| Autor: |
Baguneid, Mohamed S., Goldner, Sean, Fulford, Paul E., Hamilton, George, Walker, Michael G., Seifalian, Alexander M. |
| Zdroj: |
Journal of Vascular Surgery; April 2001, Vol. 33 Issue: 4 p812-820, 9p |
| Abstrakt: |
Purpose:Anastomotic compliance is an important predictive factor for long-term patency of small diameter vascular reconstruction. In this experimental study we compare the compliance of continuous and interrupted sutured vascular anastomoses with those using nonpenetrating clips. Methods:Both common carotid arteries in nine goats (average weight, 57 ± 5.7 kg) were transected, and end-to-end anastomoses were constructed with nonpenetrating clips or polypropylene sutures. The latter were applied with both interrupted and continuous techniques. Intraluminal pressure was measured with a Millar Mikro-tip transducer, and vessel wall motion was determined with duplex ultrasound equipped with an echo-locked wall-tracking system. Diametrical compliance was determined. Environmental scanning electron microscopy was performed on explanted anastomoses. Results:There was a reduction in anastomotic compliance and associated proximal and distal para-anastomotic hypercompliant zones with the use of all techniques. However, compliance loss was significantly less in those anastomoses with clips and interrupted sutures when compared with continuous suture (P<.001). Furthermore, the total compliance mismatch across anastomoses with continuous sutures was significantly greater than those with clips or interrupted sutures (P<.05). The mean time for constructing clipped anastomoses was 5.7 ± 1.4 minutes, which was significantly less than either continuous (P<.0001) or interrupted sutures (P<.0001). Furthermore, environmental scanning electron microscopy demonstrated minimal intimal damage with good intimal apposition in the clip group. Conclusion:Anastomoses performed with nonpenetrating clips resulted in improved para-anastomotic compliance profiles and reduced intimal damage when compared with those with polypropylene sutures. These benefits may enhance long-term graft patency by reducing the risk of anastomotic intimal hyperplasia. (J Vasc Surg 2001;33:812-20.) |
| Databáze: |
Supplemental Index |
| Externí odkaz: |
|
