Preliminary experience with laser reinforcement of vascular anastomoses

Laser tissue soldering techniques allow reinforcement of sutured repairs and may be a useful adjunct in reducing anastomotic bleeding. Initial results of our clinical trial with laser solder reinforcement are reported. Twenty one patients underwent standard polytetraflourethylene (PTFE) graft arteriovenous fistula (AVF) creation. In all patients thrombin soaked gelatin sponges were placed around the anastomoses and in 10 laser reinforcement was accomplished. Three layers were used: KTP (532 nm, power density 4.1 W/cm2, sport size .5 cm), CO2 (10,600 nm, power density 14.1 W/cm2, spot size .3 cm), and diode (805 nm, power density 9.6 2w/cm2, spot size .2 cm). The solder consisting of 0.4 cc hyaluronate, 0.2 cc albumin, and 3 drops of the appropriate laser enhancing dye (fluorescein for KTP, indocyanine green for the diode, water for CO2) was applied to the target tissues prior to laser exposure. The laser was directed over the tissue in a sweeping motion until the solder had desiccated. Several lessons are evident from our experience. First, overexposure to the laser results in solder charring and ineffective reinforcement. Greater laser exposure with less undesired solder damage is achieved if dye is added to the solder. Second, the solder should be spread over the target in a thin layer to facilitate controlled desiccation and tissue bonding. Additional layers can be applied as required. Although improvements in the solder and laser technique are required, these early results demonstrate a potential clinical use for laser soldered reinforcement during vascular anastomoses.