Anastomotic tissue response associated with expanded polytetrafluoroethylene access grafts constructed by using nonpenetrating clips.

PURPOSE: The gross, light microscopic, and scanning microscopic appearance of arterial and venous anastomoses in expanded polytetrafluoroethylene (ePTFE) access grafts constructed with nonpenetrating clips were compared with that of those constructed with polypropylene suture. We hypothesized that clip-constructed anastomoses would provide controlled approximation of native vessel intimal and medial components with the ePTFE grafts. We further hypothesized that anastomotic healing with clips would involve primarily an intimal cellular response, as compared with suture-constructed anastomoses in which cells within the media and adventitia walls participate. METHODS: Femoral artery to femoral vein arteriovenous (AV) grafts were constructed in five dogs using 4-mm internal diameter ePTFE graft material. Each animal received one AV graft with anastomoses constructed by using polypropylene sutures in one leg and one AV graft with anastomoses constructed with Vascular Closure System clips in the contralateral leg. Animals were given aspirin for the duration of the study, and grafts were explanted at 5 weeks. At the time of explantation, graft segments were grossly evaluated and then underwent light and scanning electron microscopic analysis. RESULTS: At the time of explantation, all access grafts were patent. Joining the ePTFE grafts to the native vessels with clips resulted in minimal vessel wall damage. The lumenal contours of the discontinuous approximation were smooth and without gross endothelial disruption. These observations are in contrast to the lumenal compromise and endothelial disturbance associated with the sutured anastomoses. Furthermore, hemostasis was achieved immediately in the clipped grafts, decreasing the incidence of perianastomic hematoma. Finally, cellular reconstitution occurred at the anastomotic cleft in both the sutured and the clipped junctions. The neointima exhibited an endothelial cell lining on the lumenal surface and the presence of alpha-smooth muscle cell actin positive cells within the subendothelial layer. CONCLUSION: Vascular Closure System clips are a viable alternative to suture for the approximation of ePTFE AV access grafts to native blood vessels. The use of the clips resulted in a more streamlined anastomosis, with decreased vessel wall damage, immediate hemostasis, and a trend toward shorter procedure times.     

Common bile duct repair with titanium staples

Background: Vascular Closure Staple (VCS) clips made of titanium were initially developed for microvascular anastomoses with little experience of their use in larger tubular structures. This study compares VCS clips and sutures in the closure of supraduodenal choledochotomy. Methods: In nine pigs, two longitudinal incisions of the common bile duct (CBD) were randomly assigned to closure with 4-0 interrupted polyglactin sutures or VCS clips. Results: Clip closure was significantly faster (116 ± 28 vs 581 ± 88 s). All nine CBDs were patent and without signs of calculus formation after 3 months. Clip closure resulted in slightly less narrowing of the duct lumen and thinner scar at the repair site. At histological examination, all 18 incisions had healed without signs of fistula formation or marked fibrosis. Conclusions: Choledochotomy closure with VCS clips results in as good or better wound healing than suture closure, with a comparable degree of narrowing. The time required for clip closure is only about one-fifth that of suture closure. Received: 25 September 1996/Accepted: 19 November 1996     

Arterial repair with synthetic patch by using titanium clips

BACKGROUND: Vascular closure staple (VCS) clips made of titanium were originally developed for microvascular anastomoses. There is limited experience with their applicability to vascular reconstruction in larger vessels. This study compares VCS clips to standard sutures in arterial repair using a synthetic patch. METHODS: In an experimental study with pigs, two sequential 10-mm abdominal aortotomies were allocated randomly to synthetic patch (polytetrafluoroethylene) repair with VCS clips or continuous 6-0 polypropylene sutures. Angiographic, macroscopic, and microscopic results were assessed after 2 months. RESULTS: There were no significant differences in the patency rate, vessel diameter at the repair site, or healing indices. The mean (SD) clamp time was 8.7 (3.0) minutes for clip repair and 14.3 (7.4) minutes for suture repair (p = 0.04), and the times required for the vessel reconstruction were 5.3 (1.3) and 9.3 (3.0) minutes, respectively (p = 0.009). CONCLUSION: Patched arterial repair with VCS clips is faster than sutured reconstruction with comparable results after 2 months of follow up.     

