Arterial Suture Research Articles

Optical properties of human arterial thrombus, vascular grafts, and sutures: implications for selective laser thrombus ablation

To determine the optimal wavelength for laser ablation of arterial and graft thrombus, an integrating sphere was used to obtain optical measurements from different depths of abdominal aortic aneurysm thrombi, vascular grafts, and vascular sutures. Arterial thrombus of all depths maintained the wavelength profile of oxyhemoglobin absorption: the magnitude of the absorption coefficient, however, varied with the thrombus depth or age. White vascular materials demonstrated little variation in spectral absorption coefficients. When dyes were present, the suture's spectral absorption coefficients varied with the dye utilized and the product manufacturer but the nadir of absorption was in the 450-500 nm waveband, consistent with their blue-green color. A simple thermal model was used as an indicator for the radiant exposure (energy/area) that could cause vascular material dehiscence or arterial thrombus ablation. >

Early results for anatomic correction of transposition of the great arteries and for double-outlet right ventricle with subpulmonary ventricular septal defect

Fifty patients, 21 with transposition of the great arteries plus ventricular septal defect, four with double-outlet right ventricle plus ventricular septal defect, and 25 with transposition of the great arteries plus intact ventricular septum, have undergone anatomic correction. There were four hospital deaths, all in the patients with ventricular septal defects (overall mortality rate 8%). The Lecompte maneuver was used in all patients, and in the last 25 patients the coronary arteries were transposed to medially hinged trapdoor flaps created in the neoaorta. In 10 patients (20%) intraoperative adjustments were necessary to the great vessels and coronary arteries to achieve unobstructed coronary artery flow. There have been no late deaths. Postoperative cardiac catheterization in 19 patients has revealed stenosis on the new main pulmonary artery suture line to be the main early problem. Anatomic correction of transposition (with or without ventricular septal defect) and double-outlet right ventricle septal defect would seem to be a good operative alternative to the Mustard or Senning operation, with the advantage of incorporating the left ventricle into the systemic circulation.

A Century's Worth of Arterial Sutures

In light of the advanced state of vascular surgery today, it is hard to realize that the technique of vascular suturing is barely 100 years old. Even more remarkable is the skill with which the early surgeons applied almost all of the techniques we use today. Eck's experiments in the laboratory with portal vein-to-vena caval anastomoses were followed by pessimistic predictions concerning the future of arterial sutures. Jassinowsky had just performed the first successful arterial suture when he did a clinical arterial repair and, within 15 years, Carrel had developed nearly all the technical maneuvers which we use today. Knowledge of Carrel's work spread rapidly, and practical application of his work was reflected in the development of vascular replacements, such as venous grafting, the bypass technique used for vein grafts before World War I. There was, however, a lag in further developments until the end of the forties when dos Santos and Kunlin revived old methods and opened the way for further arterial surgical advances. These early developments are well-documented, but the reasons for delaying the acceptance of their applications remain a matter for speculation.

Effect of force on anastomotic suture line disruption after carotid arteriotomy

Static and dynamic forces exerted on 6-0 polypropylene suture material after carotid arteriotomy were measured in 22 adult mongrel dogs. Force was measured in 11 normotensive animals (Group I) before and 6 weeks after carotid artery repair. Force was measured in the remaining animals during normotension and induced hypertension before and 6 weeks after operation. The tensile strength of each suture used in the study was measured by the manufacturer. The mean force required to break a 6-0 polypropylene suture measured 436.9 ± 2 g, whereas knotting of the suture decreased the tensile strength to 316.9 ± 3.9 g (p < 0.001). The static and dynamic axial forces exerted on the suture after carotid arteriotomy in Group I was in the range of 26 g and decreased to 18 g at 6 Weeks, whereas the 45 degree force exerted during the static dynamic phase measured in the range of 23 g and decreased to 16 g at 6 weeks (not statistically significant). The axial and 45 degree forces exerted on 6-0 polypropylene suture material in Group II under normotensive conditions were in the range of 14 g after carotid arteriotomy and ranged between 12 to 14 g at 6 weeks. Systolic hypertension did not result in a significant increase in axial or 45 degree forces during static or dynamic measurements, both in the range of 15 g after carotid arteriotomy. Measurements were similar at 6 weeks and ranged between 14 and 16 g. Our data indicate that 6-0 polypropylene suture material is an appropriate choice for repair of the carotid artery and that the suture material has sufficient inherent tensile strength to withstand forces generated in the neck region. Furthermore, our data indicate that spontaneous carotid artery suture line disruption is most likely related to damage to the suture strand during carotid artery repair rather than an inherent weakness in the suture material.

