An Auckland clinician who has created a prototype that connects microvascular arteries effectively is preparing to enter the United States market.

Clinician and bioengineer Dr Nandoun Abeysekera is the founder and CEO of Avasa. The company has produced an arterial coupler, a small device that simplifies microvascular surgery, providing a better standard of clinical care.

After collecting further data on performance of their device, Avasa intends to apply for approval from the US Food and Drug Administration to enter the United States market in 2025, but the startup will continue to be based in New Zealand.

“New Zealand’s the base, it’s where everything began – there are many compelling reasons to stay, which range from a supportive ecosystem, people and relationships with word-class clinicians,” Abeysekera says.

The device – an implant – connects tiny arteries, doing away with time-consuming and risky hand sewing of arteries. The device is a coupler, in principle similar to the ones that connect a garden hose to a pipe, except the vessels are no more than 5mm in diameter.

It can take up to 45 minutes to sew two arteries together and failure rates are up to five per cent.

With the coupler, the time to connect the arteries is reduced to five minutes, meaning there is less time where patients can be at risk of something going wrong – and, of course, more time for surgeons to do more operations.

While Abeysekera has seen couplers being used by plastic surgeons for connecting veins, this is the first time one has been designed specifically for arteries.

“There are no clinically effective devices for arteries,” he says. “There’s a device for veins which has really transformed care in reconstructive surgery – but it does not work for arteries as arteries are thicker and stiffer.”

Abeysekera, who has worked in both medicine and engineering, says there was an obvious clinical need for an arterial device, but no solution existed. His arterial coupling is the solution.

“I felt compelled to solve this problem, and I felt I was particularly skilled and suited to step out of the clinical space and develop a solution.”

Abeysekera came up with the idea while working as a plastic surgeon. After discussing it with plastic surgeon Jon Mathie at Middlemore Hospital, who supported the idea, he stepped back from clinical practice to start Avasa. Mathie is a world-class plastic surgeon and clinical advisor to Avasa; he studied medicine at Stanford University, then trained as a plastic surgeon at Harvard.

Illustration of the Avasa Coupler device.

“It was a Sunday morning at the hospital. Jon Mathie was on call, and I discussed the idea of taking a hiatus from clinical practice to develop this idea, and he simply said, ‘Yeah, do it’. The next day I handed in my resignation at the hospital and worked out my notice period. It just felt right.”

That was in 2018. Avasa was founded with pre-seed funding to get it off the ground, through the University of Auckland inventors fund and operationalised with $1 million venture capital funding through Bridgewest Ventures, part of Callaghan Innovation’s Technology Incubation Scheme. By the end of 2018, Avasa had won the new ventures category in an entrepreneurship programme, the University of Auckland’s Velocity competition. To date, Avasa has raised nearly $3 million in venture capital funding.

Avasa has also been named a finalist for this year’s KiwiNet Breakthrough Innovator Award, which celebrates heroes in research commercialisation. The winner will be announced at the awards celebration on 28 September.

Abeysekera says running a startup is a huge learning experience. He has a staff of two, with a further two contracted as engineers, and is in the process of recruiting a quality manager.

“My background was in engineering and medicine; I had no exposure to entrepreneurship. When I set out to develop this product, what I cared about most was the impact it would make. I had to see this product translate into the clinical environment.

“Entrepreneurship is the vehicle for that. It is the process for how you go on to make that impact. The challenge was learning that process, having not been exposed to it before.”

Abeysekera has been able to work on his startup in a capital-efficient way, saying it was easier to go about the process of developing a solution to connect arteries having worked in the industry.

“I enjoyed some very good luck at the start that enabled me to pursue this particular idea – I understood the physiology of vascular healing and the functional requirements for an arterial coupler, I had first-hand experience of the challenges that surgeons face in the operative environment, I had a background in engineering,” he said.

“I had incredible friends and mentors, and I had the generous support of the Auckland Bioengineering Institute – all of this enabled me to develop a functioning prototype without too much capital.”

Were he to start Avasa over again, Abeysekera says he would raise more capital earlier, bring on more stakeholders into the design process and start looking through the intellectual property landscape earlier for inspiration.

But his advice for new entrepreneurs? “Don’t think too much. Just start. There’s no shortcut to experience, you just have to do it.”

Story by Dave Crampton

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