Mechanics of end-to-end artery-to-PTFE graft anastomoses |
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Authors: | Philip B Dobrin Raul Mirande Steven Kang Quan Sheng Dong Robert Mrkvicka |
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Institution: | (1) Department of Surgery, University of Utah Medical School and Veterans Affairs Hospital, Salt Lake City, UT, US;(2) Department of Surgery, Loyola University Medical Center, and Hines Veterans Affairs Hospital, Maywood, IL, US |
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Abstract: | On some occasions vascular surgeons are called upon to construct an end-to-end anastomosis using prosthetic graft material.
If a spatulated anastomosis is not fashioned, three important variables that are under the surgeon’s control could affect
anastomotic dimensions: (1) selection of graft material, (2) graft size relative to the native vessel, and (3) suture technique.
Accordingly, studies were performed on 36 nonspatulated, end-to-end artery-to-polytetrafluoroethylene (PTFE) grafts to evaluate
the effects of graft size and suture technique on anastomotic dimensions. Size-matched (3 mm) and slightly oversized (4 mm)
grafts were anastomosed end-to-end to 3 mm pig carotid arteries using (1) running polypropylene (Surgilene) sutures, (2) running
polybutester (Novafil) sutures, or (3) interrupted sutures. After 30 min the vessels were excised, filled with contrast material,
and radiographs were obtained to measure anastomotic dimensions. Results showed that, at every comparable pressure, 4 mm grafts
produced larger anastomoses than did 3 mm grafts. In addition 4 mm grafts produced smoother anastomoses without a constricted
or “pinched” appearance at the graft-artery junction. Marked compliance mismatch was observed with both sized grafts. There
was no significant difference in the dimensions of the anastomoses or compliance mismatch with the three different suture
techniques. These studies indicate that, when using PTFE grafts for end-to-end anastomoses, a graft that is slightly larger
than the artery is preferable to provide the largest and smoothest anastomosis, and that any of the three suture techniques
may be used.
PTFE grafts were provided by W. L. Gore, Flagstaff, AZ. Sutures were provided by Davis & Geck, Co., Danbury, CT. No other
support, direct or indirect, was provided by any manufacturer. |
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