Vascular injuries during gynecologic surgery.

Iatrogenic vascular injuries are common in the civilian western world. The frequency seen following gynecologic surgery is not known and a questionnaire was therefore sent to all gynecologic clinics in Sweden undertaking surgery, to establish the frequency during a 5-year period and to analyse the types of injury. Case reports in the literature were also analysed. The frequencies per 10,000 operations were: after laparoscopy, 0.93, after laparotomy, 0.76 and after major vaginal surgery, 0.33. All laparoscopic injuries were localized to the iliac arteries, caused bleeding, and were treated with arterial suture without complications or late sequelae. Injuries during laparotomy were most frequently venous and all patients had hemorrhage as the main symptom. In one case the external iliac vein was ligated, with immediate postoperative swelling, and in another case the external iliac artery was ligated, after which the patient developed postoperative ischemia. The internal iliac veins were ligated, and the other vessels reconstructed. There was no mortality, but a high rate of morbidity, also with late sequelae.

Immediate complications and late sequelae of arterial catheterization in children with congenital heart disease.

Early vascular complications and late sequelae are reported in relation to 195 left heart catheterizations, 125 performed by brachial arteriotomy (BA), and 70 by percutaneous femoral artery puncture (FAP) with the Seldinger technique. Vascular complications occurred in 25 patients, 11 requiring surgical intervention, which was successful in restoring normal circulation in all. The rate of complications was higher after FAP in children 6 years old or less, while after BA the rate was significantly higher in patients of 2 years or older. In patients under 2 years, brachial artery suture repair resulted in more complications than ligation, but the cases were not randomized. Late follow-up of 101 catheterizations (35 FAP, and 66 BA, of which 38 were ligated and 28 sutured) included clinical evaluation, Doppler pressure measurements, and a comparison of the length and bone development of the catheterized and non-catheterized limbs. All these have indicated an absence of any serious late sequelae in this group 6 months to 9 years (average 4 years) after catheterization.

End-to-end suture of the posterior inferior cerebellar artery after the excision of a large aneurysm

End-to-end suture of the posterior inferior cerebellar artery after the excision of a large aneurysm

Anatomical Correction of Transposition of the Great Arteries

This method of true anatomical repair of transposition of the great arteries (TGA) avoids the transection and suture of the coronary arteries and does not require any tubes of foreign material. Because the transection goes through the infundibulum under the aortic annulus, the complete aortic root together with the coronary arteries and a muscular subvalvular rim can be sutured to the pulmonary annulus. The technical simplicity of this procedure allows its application in TGA with intact ventricular septum in the newborn when the left ventricular pressure is still high or after the left ventricle has been “prepared” by previous banding of the main pulmonary artery.

Vascularized Free Flap Transfers

The success of a free flap transfer depends entirely on the suture of a paired artery and vein between the donor and recipient sites. The interrupted suturing method with biangulation or successive interrupted suturing is the method of choice. The size of the site, small or large, does not effect either the resulting patency or the process of intimal healing. When occlusion of the anastomosed site is encountered, the transferred free flap can be saved by exploration within 6 hours after surgery. Reapplication of the clamp proximally or distally to the anastomosed site does not change the patency rate. Free groin flaps can be successfully transferred in 2 orthopedic cases.

