INFLUENCE OF SUTURE TECHNIQUE AND SUTURE MATERIAL SELECTION ON THE MECHANICS OF END-TO-END AND END-TO-SIDE ANASTOMOSES

Experiments were performed in dogs to evaluate the mechanics of 26 end -to-end and 42 end-to-side artery-vein graft anastomoses constructed w ith continuous polypropylene sutures (Surgilene; Davis & Geck, Divisio n of American Cyanamid Co., Danbury, Conn.), continuous polybutester s utures (Novafil; Davis & Geck), and interrupted stitches with either s uture material. After construction, the grafts and adjoining arteries were excised, mounted in vitro at in situ length, filled with a dilute barium sulfate suspension, and pressurized in 25 mm Hg steps up to 20 0 mm Hg. Radiographs were obtained at each pressure. The computed cros s-sectional areas of the anastomoses were compared with those of the n ative arteries at corresponding pressures. Results showed that for the end-to-end anastomoses at 100 mm Hg the cross-sectional areas of the continuous Surgilene anastomoses were 70% of the native artery cross-s ectional areas, the cross-sectional areas of the continuous Novafil an astomoses were 90% of the native artery cross-sectional areas, and the cross-sectional areas of the interrupted anastomoses were 107% of the native artery cross-sectional areas (p < 0.05). At physiologic pressu res, there were no differences in compliance among the three types of anastomosis. These data suggest that when constructing an end-to-end a nastomosis in a small vessel, one should use an interrupted suture lin e or possibly continuous polybutester suture. Forty-two end-to-side an astomoses demonstrated no differences in cross-sectional areas or comp liance for the three suture techniques. This suggests that, unlike wit h end-to-end anastomoses, when constructing an end-to-side anastomosis in patients any of the three suture techniques may be acceptable.