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<p>Microvascular anastomosis is fundamental to free-flap reconstruction, yet hand-sutured techniques remain highly skill-dependent and prolong ischemic time, contributing to thrombosis and flap loss. Current suture-less devices accelerate anastomosis but are constrained by vessel-size mismatch, eversion-related intimal injury, and inconsistent arterial performance. A clinically adaptable, arterial-capable system is needed. We developed a customizable, 3D-printed intraluminal coupler with a snap-fit connection and elastic external clasp that avoids vessel eversion and preserves length. Devices were fabricated via SLA or PolyJet printing using clinically used resins. Benchtop evaluation included burst-pressure testing, tensile testing, wettability and endothelial cytocompatibility assays with oxygen-plasma surface modification. Deployment was assessed ex vivo using porcine coronary vessels and in vivo in a porcine carotid arterial model with patency monitoring over 4&#xa0;h. Couplers sustained leakage pressures of ~ 90 mmHg vs. ~16 mmHg for hand-sutured controls (<i>P</i> &lt; 0.01), while maintaining comparable mechanical strength (≈ 2–3&#xa0;N). Plasma surface treatment reduced water contact angles (≈ 85°→≈60°) and tripled endothelial attachment, restoring confluent morphology. Ex vivo deployment achieved completion in 9.47 ± 1.20&#xa0;min, a ~ 62.5% reduction vs. published suturing times. In vivo, couplers restored immediate perfusion with no leakage or thrombosis. This 3D-printed intraluminal coupler demonstrates mechanical feasibility, rapid deploy-ability, and surface-modifiable endothelial compatibility in benchtop and short-term large-animal feasibility testing, supporting its potential for further preclinical development as a vascular anastomosis technology. Future survival studies and anti-thrombogenic surface engineering will advance readiness for clinical implementation.</p>

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In vitro and in vivo validation of a novel 3D-printed vessel anastomosis device for microvascular surgery

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年2月13日

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  • John Ser Pheng Loh,
  • Kuan-Che Feng,
  • Yijia Yuan,
  • Yinling Zhu,
  • Robert Heymann,
  • Lars Rasmusson,
  • Justin Kok Soon Tan,
  • Hwa Liang Leo,
  • Reinhilde Jacobs

摘要

Microvascular anastomosis is fundamental to free-flap reconstruction, yet hand-sutured techniques remain highly skill-dependent and prolong ischemic time, contributing to thrombosis and flap loss. Current suture-less devices accelerate anastomosis but are constrained by vessel-size mismatch, eversion-related intimal injury, and inconsistent arterial performance. A clinically adaptable, arterial-capable system is needed. We developed a customizable, 3D-printed intraluminal coupler with a snap-fit connection and elastic external clasp that avoids vessel eversion and preserves length. Devices were fabricated via SLA or PolyJet printing using clinically used resins. Benchtop evaluation included burst-pressure testing, tensile testing, wettability and endothelial cytocompatibility assays with oxygen-plasma surface modification. Deployment was assessed ex vivo using porcine coronary vessels and in vivo in a porcine carotid arterial model with patency monitoring over 4 h. Couplers sustained leakage pressures of ~ 90 mmHg vs. ~16 mmHg for hand-sutured controls (P < 0.01), while maintaining comparable mechanical strength (≈ 2–3 N). Plasma surface treatment reduced water contact angles (≈ 85°→≈60°) and tripled endothelial attachment, restoring confluent morphology. Ex vivo deployment achieved completion in 9.47 ± 1.20 min, a ~ 62.5% reduction vs. published suturing times. In vivo, couplers restored immediate perfusion with no leakage or thrombosis. This 3D-printed intraluminal coupler demonstrates mechanical feasibility, rapid deploy-ability, and surface-modifiable endothelial compatibility in benchtop and short-term large-animal feasibility testing, supporting its potential for further preclinical development as a vascular anastomosis technology. Future survival studies and anti-thrombogenic surface engineering will advance readiness for clinical implementation.