Nonpenetrating vascular clips for small-caliber anastomosis

In the search for better anastomosing techniques, an improved vascular stapler device (VCS clip applier system(R)) has been introduced. The system uses nonpenetrating clips to approximate everted vessel walls. The objective of this study was to determine the effects of nonpenetrating vascular clips on endothelial wound healing. Aortic end-to-end anastomoses were performed in male Wistar rats. A comparison was made between clipped (n = 12) and conventional hand-sewn (n = 6) anastomoses. Patency rates were verified at different time intervals (after 1, 4, and 8 weeks), after which the anastomotic sites were removed. Morphological evaluation was carried out using scanning electron microscopy. All rats survived the procedure. Closure with clips took less time than closure with conventional sutures, with decreasing aortic clamping times for the clipped procedures during the course of the experiments. Patency rates were 100% in both the "clipped" and "sutured" groups. Microscopic examination showed favorable endothelial healing at the clipped anastomotic sites, with less inflammatory reaction at 1 week, and a more complete endothelial regeneration at 4 and 8 weeks follow-up, as compared with the sutured anastomoses. The clip applier holds the promise of a useful device in anastomosing small-caliber vessels, since clip closure takes less time than suturing, while patency rates are identical, and morphological results are favorable. Training is mandatory to obtain technical skills and to achieve optimal results.     

Five years' world experience with nonpenetrating clips for vascular anastomoses

BACKGROUND: A new sutureless technique has been introduced clinically to facilitate the process of vascular reconstruction and improve patency. The Vessel Closure System (VCS) is nonpenetrating, creates an elastomeric everted anastomosis, and is easily and reproducibly applied. The objective of this report is to review the published world experience that has accrued regarding these clips with attention to the assets, liabilities, and pitfalls associated with the new technology. DATA SOURCES: Medline search and manual cross-referencing were performed, after which 61 original articles were identified on the use of VCS clips for vascular anastomoses. RESULTS: Advantages of the clips compared with sutures include the technical ease of application, the reduced anastomotic time, the superior hemodynamics, and the improved healing pattern of the anastomosis. Disadvantages include the potential problems in atherosclerotic vessels, lack of prospective randomized long-term follow-up, and initial costs. The best clinical results have been achieved in microvascular repair, as well as with vascular access and transplantation surgery. CONCLUSIONS: The VCS clip technology has become an accepted vascular anastomosing technique, which in future could lead to the use of clips as a standard approach and the use of sutures only in case of severe atherosclerosis and other circumstances in which vessel edges are difficult to evert.     

Study comparing sutures and nonpenetrating titanium clips for arteriotomy closure after embolectomy

Background: The vascular closure staple (VCS) clip applier system is an alternative to suture for closing arteriotomies and performing vascular anastomoses. This study was designed to evaluate the possible advantages of its use in closing arteriotomies after embolectomy. Methods: In this study, 26 patients with upper or lower extremity embolism underwent embolectomy, and the arteriotomy was closed using either VCS clips (group A) or sutures (group B). Results: The time required for arteriotomy closure with clips (11.2 ± 2.7s) was considerably shorter than the time required with sutures (241.2 ± 48.7s; p < 0.0001), resulting also in shorter clamp times (380.8 ± 127.3s vs 612.7 ± 112.6 s; p < 0.0001). No hemodynamically significant stenoses or pseudoaneurysms were detected at the arteriotomy sites in any of the patients up to 1 year after embolectomy. Conclusions: The VCS clip applier system, a quick and easy method for closing arteriotomies, is as safe as sutures in terms of narrowing of the artery and formation of pseudoaneurysm. apd: 25 April 2001     

Vascular closure staples-a new technique for biliary reconstruction: prospective randomized comparison with manual suture in an animal model.