Operative Surgery, ed 3, Vascular Surgery

There is no shortage of books on vascular surgical technique, so it cannot be said that this one fills an acute, unmet need. But this is true for any new textbook on surgical technique. So many skillful and articulate surgeons have been performing vascular procedures during the past two decades that most of the techniques have become standard and universal. Nevertheless, as long as special problems can arise to test the surgeon's skill, there will always be a place for variable solutions. This book was written by 19 English and American surgeons, one American anesthesiologist, and one American radiologist. It was edited by Dr Charles Rob, a distinguished vascular surgeon recently retired from the chairmanship at the University of Rochester. The subject matter is global. The first five sections deal with the following fundamentals: the exposure of major blood vessels, arterial suture, embolectomy, and arteriography both in the x-ray department

Aneurysm of Pericardial Right Ventricular Outflow Tract Patches

Among 1,022 patients who underwent repair of tetralogy of Fallot, 252 received a pericardial patch of the right ventricular outflow tract; of these, 10 subsequently developed an aneurysm of the right ventricular outflow tract. Cardiac catheterization and angiography revealed moderate pulmonary insufficiency in all patients, a residual pressure gradient in the right ventricular outflow tract in 7, and a residual ventricular septal defect in 2 patients. Reoperation was indicated in 8 patients because of progressive distention of the aneurysm, residual infundibular or pulmonary artery stenosis, and recurrent ventricular septal defect. Reconstruction of the right ventricular outflow tract was accomplished by resection of the aneurysm and insertion of a woven Dacron patch in 5 patients, primary suture of the pulmonary artery in 2, and implantation of a woven Dacron conduit containing a Björk-Shiley cardiac valve prosthesis in 1 patient. There were no early or late deaths. When reconstruction of the right ventricular outflow tract is necessary, we recommend a woven Dacron patch because pericardium may form an aneurysm.

Aneurysm of pericardial right ventricular outflow tract patches (author's transl)

Among 1022 patients who underwent total repair of tetralogy of Fallot, 252 patients received a pericardial patch of the right ventricular outflow tract (RVOT); and of these 10 subsequently developed an aneurysm of the RVOT. Cardiac catheterization and angiography revealed moderate pulmonary unsufficiency in all patients, a residual pressure gradient in the RVOT in seven and a residual ventricular septal defect in two patients. Surgery was indicated in eight patients because of progressive distension of the aneurysm. Reconstruction of the RVOT was accomplished by resection of the aneurysm and insertion of a woven Dacron patch in five patients, primary suture of the pulmonary artery in two and implantation of a woven Dacron conduit containing a Björk-Shiley valve in one patient. No early or late death occured. Although aneurysms of the RVOT with pericardial patches represent a rare complication after total correction of tetralogy of Fallot, we recommend primary reconstruction of the RVOT with a woven Dacron patch.

Distant Transfer of an Island Flap by Microvascular Anastomosis

The first clinical cases of composite graft of skin and fat were reported by Daniel and Taylor (1973). O'Brien et al (1973) and Harii et al (1973) have also reported on some successful cases of groin flap transfer.The authors reported five cases of distant transfer of an island flap by microvascular anastomosis. The groin flap was used for four cases and a hypogastric flap was used for one. In all cases, end-to-end anastomosis of vein and end-to-side suture of artery were performed.All grafted flap was taken completely and no complication was noticed during the operation and after the surgery.

Ascending Aortic Aneurysms with Associated Aortic Regurgitation

A safe method for replacement of the entire aortic valve, root, and ascending aorta for aortic insufficiency associated with an ascending aortic aneurysm is supported. This method utilizes a composite synthetic graft and valve with direct annular suture and implantation of the coronary arteries in the graft. The advantages of the technique include a shortened operation and freedom from postoperative hemorrhage, paraprosthetic leakage, and recurrent aneurysm formation.

Mechanical arterial suture in contaminated wounds

<h2>Summary</h2> Experiments were carried out in pigs in which end to end femoral anastomoses were performed with a Soviet vascular stapler (ASC-4). The animals were divided into two groups. Group I, the control group of five animals, included anastomoses performed under sterile conditions; in group II, ten animals, anastomoses were performed in infected wounds. Results show that arterial suture with the ASC apparatus may prove successful even in infected wounds when the correct technic and adequate antibiotic coverage (Terramycin depot) are employed.

