Influence of suture technique and suture material selection on the mechanics of end-to-end and end-to-side anastomoses.
Experiments were performed in dogs to evaluate the mechanics of 26 end-to-end and 42 end-to-side artery-vein graft anastomoses constructed with continuous polypropylene sutures (Surgilene; Davis & Geck, Division of American Cyanamid Co., Danbury, Conn.), continuous polybutester sutures (Novafil; Davis & Geck), and interrupted stitches with either suture material. After construction, the grafts and adjoining arteries were excised, mounted in vitro at in situ length, filled with a dilute barium sulfate suspension, and pressurized in 25 mm Hg steps up to 200 mm Hg. Radiographs were obtained at each pressure. The computed cross-sectional areas of the anastomoses were compared with those of the native arteries at corresponding pressures. Results showed that for the end-to-end anastomoses at 100 mm Hg the cross-sectional areas of the continuous Surgilene anastomoses were 70% of the native artery cross-sectional areas, the cross-sectional areas of the continuous Novafil anastomoses were 90% of the native artery cross-sectional areas, and the cross-sectional areas of the interrupted anastomoses were 107% of the native artery cross-sectional areas (p < 0.05). At physiologic pressures, there were no differences in compliance among the three types of anastomosis. These data suggest that when constructing an end-to-end anastomosis in a small vessel, one should use an interrupted suture line or possibly continuous polybutester suture. Forty-two end-to-side anastomoses demonstrated no differences in cross-sectional areas or compliance for the three suture techniques. This suggests that, unlike with end-to-end anastomoses, when constructing an end-to-side anastomosis in patients any of the three suture techniques may be acceptable.
Baumgartner
N
N
Loyola University Medical Center, Department of Surgery, Maywood, IL 60153, USA.
Dobrin
P B
PB
Morasch
M
M
Dong
Q S
QS
Mrkvicka
R
R
D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D001696:Biomechanical Phenomena; D004285:Dogs; D066298:In Vitro Techniques; D011091:Polyesters; D011126:Polypropylenes; D013537:Sutures; D014656:Vascular Surgical Procedures / Q000379:methods
D011091:Polyesters; D011126:Polypropylenes; C048850:polybutester