Can minimal arterial aggressions using non-penetrating mechanical clip suture prevent myo-intimal hyperplasia? Preliminary results

Subject: Vascular anastomosis is still associated with a significant rate o f early(stenosis, thrombosis) and delayed (intimal hyperplasia) complicatio ns. Even though suture closure remains the most widespread standard procedu re, many mechanical systems have been developed mostly using non penetratin g clips, aiming to make the suture easier, to reduce the operating time and to reduce the scarring process of the arterial wall. We investigated the u sefulness of non penetrating titanium Vascular Closure Staple (VCS) develop ed for peripheral blood vessels anastomosis, in a study on 20 rabbits with the small VCS system. Material and methods: On 20 rabbits, 9 of the aortic sutures were done with VCS clips and 11 were done by standard closure. Results: We found a significant Improvement in the operating time of the cl osure (9 +/- 2 minutes versus 14 +/- 4 minutes), early and delayed (10 week s) patency and the respect of the aorta diameter (0.248 +/- 0.01 centimetre s versus 0.246 +/- 0.039 centimetres) and loss of surface (40.3 +/- 5.59% v ersus 45.6 +/- 6.34%). The main improvement is the reduced intimal hyperpla sia (0.128 +/- 0.05 millimetres versus 0.198 +/- 0.032 millimetres. P = 0.0 12). Conclusion : Arterial closure can be performed more rapidly with VCS clips than with suture closure, and with a marked reduced reaction of intimal hyp erplasia. With those elements it is necessary to continue the experimental studies and to evaluate the VCS sutures at mean and long term.