Venous Thrombosis in Coupled Versus Sutured Microvascular Anastomoses

In Brief Background: The anastomotic coupling device (ACD) is currently used for microsurgical venous anastomoses as an alternative to sutures and can reduce anastomotic time. Methods: We reviewed the microsurgical procedures performed at the University of Texas M. D. Anderson Cancer Center over a 40-month period. Procedures were performed for elective reconstruction of the breast, head or neck, or extremities after tumor excision. Thrombosis and ultimate flap salvage rates were compared between cases using ACDs and those using sutures for the venous anastomoses. Results: Seven hundred twenty-three free flaps were included in the study. There were no intraoperative technical complications using the ACD. Overall, the venous thrombosis rates were not significantly different between the ACD (1.4%, 2/139 cases) and sutured (3.3%, 19/584 cases) groups. Salvage rates following venous thrombosis were not significantly different for venous anastomoses performed with an ACD (50%, 1 of 2 cases salvaged) compared with venous anastomoses performed with sutures (68.4%, 13 of 19 cases salvaged). Conclusion: The ACD is a useful alternative to sutured venous anastomoses that can reduce anastomotic time while achieving similar patency rates. A review of 723 free flaps showed that venous anastomoses were performed with sutures in 584 cases and with an anastomotic coupling device in 139. Thrombosis rates were not significantly different between the 2 groups, nor were salvage rates on re-exploration.