[Non-penetrating vascular staples prevent myo-intimal hyperplasia and maintain arterial vasomotor reaction].
OBJECTIVE
Vascular anastomosis is still associated with a significant rate of early or delayed complications, particularly restenosis. We have previously demonstrated that non-penetrating clips can help prevent intimal hyperplasia. The aim of this study was to evaluate how well the use of mechanical clips prevents intimal hyperplasia while maintaining arterial vasomotor function.


METHODS
An aortic suture was performed in 38 rabbits. A standard closure was used for 15 sutures and a small vascular closure staple (VCS) for 23. Morphological analysis was performed with standard staining, histomorphometry and immunochemical staining for smooth muscle and endothelial cells. Vasomotor response was assessed using IntraVacularUltraSound with baseline luminal area and luminal area after injection of acetylcholine and nitroglycerin. Vasomotor response was assessed before suture and before removing the aorta.


RESULTS
There was a significant improvement in operating time for closure with vascular staples (8 +/- 2 minutes versus 13 +/- 3 minutes) without thrombosis. We noted reduced intimal hyperplasia with staple closure (0.156 +/- 0.052 versus 0.087 +/- 0.042 mm, p<0.01). There was no difference for the medial thickness and the intima/media ratio was significantly different. The luminal area after suture was significantly better after vascular staple closure (16.78 +/- 0.639 mm(2) versus 17.24 +/- 0.492 mm(2), p=0.016). Vascular response to acteylcholine and nitroglycerin was equivalent for the two groups.


CONCLUSIONS
Vascular closure staples are efficient for arterial closure. These non-penetrating systems prevent intimal hyperplasia and maintain physiological arterial vasomotor response.
Ducasse
E
E
Service de Chirurgie Vasculaire, Hôpital Saint-Philibert, Groupe Hospitalier de l'Institut Catholique de Lille, 115, rue du Grand But, 59462 Lomme, France.
Parrens
M
M
Basseau
F
F
Chevalier
J
J
Puppinck
P
P
D000818:Animals; D001012:Aorta, Abdominal / Q000601:surgery*; D005260:Female; D006965:Hyperplasia; D007813:Laparotomy; D011183:Postoperative Complications / Q000517:prevention & control*; D011817:Rabbits; D013536:Suture Techniques; D013537:Sutures; D017539:Tunica Intima / Q000473:pathology*; D017540:Tunica Media / Q000473:pathology*; D014656:Vascular Surgical Procedures / Q000295:instrumentation*; D014666:Vasomotor System / Q000502:physiology