Work

Suture-less vascular anastomosis – State of the art, challenges and perspectives: A review

Year: 2026

Type: review

Abstract: Vascular microanastomosis is a cornerstone of reconstructive, transplantation, and cardiothoracic surgery, enabling the reconnection of tiny blood vessels to restore circulation to transplanted tissues or donor organs. Traditionally, this delicate process relies on hand suturing under microscopic magnification, a demanding and time-consuming technique that requires extensive training and precision. Despite decades of refinement, conventional suturing remains limited by human factors. Technical errors can lead to thrombosis, tissue necrosis, hematoma, or flap loss, with serious implications for patient outcomes and healthcare costs. In response, suture-less anastomosis methods have emerged as promising alternatives. These devices use mechanical couplers, rings, clips, magnets, or bioengineered scaffolds to connect vessel ends rapidly and reproducibly, aiming to reduce operative time, minimize ischemia, and improve procedural consistency across surgical teams. Recent innovations have introduced biodegradable and intraluminal designs that reduce foreign-body reactions, lower palpability, and accommodate vessel growth, offering distinct advantages in paediatric and long-term reconstructive settings. Despite these advances, the widespread clinical adoption of suture-less technologies remains constrained by unresolved challenges. Key considerations include ensuring mechanical stability under physiological pulsation, optimizing biocompatibility to prevent thrombosis at the junction, and adapting device geometries to the diversity of vessel sizes and wall structures encountered in clinical practice. Continued translational research is needed to refine materials, simplify deployment mechanisms, and integrate these systems seamlessly into microsurgical workflows. This review synthesizes current developments in suture-less vascular anastomosis, critically evaluating their benefits and limitations across experimental and clinical studies. It also identifies future research priorities at the intersection of materials science, additive manufacturing, and surgical engineering. As these disciplines converge, next-generation suture-less devices hold the potential to redefine vascular repair by making micro-anastomosis faster, safer, and more accessible, thus transforming reconstructive and transplant surgery for patients who depend on these life-saving procedures.

Source: Biomedical Engineering Advances

DOI: 10.1016/j.bea.2026.100207