BACKGROUND: In orthotopic liver transplantation the incidence of biliary complications is up to 49%. In view of the relative frequency of such complications despite seemingly good preconditions, method-related disadvantages of conventional suture must also be considered as a possible cause. These include perforating needle injury of the choledochal wall with at least temporary exposure of suture material in the lumen, suboptimal approximation of the mucosa, and an additional decrease in blood flow in the choledochal stumps as a result of suture-related tissue strangulation. Hence the search for alternative anastomosis techniques. METHODS: To evaluate the surgical suitability of extramucosal titanium clips (Vascular Closure Staples; VCS) in comparison with conventional manual suture, a study was performed in 36 pigs, which were randomly assigned to 4 groups, each containing 9 animals. Choledochal excision was performed in 18 pigs and transection in the other 18 pigs; end-to-end anastomosis was then carried out, using a VCS stapler in half of the animals in each of these two groups and conventional manual suture in the other half. Pre- and postanastomotic blood flow was measured during the surgery with the aid of a laser Doppler flow meter. The long-term behavior of the closure techniques was ascertained by regular laboratory checks over the ensuing 6-month observation period, after which the pigs were killed so that the specimens could be harvested. RESULTS: Using medium-sized VCS clips, we were able to create a tension-free, everted biliary anastomosis with exact mucosal approximation and no narrowing of the lumen, and without any technical problems during the performance of the procedure. Measurements with the laser Doppler flow meter showed well-preserved anastomotic blood flow after clip reconstruction, with significantly higher perfusion values than after manual suture. The postoperative courses of the investigated laboratory parameters did not reveal any significant differences between the two methods. In contrast, histomorphometric evaluation showed wall thickness and thus fibrosis in the anastomosis region to be less in the clip group than in the suture group (median: 510 microm versus 660 microm, P<0.001). In the pigs in which clip anastomosis was used, there were no detectable anastomotic stenoses; in the pigs in which conventional suture was used, however, ultrasonography revealed five anastomoses with varying degrees of narrowing. CONCLUSIONS: Extramucosal VCS clip anastomosis not only offers potential advantages with respect to nonpenetrating and optimal mucosal contact, investigations in animals also show it to be superior to conventional manual suture as regards anastomotic blood flow and medium-term fibrosis formation. We believe that our data and the available literature warrant a clinical evaluation of this technique in appropriate studies.     

Clinical experience with non-penetrating vascular clips in free-flap reconstructions.

To date, the gold standard for performing a microvascular anastomosis has been the penetrating suture with attached needle. During the last two decades, non-penetrating techniques have been introduced, including the Unilink system for end-to-end anastomoses, and the VCS clip-applier system for both end-to-end and end-to-side anastomoses. The aim of this study was to compare the results of different techniques used to create microvascular anastomoses in free-flap reconstructions. Between January 1995 and October 1999, we performed 474 microvascular anastomoses in 216 consecutive free-tissue transfers. The anastomosis techniques included manual sutures (42%), Unilink rings (34%) and VCS clips (24%). Seven combined sutured-clipped anastomoses were excluded from further analysis. The mean anastomotic time when rings were applied was significantly shorter than when using clips (P 0.0001) or sutures (P 0.0001). Venous anastomoses using clips took less time than those using sutures (P 0.05). There were 19 anastomotic failures, all of which lead to early flap failure. Ten flaps were salvaged by early reoperation; nine flaps were lost. Three more flaps were lost as a result of other causes, bringing the flap survival rate down to 94.4%. Early flap failure was caused by failure of the arterial anastomosis in eight cases; all of them were sutured (these represented 5% of all arterial anastomoses with sutures). None of the clipped arterial anastomoses failed. Early flap failure was caused by failure of the venous anastomosis in 11 patients. Three of these anastomoses were sutured (representing 6% of all venous anastomoses with sutures), seven were anastomosed with rings (representing 5% of all venous anastomoses with rings) and one was clipped (representing 2% of all venous anastomoses with clips). Both the VCS clip-applier system and the Unilink system are easy to handle and allow fast microvascular anastomoses without intraluminal penetration. The patency rate of clipped vessels is at least as good as the patency rates of vessels anastomosed using sutures or rings.     

Occlusive changes at the coronary artery--bypass graft anastomosis. Morphologic study of 95 grafts.

