Argon laser-welded arteriovenous anastomoses

This study compared the healing of laser-welded and sutured canine femoral arteriovenous anastomoses. Arteriovenous fistulas 2 cm in length were created bilaterally in the femoral vessels of 10 dogs and were studied at 1 (n = 2), 2 (n = 2), 4 (n = 3), and 8 (n = 3) weeks. In each animal, one anastomosis (control) was closed with running 6-0 polypropylene sutures, and the contralateral anastomosis (experimental) was sealed with an argon laser (0.5 watt, 4 minutes of exposure, 1830 J/cm²/1 cm length of anastomosis). At removal all experimental anastomoses were patent without hematomas, aneurysms, or luminal narrowing. Histologic examination at 4 weeks revealed that laser-welded anastomoses had less inflammatory response and almost normal collagen and elastin reorientation. At 8 weeks sutured anastomoses had significant intimal hyperplasia whereas laser repairs had normal luminal architecture. Tensile strength and collagen production, measured by the synthesis of hydroxyproline and the steady-state levels of type I and type III procollagen messenger ribonucleic acids, at the anastomoses and in adjacent vein and artery specimens were similar in sutured and laser-welded repairs at 2, 4, and 8 weeks. We conclude that argon laser welding of anastomoses is an acceptable alternative to suture techniques, with the advantage of improved healing without foreign body response and possible diminished intimal hyperplasia at the anastomotic line.