Cobar Juan P, Fridling Jeremy, Cleary Colin, Gifford Edward, Li Ya-Huei, Thompson Stephen, Ebadinejad Amir, Aitcheson Elizabeth, Shah Parth S, Gallagher James, Jain Akhilesh, Divinagracia Thomas, Glotzer Owen
Department of Surgery, University of Connecticut School of Medicine, Farmington, CT.
Division of Vascular Surgery, Hartford Healthcare Heart and Vascular Institute, Hartford, CT.
J Vasc Surg Cases Innov Tech. 2025 Apr 1;11(4):101789. doi: 10.1016/j.jvscit.2025.101789. eCollection 2025 Aug.
The proximal anastomosis is a crucial step during open repair of an abdominal aortic aneurysm. A technically sound anastomosis decreases intraoperative blood loss, as well as the operative time needed for suture line repair. Traditionally, a continuous running suture is used for the construction of this anastomosis. At the author's institution, the technique of an interrupted pledgeted proximal anastomosis is selectively used when the quality of the aortic tissue is suboptimal. This report describes the technique of the interrupted pledgeted proximal aortic anastomosis and compares outcomes to the traditional continuous technique. Among 60 pledgeted and 48 continuous anastomoses, we found equivalent clamp time, operative time, and intraoperative estimated blood loss for the two techniques. However, patients with a continuous anastomosis had higher risks of additional reinforcement during hospitalization (43.3% pledgeted vs 72.9% continuous; P = .002). The interrupted anastomotic technique presented here is a valuable option in open abdominal aortic aneurysm repair when faced with friable aortic tissue.
在腹主动脉瘤开放修复术中，近端吻合是关键步骤。技术上可靠的吻合可减少术中失血以及缝合线修复所需的手术时间。传统上，这种吻合采用连续缝合。在作者所在机构，当主动脉组织质量欠佳时，会选择性地使用间断带垫片近端吻合技术。本报告描述了间断带垫片近端主动脉吻合技术，并将其结果与传统连续技术进行比较。在60例带垫片吻合和48例连续吻合中，我们发现两种技术的阻断时间、手术时间和术中估计失血量相当。然而，连续吻合的患者在住院期间需要额外加固的风险更高（带垫片组为43.3%，连续组为72.9%；P = .002）。当面对脆弱的主动脉组织时，本文介绍的间断吻合技术是腹主动脉瘤开放修复术中一种有价值的选择。