Ninety-five bypass graft anastomoses in 52 patients dying up to 4 years after direct coronary revascularization were studied at autopsy by angiograms and serial histologic sectioning of the graft-artery anastomosis. When new coronary occlusions and narrowings occurred, they were adjacent to either the proximal or distal ends of the anastomosis and were due to compression or loss of circumference of the arterial lumen (40 per cent), thrombus formation (40 per cent), mural dissection of the coronary wall (8 per cent) or the combination of compression and thrombosis (12 per cent). Small coronary artery diameter, local atheromas, and extension of the arteriotomy into a branch vessel were significant factors predisposing to occlusive changes. The findings emphasize the importance of careful artery selection for bypass, the need to avoid local vascular disease and branch-points, and the technical difficulties encountered in the presence of local vascular lesions or small coronary arteries.     

Magnetic vascular coupling for distal anastomosis in coronary artery bypass grafting: a multicenter trial

OBJECTIVE: The hand-sewn anastomosis is the "gold standard" for performing coronary artery bypass grafts. However, performing a hand-sewn anastomosis is more demanding and time-consuming when used in less invasive approaches such as small access, totally endoscopic or beating heart surgery. In conjunction with attempts to reduce the surgical trauma of coronary artery bypass grafts by using these less invasive approaches, alternative methods for constructing distal anastomoses should be explored. These data report on predischarge angiographic findings and 30-day clinical follow up of patients who have received a new distal anastomotic device. METHODS: In a multicenter trial, 32 patients (mean age: 65 +/- 9 years; 85% men) requiring multivessel coronary artery bypass surgery had 1 of the anastomoses performed using a novel anastomotic technology. The Magnetic Vascular Positioner System was used in 1 of the bypass grafts and the other bypasses were completed by conventional hand-sewn technique. The Magnetic Vascular Positioner System consists of 4 magnetic, gold-plated implants and 2 delivery devices that facilitate the creation of a functional end-to-side anastomosis. A predischarge angiogram was performed to evaluate graft patency. RESULTS: There were no device-related major adverse events. The application of the Magnetic Vascular Positioner device was successful in 32 of 41 cases (78%). Nine patients were intended for treatment but did not receive the Magnetic Vascular Positioner System. In 5 of the cases the coronary artery was too small; 1 case had a posterior wall plaque in the target artery; and 3 patients had a nonhemostatic anastomosis after coupling of the port and were subsequently converted to hand-sewn anastomoses. The median total Magnetic Vascular Positioner anastomotic time was 137 seconds with a range from 65 to 370 seconds. Overall patency rate of the Magnetic Vascular Positioner anastomosis was 93.5% versus 91.7% (P = not significant) in hand-sewn grafts. One patient (3.1%) died due to low cardiac output but had patent grafts at autopsy. One myocardial infarction (3.1%) occurred the day after a percutaneous transluminal coronary angioplasty of a hand-sewn graft. One prolonged mechanical ventilation (3.1%) was required because of pneumonia and adult respiratory distress syndrome. CONCLUSIONS: Magnetic vascular coupling in coronary surgery is safe and effective and has acceptable early patency rates. This new technique may facilitate beating heart and minimally invasive coronary artery bypass grafts.     

Primary closure of a cerebrospinal fluid fistula by nonpenetrating titanium clips in endoscopic endonasal transsphenoidal surgery: technical note

Postoperative cerebrospinal fluid (CSF) leakage is one of the most common and aggravating complications in transsphenoidal surgery. Although primary closure of the fistula would be the most desirable solution for an intraoperatively encountered CSF leak, it is difficult to achieve in such a deep and narrow operative field. In this article, the authors report endonasal endoscopic applications of no-penetrating titanium clips to repair a CSF fistula following tumor removal. The AnastoClip Vessel Closure System (VCS; LeMaitre Vascular, Boston, MA) was used for closure of a CSF fistula in endonasal transsphenoidal surgery. In all four patients, CSF leakage was successfully obliterated primarily with two to five clips. There was no postoperative CSF rhinorrhea or complications related to the use of the VCS. Metal artifact by the clips on postoperative images was tolerable. Primary closure of the fistula using the VCS was an effective strategy to prevent postoperative CSF leakage in transsphenoidal surgery. Future application can be expanded to reconstruction of the skull base dura via endonasal skull base approaches.     

