Mechanics of Spatulated End-to-End Artery-to-Vein Anastomoses

Abstract

It previously has been shown that in straight end-to-end artery-to-vein anastomoses, maximum dimensions are obtained with an interrupted suture line. Nearly equivalent dimensions are obtained with a continuous compliant polybutester suture (Novafil), and the smallest dimensions are obtained with a continuous noncompliant polypropylene suture (Surgilene). The present study was undertaken to examine these suture techniques in a spatulated or beveled anastomosis in living dogs. Anastomoses were constructed using continuous 6-0 polypropylene (Surgilene), continuous 6-0 polybutester (Novafil), or interrupted 6-0 polypropylene or polybutester. Thirty minutes after construction, the artery, vein, and beveled anastomoses were excised, restored to in situ length and pressurized with the lumen filled with a dilute suspension of barium sulfate. High resolution radiographs were obtained at 25 mmHg pressure increments up to 200 mmHg. Dimensions and compliance were determined from the radiographic images. Results showed that, unlike straight artery-to-vein anastomoses, there were no differences in the dimensions or compliance of spatulated anastomoses with continuous Surgilene, continuous Novafil, or interrupted suture techniques. Therefore a continuous suture technique is acceptable when constructing spatulated artery-to-vein anastomoses in patients.