Does vascular stapling improve compliance of vascular anastomoses?
Elastic properties of vessel walls are altered by vascular anastomoses. Such alterations may lead to neointimal hyperplasia, which is a common cause of reocclusion following vascular surgery. The severity of paraanastomotic hypercompliant zones and anastomotic compliance drop depend on suturing material and on elastic properties of the anastomotic vessel segments. This study compares paraanastomotic hypercompliance and anastomotic compliance drop when using a new vascular closure system (VCS) and a conventional, continuous suture line in the preparation of end-to-end anastomoses. Compliance of artery-artery, vein-artery, and polytetrafluoroethylene-artery anastomoses was measured in an artificial circulation system at mean pressures of 60, 90, and 120 mm Hg, comparing conventional suturing and the VCS. When using the VCS for vein-artery anastomoses, significantly less postanastomotic hypercompliance was achieved at mean pressures of 60 mm Hg (14.2 +/-3.8% above remote postanastomotic area), compared to suture (55.1 +/-14.8%, p<0.05). At 90 mm Hg, respective values were 11.0 +/-2.3% for VCS and 54.7 +/-10.1% for suture, p<0.01. At 120 mm Hg, in polytetrafluoroethylene-artery anastomoses, the anastomotic compliance drop was significantly less when using the continuous suture line (93.9 +/-1.1% below remote postanastomotic compliance), compared to VCS (97.2 +/-0.2%, p<0.05). Compared to conventional suturing, use of the VCS reduced postanastomotic hypercompliance in vein-artery anastomoses.
Stansby
G
G
Department of Vascular and Endovascular Surgery, University of Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
Knez
P
P
Berwanger
C S
CS
Nelson
K
K
Reichert
V
V
Schmitz-Rixen
T
T
D000714:Anastomosis, Surgical / Q000379:methods; D001794:Blood Pressure / Q000502:physiology; D002343:Carotid Artery, Internal / Q000601:surgery; D006801:Humans; D017792:Surgical Stapling; D014656:Vascular Surgical Procedures; D014680:Veins / Q000601:surgery