Methods of vascular control during laparoscopic donor nephrectomy

Vascular control during laparoscopic donor nephrectomy (LDN) requires expeditious control of the renal artery and vein while preserving maximum graft vascular length. The vascular stapler with three rows of staples on either side of the division has been widely used, but it loses more vascular length than other methods. In the accompanying video, we illustrate vascular control with the different staplers and locking polymer clips. The techniques include two nonabsorbable polymer ligating clips (10-mm Hem-o-Lok; MLX Weck Closure Systems), the Endo-GIA Universal stapler (35-mm length, 2.5-mm staples; Autosuture), and the Endo-TA 30 stapler (30-mm length, 2.5-mm staples; Autosuture). In an in-vitro study, we previously determined that the Endo-TA 30 stapler and the polymer clips resulted in significantly less compromise of the vessel length compared with the other methods of vascular control. LDN has been recently included by the clip manufacturer as a contraindication for the use of the polymer locking clips. The Endo TA stapler can be used when preservation of maximum graft vascular length is important.     

Vascular control of the renal pedicle using the hem-o-lok polymer ligating clip in 50 consecutive hand-assisted laparoscopic nephrectomies

BACKGROUND AND PURPOSE: A crucial step in laparoscopic nephrectomy is control and ligation of the renal pedicle. Commonly, an endovascular gastrointestinal anastomosis (GIA) stapling device, titanium staples, or both is employed for vascular control. Herein, we report on the use of the Hem-o-Lok polymer ligating clip (Weck Closure Systems, Research Triangle Park, NC) for the routine control of the renal pedicle (both venous and arterial) during hand-assisted laparoscopic radical nephrectomies. PATIENTS AND METHODS: From March 2001 to December 2002, 50 hand-assisted simple or radical nephrectomies were performed by a single surgeon. The Hem-o-lok polymer ligating clip was utilized exclusively for ligation of the renal pedicle, with placement of two clips on the patient's side and one distally on the specimen side. RESULTS: Vascular control was achieved safely in all cases. Neither slippage nor complications were found in any of these cases. CONCLUSIONS: Vascular control of the renal pedicle via the Hem-o-Lok polymer ligating clip is safe and dependable for laparoscopic radical/simple nephrectomies.     

Successful vein bypass in patients with an ischemic limb and a palpable popliteal pulse

Patients presenting with an ischemic foot who have a palpable popliteal pulse have not always been considered to be suitable candidates for arterial reconstruction. Since 1976, 32 distal bypasses were performed in 30 such patients, 77% of whom were diabetic. Proximal anastomoses were from the distal superficial femoral or popliteal artery. Autologous vein was used in all cases. There were six graft failures, all of which occurred within eight months. Three failures, which all occurred within the first month, required below-the-knee amputation. Using life-table analysis, the one- and three-year patency rates were both 79%. One- and three-year limb-salvage rates were 89% and 82%, respectively. We conclude that the results of distal vein graft reconstruction originating from the superficial femoral or popliteal artery are comparable with those of any group of patients with arterial occlusive disease of a lower extremity.     

Non-penetrating vascular clips anastomosis inhibited intimal thickening under poor runoff conditions in canine autogenous vein grafts.

OBJECTIVE: Late graft failure is still a significant problem, particularly in cases with poor runoff vessels. The main cause of late graft failure is intimal thickening of the anastomotic region. Vascular closure system (VCS) clips may provide ideal anastomosis, since they do not penetrate the wall. Therefore, we examined whether the VCS clips affect intimal thickening under poor runoff conditions in the canine autogenous vein grafts. METHODS: A canine poor runoff model was prepared at both femoral veins. Four weeks after the first surgical procedure, two groups were established according to the two different methods of anastomosis employed. The right femoral vein graft was performed using polypropylene sutures, conventional surgical anastomosis (control group), while the left femoral vein graft was performed using VCS clips anastomosis (VCS group). Four weeks after grafting, the vein grafts were removed and the intimal thickening of proximal, distal anastomosis and midportion of the vein grafts were examined histologically. RESULTS: In the control group, flow rate and variation were 26+/-8 ml/min and 51+/-10 dynes/cm(2), respectively. In the VCS group, the flow rate and variation were 23+/-11 ml/min and 44+/-14 dynes/cm(2), respectively. There were no significant differences between the two groups. The average value of intimal thickening of both the anastomotic region and the midportion of the vein graft in the VCS group was significantly inhibited compared to that of the control group. The number of positive cells of masson trichrome stain in the VCS group was significantly less than that of the control group. CONCLUSIONS: These experiments indicate that VCS clips significantly inhibit intimal thickening under poor runoff conditions in canine autogenous vein grafts to a greater extent compared to suture-constructed anastomosis. One mechanism that may account for the decreased intimal thickening is the inhibition of the expression of transforming growth factor-beta (TGF-beta), because the number of positive cells of masson trichrome stain in the VCS group was significantly less than that of the control group.     

