Couplers in Arterial and Venous Repairs

p r w In B ri ef FOLLOWING ALEXIS CARREL’S 1902 description of the first successful arterial anastomosis, continued refinement of the technique has led to reproducible results and expanding applications beyond his initial goal of organ transplantation. Atraumatic couling of vessels of varying size is the cornerstone of icrovascular surgery. Carrel emphasized principles of essel handling, use of sharp round needles, vessel riangulation, and irrigation with crystalloid. These enets laid the foundation for cardiovascular surgery, imb revascularization, free tissue transfer, and replanation of amputated parts. Traditional sutured microvascular anastomosis inolves vessel stump preparation through sharp transecion and adventitia removal, stump positioning for adquate visualization and atraumatic manipulation, and assage of monofilament microsuture (usually 8-0 to 1-0) on round-bodied needles without cross-stitching he lumen or tearing the intima. Following a steep earning curve to master the technique, even a skilled icrosurgeon finds this process time consuming and is ntermittently humbled by thrombosis and anastomosis ailure. Reported suture anastomosis failure rates rangng from 2% to 10% persist from reputable microvasular centers. Proposed sources of failure include ntraluminal exposure of foreign material (suture), indequate vessel wall eversion with exposed intralumial adventitia, uneven suture placement or cross-stitchng (back-walling) of lumen, luminal stenosis from mprecise bites, and tension. In 1962, Nakayama et al described the first microascular ring coupling device, which consisted of 2 metal ings with 12 interlocking metal pins and reciprocating oles. The vessel ends are passed through the ring and verted at a 90° angle, thereby impaling the vessel all on the protruding pins before pressing the rings