The goal of this study was to establish an easier and shorter method of microvascular anastomosis using the Arista hemostatic agent. Arista is a polysaccharide hemostatic product that absorbs water and low-molecular weight compounds from the blood and thus concentrates the platelets and clotting proteins on the surface of the vascular bed, thereby enhancing endogenous clotting mechanisms. Rat carotid arteries were clamped, divided and repaired using conventional microsurgical technique with eight interrupted10-0 Nylon suture (Control Group) or with three simple interrupted 10-0 Nylon stay sutures and Arista powder (Arista Group). The two groups were evaluated for (1) anastomosis time (2) patency after 1 hour, 24 hours, and 28 days, and (3) histology.
The results revealed that there was no statistically significant difference between the patency rates of the two groups. The anastomosis time was, however, significantly less for the Arista group as compared with the control group (12 vs. 21 minutes). Histological evaluation of the Arista group revealed qualitatively less perivascular foreign-body giant cell reaction than the control group. Furthermore, there was no evidence of vascular mural fibrinoid necrosis, indicating that Arista was nontoxic for the vessel walls.
The conventional suture technique for microvascular anastomosis is difficult for beginners, time consuming, and may cause trauma to the vessel wall. To this end, alternative methods such as mechanical devices, laser welding, and tissue adhesives have been used. This study nicely supports the concept that Arista may be used for microvascular anastomosis with reduced clamp times, ease of use, and equivalent patency rates as compared with the gold-standard suture method in the rat carotid artery. Certainly, more studies will be needed to determine this methods tensile strength, efficacy in larger caliber vessel anastomosis, anastomosis of veins, and post-operative hematoma rates prior to the commencement of clinical