Vessel length following laparoscopic donor nephrectomy: impact of vascular ligation technique on allograft vessel length

PURPOSE: A variety of techniques have been used to secure the renal artery and vein during laparoscopic donor nephrectomy. The purpose of this study is to compare the amount of vessel length lost when the artery and vein are secured with four different techniques. METHODS: A model was constructed to simulate a left laparoscopic donor nephrectomy. In this model vessel length lost was determined when veins were secured using polymer locking (PL) clips, the endo-GIA stapling device, and the endo-TA stapling device. Arterial length lost was determined for the same three techniques, as well as securing the artery with titanium (Ti) clips. RESULTS: The mean arterial length lost for the PL clips, Ti clips, endo-TA, and endo-GIA stapling devices was 6.2, 6.3, 9.8, and 10.0 mm, respectively. Both clip types produced less loss of arterial length than both types of stapling devices (P<0.001), and there was no difference between the two types of stapling devices (P=0.73) or clips (P=0.85). The mean venous length lost for the PL clip, endo-GIA, and endo-TA stapling devices was 5.7, 10.1, and 9.4 mm, respectively. The PL clips resulted in significantly less vessel loss compared to both stapling devices (P<0.001), and there was no difference between the two stapling devices (P=0.40). CONCLUSIONS: Both types of clips resulted in longer graft arterial lengths compared to both stapling devices. PL clips resulted in longer graft vein length compared to the two stapling devices. The endo-TA stapling device was limited in this model by its inability to articulate.     

Angiographic, ultrasonographic, and macroscopic assessment of aortic growth after VCS clips, interrupted polypropylene, or running polyglycolic acid anastomosis

Background/Purpose

Lack of growth after surgery is still an unsolved issue in growing vessels. Aortic surgery is an integral part of vascular pediatric surgery. As an alternative to address this lack of growth in this scenario, we propose the use of titanium clips for vascular anastomosis.

Methods

Thirty-two domestic swine were used in this study. Animals entered the study when they were 55 days old and were subjected to an end-to-end aortic anastomosis using vasular closure stapler (VCS) clips, interrupted polypropylene, or running polyglycolic acid suture. Control group animals were sham-operated. Pigs were allowed to grow for 6 months, during which time they were subjected to serial ultrasonographic and angiographic studies to assess vascular growth.

Results

VCS clip anastomosis outcome was comparable with polypropylene or polyglycolic acid suture anastomosis. No significant differences in either longitudinal or transversal vascular growth were seen between the 3 studied suturing techniques and the control group.

Conclusions

Our vascular growth and patency results suggest that VCS clips may provide a suitable alternative to conventional suture in pediatric aortic vascular surgery.     

A comparison of para-anastomotic compliance profiles after vascular anastomosis: nonpenetrating clips versus standard sutures

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.     

纵向生物力学特性对动脉损伤修复方法选择的影响

目的 研究人体四肢主要动脉不同长度损伤与修复方法选择之间的关系，比较由于因管纵向性物力学特性面产生的修复差异，为临床修复效果及近，远期疗效评价提供依据。方法 回顾分析应用端端吻合法和自体静脉移植法修复的四肢主要动脉伤共１７７例１８５条血管，对相同损伤部位而不同修复方法的血管的真性缺损长度做ｔ检验比较，通过９５％置信区间分析两种修复方法的选取界限。对自体静脉移植修复血管中真性缺损长度做ｔ移植长度做线