Needle-landing arteriotomy for microvascular anastomosis in patients with moyamoya disease: A technical note

Background

Microvascular anastomosis is vital in cerebrovascular surgery, particularly in bypass procedures for moyamoya disease. Conventional arteriotomy methods, such as a linear incision or fishmouth techniques, can prolong clamping time, increasing ischemic risk. To address this, the authors developed the “needle-landing arteriotomy” technique to reduce clamping time and improve arteriotomy efficiency.

Methods

We evaluated the efficacy of needle-landing arteriotomy through in vivo and in vitro investigations. Six patients with moyamoya disease underwent bypass surgery. Each of the three patients was treated with the conventional arteriotomy and needle-landing methods. Clamping time, patency, and complications were assessed intraoperatively and at a six-month follow-up. In the in vitro study, neurosurgeons and residents performed simulated arteriotomies to compare both techniques.

Results

The needle-landing technique significantly reduced clamping time in vivo by 55 % (176 ± 20.8 s vs. 97.3 ± 30.8 s, P < 0.02). All surgeries were successful with no complications. Follow-up angiography confirmed patent bypass grafts. The technique also shortened the clamping time in vitro.

Conclusion

The needle-landing technique simplifies recipient vessel preparation by improving visibility and reducing procedural complexity. This minimizes the risk of inadvertent suturing and shortens clamping time, which is crucial for preventing ischemic complications, while also reducing performance variability, making it especially helpful for less-experienced surgeons. It is particularly valuable in cerebrovascular bypass procedures for patients with moyamoya disease.