Improving the patency of vascular bypass grafts: the role of suture materials and surgical techniques on reducing anastomotic compliance mismatch.
BACKGROUND
compliance mismatch is an important factor in the development of myointimal hyperplasia in both coronary and vascular anastomoses. This mismatch may be reduced by the use of newer suture materials and techniques. This review discusses the current techniques and materials used to date in generating anastomoses in both coronary and vascular applications and to correlate these with the degree of inherent compliance achieved.


METHODS
PubMed, ISIS, CAS and PAS database searches were performed. Other articles were cross-referenced.


CONCLUSIONS
continuous suture is still the most used technique in both cardiac and vascular surgery for the generation of anastomoses due to the reduced time and improved haemostasis. However, continuous suture results in a greater compliance mismatch than the interrupted technique. Vein cuffs and patches improve compliance and transmission of pulsatile blood flow and offer improvement of graft patency. Alternative to sutures are biological glue, clips and laser generated solders all of which have shown promising results, but further work is required before they become applicable for routine use.
Tiwari
A
A
Tissue Engineering Centre, University Department of Surgery, Royal Free and University College Medical School, University College London and The Royal Free Hospital, London, UK.
Cheng
K-S
KS
Salacinski
H
H
Hamilton
G
G
Seifalian
A M
AM
D000714:Anastomosis, Surgical / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D006965:Hyperplasia / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D013537:Sutures / Q000009:adverse effects*; D017539:Tunica Intima / Q000473:pathology* / Q000503:physiopathology*; D014654:Vascular Patency / Q000502:physiology*