Vascular closure staples reduce intimal hyperplasia in prosthesis implantation.
BACKGROUND
Vascular surgery, like the various other surgical specialities, has seen an increasing demand toward faster and more minimally invasive procedures. One such need is to create a reliable vascular anastomosis that is faster, easier and less damaging to the tissue. The vascular closure staples (VCS*) device provides such characteristics but, to date, no studies have investigated its effectiveness in reducing intimal hyperplasia when used for vascular prosthesis implantation. The present study evaluated its effectiveness compared with suturing of a graft in vascular prosthesis implantation.


METHODS
Twelve female Merino sheep underwent gelatin sealed Dacron patch graft implantation into the left and right common carotid artery. Grafts were randomly allocated so that one carotid artery and graft was anastomosed using sutures and the other with VCS*. The two techniques were compared for operation time, clip/suture numbers and blood loss during the implantation procedure. After a 4-week period, the sheep were killed and the grafts were harvested for intimal hyperplasia (IH) assessment.


RESULTS
There was a significant reduction in the amount of IH seen in the VCS* group (mean +/- SD: 0.278 +/- 0.079 mm2/mm) when compared with the sutured group (0.575 +/- 0.331 mm2/mm) (P < 0.05). There was also significant reduction in anastomosis time (mean +/- SD: 14 +/- 4.4 min) and fewer points of contact (23 +/- 1.4) using the VCS* compared with suturing (22 +/- 3.2 min, P < 0.01; 27 +/- 3.3, P < 0.05, respectively).


CONCLUSIONS
In this model, the VCS* shows several distinct advantages over suturing with significant time saving at operation and, most importantly, the reduction of IH seen at 1 month.
Hawthorne
Wayne J
WJ
The University of Sydney Department of Surgery, Westmead Hospital, New South Wales, Australia. wayneh@med.usyd.edu.au
Ao
Peng Y
PY
Fletcher
John P
JP
D000714:Anastomosis, Surgical; D000818:Animals; D019917:Blood Vessel Prosthesis Implantation; D006965:Hyperplasia / Q000517:prevention & control; D011897:Random Allocation; D012756:Sheep; D013536:Suture Techniques; D013537:Sutures; D017539:Tunica Intima / Q000473:pathology*; D018084:Ultrasonography, Interventional