[Histopathology of microsurgical arterial repair. Use of fibrin cryoprecipitates]. / Histopathologie de la réparation artérielle microchirurgicale. Apport des cryoprécipités fibrineux.

The increasing practice of small arteries anastomosis especially in neurosurgery entails improvements in suture techniques. Classical suture is slow and needs a prolonged clamping. The stitches are responsible for severe necrotic lesions in the arterial wall. A biological glue made of cryoprecipitated human fibrinogen, factor XIII and fibronectin, locally activated by thrombin, is tested here on rabbit's common carotid. The application of the glue on intact or sectioned arteries appears innocuous, notably with regard to its thrombogenic potential. Comparison of classical sutures and sutures with glue and a greatly reduced number of stitches shows histological results of equivalent quality. At the early stages, the fibrin glue doesn't exceed in volume the usual perianastomotic hematoma. It is completely resorbed within two weeks. Later the scar is thinner than after classical suture, although no ruptures or aneurysms were observed. This method shortens the surgical procedure, with presumed benefit for the drained territories. It diminishes the lesions caused by the stitches. Moreover it allows an easy application of an arterial patch on the sectioned vessel: a comparative series with sutured patches shows on the contrary poor results. Although aggresive for the tissues, a minimal number of stitches remains necessary: it is actually the only available means of correctly positioning the anastomosis area.

[Proximal temporo-sylvian anastomosis with an arterial cuff glued with fibrin. Technical, anatomical and arteriographic considerations]. / L'anastomose temporo-sylvienne proximale avec coiffe artérielle collée à la fibrine. Considérations techniques, anatomiques et artériographiques.

The authors present a new method of temporo-sylvian anastomosis used 8 times since 1982. This anastomosis called proximal is done on the insular segment (M2) of the sylvian artery and gives better revascularizations than the classic method (M4 or distal). The arterial cuff and the fibrin glue simplify, accelerate and improve the usual microsuture. A good knowledge about the microsurgical anatomy of the middle cerebral artery and its variants is important. The proximal sylvian artery and its perforators (50% occlusion in our cases) may be explored by this approach.