluminal devices, and methods assisted by lasers or vacuums, with a particular emphasis on tissue adhesives. We analyze these devices for artery compatibility, material composition, potential for intimal damage, risks of thrombosis and restenosis, and complications arising from their deployment and maintenance. Additionally, we discuss the challenges faced in the development and clinical application of sutureless anastomotic techniques. Ideally, a sutureless anastomotic device or technique should eliminate the need for vessel eversion, mitigate thrombosis through either biodegradation or the release of antithrombotic drugs, and be easily deployable for broad use. The transformative potential of sutureless anastomotic approaches in microvascular surgery highlights the necessity for ongoing innovation to expand their applications and maximize their benefits. [Display omitted] •Summarizing sutureless anastomotic devices currently approved by the FDA.•Exploring extraluminal and intraluminal devices, laser- and vacuum-assisted methods, and tissue adhesives.•Comparing sutureless anastomotic devices, focusing on intima damage and thrombosis risk.•Highlighting the challenges in developing sutureless anastomotic techniques in clinical settings.