Stapled versus hand-sewn vascular anastomoses - An experimental study in the rabbit

Objective: Narrowing of vascular anastomoses is a frequently encountered su rgical problem, with intimal hyperplasia being one of its most important ca uses. The aim of the present study was to compare in a rabbit model 'manual ' (hand-sewn) with 'stapled' anastomoses (using a staple device) with respe ct to occurrence and severity of intima I hyperplasia, Materials and Method s: Twenty-four male rabbits (mean weight 2,849 g)were randomly allocated to one of two groups (n = 12). An end-to-end anastomosis of the left femoral artery was performed in all animals under general anesthesia. The anastomos is was hand sewn in group 1, while a vascular closure stapler (VCS) was use d in group 2, Both anastomotic time and total operation time were recorded. After 28 days, the rabbits were sacrificed. The femoral artery of operated and nonoperated sides were removed and pre-pared for anatomopathological e xamination. The I/M ratio (= difference between tunica intima and tunica me dia) was determined on hematoxylin-eosin stained slides. All results were a nalyzed using Student's t test. Results: Mean anastomotic times were 25 +/- 7 min for the 'manual' group and 17 +/- 9 min for the 'stapled' group (p = 0.02), There was no significant difference in the total operation time (55 +/- 15 vs, 41 +/- 18 min, p = 0.057). All animals survived the anastomosis procedure. In the group of 'manual' anastomosis, morbidity was significant ly higher, At the moment of sacrifice, all anastomoses were patent. There w as no difference in the I/M ratio between the groups. Conclusions: The use of VCS is a promising alternative to hand-sewn anastomoses. It takes less t ime to perform a stapled anastomosis, the technique has a shorter learning period and morbidity seems to be lower when vascular anastomoses are applie d with the VCS in this rabbit model, Copyright (C) 2000 S. Karger AG, Basel .