Reconnecting severed blood vessels is mostly done the same way today — with sutures — as it was 100 years ago, when the French surgeon Alexis Carrel won a Nobel Prize for advancing the technique. Now, a team of researchers at the Stanford University School of Medicine has developed a sutureless method that appears to be a faster, safer and easier alternative. In animal studies, a team led by Stanford microsurgeon Geoffrey Gurtner, MD, used a poloxamer gel and bioadhesive rather than a needle and thread to join together blood vessels, a procedure called vascular anastomosis. Results of the research are published online Aug. 28 in Nature Medicine. Lead authors of the study were Stanford postdoctoral scholar Edward Chang, MD, and surgery resident Michael Galvez, MD.
The big drawback of sutures is that they are difficult to use on blood vessels less than 1 millimeter wide. Gurtner began thinking about alternatives to sutures about a decade ago. “Back in 2002, I was chief of microsurgery at Bellevue in New York City, and we had an infant — 10 to 12 months old — who had a finger amputated by the spinning wheel of an indoor exercise bike,” said Gurtner, senior author of the study and professor of surgery. “We struggled with reattaching the digit because the blood vessels were so small — maybe half a millimeter. The surgery took more than five hours, and at the end we were only able to get in three sutures.
“Everything turned out OK in that case,” he continued. “But what struck me was how the whole paradigm of sewing with a needle and thread kind of falls apart at that level of smallness.”
Sutures are troublesome in other ways, too. They can lead to complications, such as intimal hyperplasia, in which cells respond to the trauma of the needle and thread by proliferating on the inside wall of the blood vessel, causing it to narrow at that point. This increases the risk of a blood clot getting stuck and obstructing blood flow. In addition, sutures may trigger an immune response, leading to inflamed tissue that also increases the risk of a blockage.
The new method could sidestep these problems. “Ultimately, this has the potential to improve patient care by decreasing amputations, strokes and heart attacks while reducing health-