Direct union of coronary arteries after excision of short segments—An approach without arterial sutures, prostheses, or adhesives

Ten dogs underwent excision of a short segment of the diagonal branch of the left anterior descending coronary artery, the distal left circumflex coronary artery or one of its branches. Hemostasis was secured by suturing the overlying epicardium except in two animals in which the addition of a pericardial patch was necessary to control bleeding. Arterial sutures, prostheses, or adhesives were not used. Two animals died in the first 36 hr after surgery, one of massive pulmonary atelectasis, the other of bleeding. Arteriograms in the eight surviving animals showed healing of the divided coronary arteries with excellent distal filling in seven of them. Vascular union was noted as early as the fifth postoperative day and as late as the end of the 3-month follow-up period. The possibility of applying this simple surgical technique to certain instances of coronary arterial occlusive disease is discussed.

Isolated Injury to the Median Nerve above the Elbow

Isolated median-nerve injuries above the elbow are uncommon and are usually associated with injury to the brachial artery. The typical findings in the thirteen patients studied were loss of sensation in the distribution of the nerve and atrophy of the forearm flexors and thenar muscles in all patients. The only consistent motor loss was lack of flexion of the interphalangeal joints of the thumb and index finger. Inability to rotate the thumb occurred in five of the thirteen patients. Forearm pronation was weakened but was never completely lost. Suture of the brachial artery restored the radial pulse in all patients but not always immediately. Both primary and secondary nerve suture resulted in an excellent return of protective sensation. In two young patients with primary nerve repair sudomotor activity returned twenty-three and twenty-six months, respectively, after injury. Action of the digital flexors returned clinically and electromyographically in all patients. In four patients an abnormal grasp developed and they had to relearn thumb and index finger flexion. During the time required for nerve regeneration, burns of the hand were a significant complication for five of the thirteen patients. Loss of thumb rotation, which occurred in five of the thirteen patients, appeared to be the most serious disability. Nerve suture was effective in restoring this function in only one of the five patients. Tendon transfer to restore thumb rotation was performed in the remaining four patients. This procedure was reserved for patients who have reinnervation of the forearm muscles, a return of protective sensation to the hand, and joints that have been kept supple by exercising and splinting.

INTERNAL MAMMARY AND CORONARY ARTERY SUTURE-ANASTOMOSIS WITH USE OF PATCH GRAFTING.

INTERNAL MAMMARY AND CORONARY ARTERY SUTURE-ANASTOMOSIS WITH USE OF PATCH GRAFTING.

Use of autogenous dermis for protection of the carotid artery and pharyngeal suture lines in radical head and neck surgery

Use of autogenous dermis for protection of the carotid artery and pharyngeal suture lines in radical head and neck surgery

The comparative development of atherosclerosis in the normal aorta, synthetic vascular grafts and endarterectomized aorta

Summary A segment of abdominal aorta in mongrel dogs was endarterectomized, removing the intima and 50 to 75 per cent of the media. A dacron bypass graft was then sutured end to side to the endarterectomized segment, and end to side to the normal aorta proximally or distally, doubly ligating the bypassed aorta at both ends. The thyroid gland was removed surgically and the dogs placed on a 5 per cent cholesterol diet and given 50,000 units vitamin D daily. They were sacrificed two to seven months later, at which time the proximal abdominal aorta had significantly more atherosclerosis than the dacron graft or endarterectomized aorta. The new intima lining the dacron graft was almost identical with that lining the endarterectomized segment of aorta, and both areas of new intima were quite resistant to the development of atherosclerosis. The caliber of the endarterectomized aorta was the same as that of the proximal aorta, without any evidence of increased fibrosis about it. There was no evidence that arterial suture lines were more susceptible to atherosclerosis than the adjacent vessels.