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Vascular anastomosis using controlled phase transitions in poloxamer gels


Vascular anastomosis is the cornerstone of vascular, cardiovascular and transplant surgery. Most anastomoses are performed with sutures, which are technically challenging and can lead to failure from intimal hyperplasia and foreign body reaction. Numerous alternatives to sutures have been proposed, but none has proven superior, particularly in small or atherosclerotic vessels. We have developed a new method of sutureless and atraumatic vascular anastomosis that uses US Food and Drug Administration (FDA)-approved thermoreversible tri-block polymers to temporarily maintain an open lumen for precise approximation with commercially available glues. We performed end-to-end anastomoses five times more rapidly than we performed hand-sewn controls, and vessels that were too small (<1.0 mm) to sew were successfully reconstructed with this sutureless approach. Imaging of reconstructed rat aorta confirmed equivalent patency, flow and burst strength, and histological analysis demonstrated decreased inflammation and fibrosis at up to 2 years after the procedure. This new technology has potential for improving efficiency and outcomes in the surgical treatment of cardiovascular disease.

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Figure 1: Thermoreversible properties of poloxamer nanogel.
Figure 2: Thermoreversible poloxamer nanogel and cyanoacrylate glue sutureless anastomoses in vivo.
Figure 3: Poloxamer nanogel anastomoses show long-term patency, flow and equivalent burst strength in vivo.
Figure 4: Poloxamer nanogel anastomoses show less vascular intimal damage.

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We thank C. Zarins for providing use of his laboratory burst strength apparatus. We also thank T. Doyle for assistance in small-animal imaging (Stanford Center for Innovation in In-Vivo Imaging) and Y. Park for expert technical assistance. This work was supported by a Stanford Bio-X Interdisciplinary Initiatives Research Award (to G.G.F. and G.C.G.).

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Authors and Affiliations



E.I.C. was responsible for experimental design and data analysis, and wrote the manuscript. M.G.G. designed experiments, analyzed data and wrote the manuscript. J.P.G. analyzed data and wrote the manuscript. C.D.H. designed experiments and analyzed data. S.E. performed imaging studies and analyzed data. C.T.R. and J.R. designed poloxamer experiments and analyzed data. K.-M.S. designed poloxamer experiments. O.J.A. was responsible for burst strength experimental design and data analysis. G.G.F. supervised poloxamer experiments and data analysis. M.T.L. provided ideas and wrote the manuscript. G.C.G. supervised all aspects of this work and wrote the manuscript.

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Correspondence to Geoffrey C Gurtner.

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The authors declare no competing financial interests.

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Chang, E., Galvez, M., Glotzbach, J. et al. Vascular anastomosis using controlled phase transitions in poloxamer gels. Nat Med 17, 1147–1152 (2011).

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