A comparison of para-anastomotic compliance profiles after vascular anastomosis: Nonpenetrating clips versus standard sutures

Purpose: Anastomotic compliance is an important predictive factor for long- term patency of small diameter vascular reconstruction. In this experimenta l study we compare the compliance of continuous and interrupted sutured vas cular anastomoses with those using nonpenetrating clips. Methods: Both common carotid arteries in nine goats (average weight, 57 +/- 5.7 kg) were transected, and end-to-end anastomoses were constructed with nonpenetrating clips or polypropylene sutures. The latter were applied with both interrupted and continuous techniques. Intraluminal pressure was meas ured with a Millar Mikro-tip transducer, and vessel wall motion was determi ned with duplex ultrasound equipped with an echo-locked wall-tracking syste m. Diametrical compliance was determined. Environmental scanning electron m icroscopy was performed on explanted anastomoses. Results: There was a reduction in anastomotic compliance and associated pro ximal and distal para-anastomotic hyper-compliant zones with the use of all techniques. However, compliance loss was significantly less in those anast omoses with clips and interrupted sutures when compared with continuous sut ure (P <. 001). Furthermore, the total compliance mismatch across anastomos es with continuous sutures was significantly greater than those with dips o r interrupted sutures (P < .05). The mean time for constructing clipped ana stomoses was 5.7 +/- 1.4 minutes, which was significantly less than either continuous (P < .0001) or interrupted sutures (P < .0001). Furthermore, env ironmental scanning electron microscopy demonstrated minimal intimal damage with good intimal apposition in the clip group. Conclusion: Anastomoses performed with nonpenetrating clips resulted in imp roved para-anastomotic compliance profiles and reduced intimal damage when compared with those with polypropylene sutures. These benefits may enhance long-term graft patency by reducing the risk of anastomotic intimal hyperpl asia.