ABSORBABLE SUTURE IN VASCULAR-SURGERY

The choice of suture material in surgery is often individual and a res ult of personal experience. Cardiovascular surgeons have always been r eluctant to use absorbable suture material for direct arterial or veno us anastomoses for different reasons, mainly because of suspected anas tomotic dilatation or even rupture during or after the absorption phas e. More than ten years ago, a new class of synthetic, monofilament, fl exible, biodegradable suture material was introduced for clinical use. Since then, much experimental and clinical work has been carried out to evaluate physical and biological characteristics of this class of s uture material (polydioxanone/polydimethylsiloxane=[PDS] and polytrime thylene-carbonate=[PTMC]) in many different tissues, including vascula r tissue. There is increasing evidence that slow-absorbable sutures wi ll gain clinical importance for cardiovascular and peripheral vascular surgery in the future, since many experimental and clinical studies d uring the last forty years have proven histologic superiority over non absorbable materials. Descriptions of healing processes in blood vesse ls after surgical anastomoses lead to the conclusion that persisting f oreign suture material results in persistent cellular reactions and ch ronic inflammatory responses and may consequently disturb physiologic functions such as compliance at the anastomotic site. It is the purpos e of this article to give a review of the literature. Implications are discussed for surgery of growing vessels, transplantation surgery, mi crosurgery, and surgery in infected anastomoses. Nonabsorbable suture material should no longer be used for direct vascular anastomoses.