Baguneid M S, Goldner S, Fulford P E, Hamilton G, Walker M G, Seifalian A M
Department of Vascular Surgery, Manchester Royal Infirmary and Medical School, UK.
J Vasc Surg. 2001 Apr;33(4):812-20. doi: 10.1067/mva.2001.112806.
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.
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.
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.
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.
吻合口顺应性是小直径血管重建长期通畅的重要预测因素。在本实验研究中，我们比较了连续缝合和间断缝合血管吻合口与使用非穿透性血管夹的吻合口的顺应性。
将9只山羊（平均体重57±5.7千克）的双侧颈总动脉横断，用非穿透性血管夹或聚丙烯缝线进行端端吻合。后者采用间断和连续技术。用Millar Mikro-tip换能器测量腔内压力，并用配备回声锁定壁跟踪系统的双功超声确定血管壁运动。测定直径顺应性。对取出的吻合口进行环境扫描电子显微镜检查。
使用所有技术后，吻合口顺应性以及相关的近端和远端吻合口旁高顺应性区域均降低。然而，与连续缝合相比，使用血管夹和间断缝合的吻合口顺应性损失明显更小（P<.001）。此外，连续缝合的吻合口的总顺应性不匹配明显大于使用血管夹或间断缝合的吻合口（P<.05）。构建血管夹吻合口的平均时间为5.7±1.4分钟，明显少于连续缝合（P<.0001）或间断缝合（P<.0001）。此外，环境扫描电子显微镜显示血管夹组内膜损伤最小，内膜贴合良好。
与聚丙烯缝线吻合相比，使用非穿透性血管夹进行吻合可改善吻合口旁顺应性，并减少内膜损伤。这些益处可能通过降低吻合口内膜增生的风险来提高移植物的长期通畅率。
