If a surgeon decides to make a bypass, he needs to choose 1 or 2 sites on a recipient blood vessel (mostly an artery) to make an anastomosis (the artificial connection place of 2 bloodvessels). ELANA is an anastomosis technique. ELANA stands for Excimer Laser Assisted Non-occlusive Anastomosis. The ELANA technique is used to make an end-to-side (T-shaped) anastomosis without temporary closing of the recipient artery. This is a very important feature in bypass surgery, because it facilitates the creation of anastomoses on places previously impossible with conventional anastomosis techniques, for example a cerebral artery.
During the construction of a conventional anastomosis it is necessary to occlude a recipient artery for 10 minutes up to 45 minutes (depending on the place of the anastomosis), not withstanding extension of this time because of complications (for example wrong suturing or unexpected haemorrhage). In case of conventional anastomosis grafting in the brain, this temporary occlusion may well lead to a so called ischemic event of the brain (brain cell death due to low oxygen supply), because especially brain cells are very vulnerable to a lack of blood flow which delivers oxygen.
ELANA gives the neurosurgeon the opportunity to create a high flow bypass without the risk of a conventional anastomosis and without any time pressure.
In the following description of the ELANA technique an aneurysm is treated with a bypass and subsequent parent vessel occlusion. In the exact same way, an occluded vessel or a tumour can be bypassed.
The distal anastomosis can be made on vessels with a diameter not smaller than 2,6 mm.
First (fig. 1a above) the platinum Elana Ring 2.6 or 2.8 is stitched to the donor vessel (mostly the saphenous vein, or radial artery). After preparation and selection of an anastomosis site, the surgeon stitches the donor vessel with the Elana Ring to the recipient artery. The recipient artery is never occluded during the procedure.
The Elana Catheter 2.0 conducting laser light is slid in the donor vessel (fig. 1b). By means of a vacuum suction pump the hollow catheter sucks the wall of the recipient vessel against the grid of the catheter. With laser light, the catheter cuts a round hole in the wall of the main vessel. The Elana Ring ensures the catheter sits in place and doesn’t shoot through.
The disk of cut out tissue stays sucked to the catheter tip, which is then carefully retrieved (fig. 1c). The donor vessel is temporarily occluded with a clip. The recipient artery stays unoccluded.
As a proximal, extracranial anastomosis site the temporal artery (STA) can be chosen. This is performed in a conventional way because patients tolerate temporary occlusion time in these regions, with the exception of a small group of patients with
The two donor grafts are connected with sutures. The temporary clips on the donor vessels are removed; the surgeon can treat disease, for example taking out the aneurysm or tumor from the circulation.
The ELANA Technique can also be used for IC-IC bypass grafting for more peripheral pathology. Depending on recipient size, degree of arteriosclerosis and if the site is surgical reachable, a proximal and distal ELANA or only a proximal ELANA can be performed.
The products that are needed to perform the ELANA technique (apart from common bypass tools) are distributed by ELANA bv. These products are:
A) The Elana Surgical Kit(HUD), containing Elana Catheter 2.0, Elana Rings 2,6 & 2,8 and Vacuum connection Set),
B)The Spectranetics CVX-300 laser system and
C) The Medela Dominant 50 / Flex vacuum system. More information on these products can be found here.