Differential endothelial injury caused by vascular clamps and vessel loops. II. Atherosclerotic vessels.

Performance of a vascular anastomosis or repair requires meticulous, gentle technique and a bloodless operative field. Many vascular surgeons rely on commercial "atraumatic" vascular clamps for the latter; however, most experimental evidence incriminates clamps as agents of moderate to severe endothelial and medial injury. Our previous studies in normal canine aortoiliac vessels have demonstrated that silastic rubber vessel loops did not cause injury in that setting; this study examines in vivo atherosclerotic human femoropopliteal artery segments. Ten centimeter segments of perfused femoropopliteal arteries were exposed during performance of above-knee lower extremity amputation for endstage vascular insufficiency. DeBakey, Cooley, Fogarty, and bulldog vascular clamps, and double-looped silastic rubber vessel loops were applied at 3-centimeter intervals for 15 minutes. Each segment was then examined under scanning electron microscopy. All vascular clamps caused endothelial and presumed medial injury; no injury was seen with the vessel loops. Selective and preferential use of silastic rubber vessel loops is thus advocated to minimize iatrogenic complications.