title: Vascular clips have no significant effect on the cellular proliferation, intimal changes, or peak systolic velocity at anastomoses in rabbit vein grafts.
abstract: OBJECTIVE
  This study compares vascular closure staples (VCSs) with conventional sutures in the rabbit carotid vein graft model to determine whether anastomotic technique affects cellular proliferation, blood velocity, or intimal changes when measured over a period of 3 months postoperatively.
  
  
  METHODS
  Twenty-six New Zealand White rabbits weighing 3.0-3.2 kg underwent interposition of jugular vein grafts in left carotid arteries. Half of the animals had anastomoses performed with small VCSs (n = 13) and half had anastomoses performed with 8-O interrupted polypropylene suture. Animals were allowed to survive for 1 week (n = 4, VCS; n = 4, suture), 2 weeks (n = 4, VCS; n = 4, suture), and 3 months (n = 5, VCS; n = 5, suture). The peak systolic velocity (PSV) at the distal anastomosis was measured after completion of the graft and again at sacrifice in the 3-month survival groups. At sacrifice, sections were taken from the middle and distal end of the vein graft and the distal carotid artery. Vascular cell proliferation was measured using 5-bromo-2'-deoxyuridine labeling and intimal changes were measured using digitized microscopic images.
  
  
  RESULTS
  All 26 grafts were open at the time of sacrifice. PSV at the distal clipped anastomosis was 40.52 cm/s (t = 0) and 34.3 cm/s (t = 3 months, P = 0.31). PSV at the distal sutured anastomosis was 38.30 cm/s (t = 0) and 39.23 cm/s (t = 3 months, P = 0.82). There was no difference between the two techniques at either t = 0 or t = 3 months (P = 0.51 and P = 0.31, respectively). Endothelial cell proliferation and smooth muscle cell proliferation at the anastomosis was highest during the 2 weeks after the procedure, then returned to baseline levels by 3 months. But there was no significant difference between the clipped and sutured groups with respect to vascular cell proliferation postoperatively. The intimal thickness changed significantly in the vein graft at the anastomosis for both the clipped and sutured groups (P = 0.0007 and P = 0.002). But there was no difference when the intimal changes for each technique were compared (P = 0.94).
  
  
  CONCLUSIONS
  No differences were observed when peak systolic velocity, vascular cell proliferation, and intimal changes were compared between sutured and stapled anastomoses in rabbit vein interposition grafts over a period of 3 months after surgery.
authors.affiliation: Division of Vascular Surgery, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Caiati
authors.forename: J D
authors.initials: JD
authors.lastname: Madigan
authors.forename: G
authors.initials: G
authors.lastname: Bhagat
authors.forename: A I
authors.initials: AI
authors.lastname: Benvenisty
authors.forename: R
authors.initials: R
authors.lastname: Nowygrod
authors.forename: G J
authors.initials: GJ
authors.lastname: Todd
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D001783:Blood Flow Velocity; D002339:Carotid Arteries / Q000601:surgery*; D002341:Carotid Artery Thrombosis / Q000473:pathology / Q000601:surgery; D002455:Cell Division; D004730:Endothelium, Vascular / Q000473:pathology; D006083:Graft Occlusion, Vascular; D006965:Hyperplasia; D009131:Muscle, Smooth, Vascular / Q000473:pathology; D011183:Postoperative Complications / Q000473:pathology; D011817:Rabbits; D013525:Surgical Instruments; D013537:Sutures; D017539:Tunica Intima / Q000473:pathology; D014680:Veins / Q000473:pathology / Q000637:transplantation*