[Injury of polyester grafts by vascular clamps].
Protected vascular clamps are not new. Clamp associated damage of human arteries has already been published over 20 years ago. The necessity of protective clamps seems to have been forgotten. In our explant archive (230 explants) we have observed an accumulation of graft ruptures in the groin (13 of 25 ruptures). We presume a multifactorial process. Clamp damage could be part of it. The aim of this study is to prove the clamp induced damage of polyester vascular grafts and to examine whether protected clamps can reduce this.


METHODS
Five unprotected (Aesculap(R) FB512R, FB502, FB517, Ulrich CC1235, CV3535) and 5 protected vascular clamp types (Aesculap(R) FB667, FB668, Edwards(R) - formally Baxter(R) - Fogarty(R) CV5050, CV5201, Edwards(R) Cosgrove(R) CV1033) were tested. A longitudinal burst test was performed after maximal clamp closure on 6 different, multifilament polyester yarns of 2 different vascular grafts manufacturers (B. Braun(R), Edwards(R)).


RESULTS
The yarn tests with protected clamps showed no difference to those of the unclamped yarns. After clamping with unprotected vascular clamps the stress-strain-diagrams differed significantly. The mean, maximum burst strength was up to 75 % lower. Video documentation revealed filament ruptures. Damage of the yarn surface was seen on a simple woven graft in scanning electron microscopy (SEM).


CONCLUSIONS
The application of unprotected vascular clamps on polyester vascular grafts is common in Germany (56 %). The observed damage of multifilament polyester yarns makes it necessary to re-consider the use of unprotected vascular clamps. The benefit for biological vessels has already been shown.
Riepe
G
G
Gefäss Centrum Harburg - GCH, Allgemeines Krankenhaus Harburg, Hamburg, Germany.
Meincke
J
J
Nassutt
R
R
Seemann
D
D
Chakfé
N
N
Morlock
M
M
Gross-Fengels
W
W
Imig
H
H
D001807:Blood Vessel Prosthesis; D003625:Data Collection; D019544:Equipment Failure Analysis; D005858:Germany; D006801:Humans; D008855:Microscopy, Electron, Scanning; D011091:Polyesters; D011474:Prosthesis Design; D012307:Risk Factors; D013499:Surface Properties; D013525:Surgical Instruments / Q000009:adverse effects*
D011091:Polyesters