Effect of suture technique on blood velocity waveforms in the microvascular anastomosis of autogenous vein graft

Abstract

In using autogenous vein grafts in microvascular surgery, maintenance of compliance at the site of anastomosis is of importance in achieving patency. Using high-frequency, 20 MHz, pulsed Doppler ultrasonography to monitor blood flow velocity through the vein graft, we have evaluated the effects of continuous and interrupted suture technique on anastomotic compliance in vessels less than 1.5 mm in diameter. In 15 dogs, 15 procedures of each technique, using the continuous technique in one limb and the interrupted technique on the contralateral limb, patency rates for both techniques, documented by arteriography, are 100% at a mean follow-up of 11 weeks. There were no significant differences in the blood velocity profile and pulsatility proximally, distally, and at the graft site between continuous and interrupted technique. This study confirms the suggestion that autogenous vein graft has sufficient elasticity to maintain normal arterial blood velocity waveforms.

From simple interrupted to complex spiral: A systematic review of various suture techniques for microvascular anastomoses

“…First, comparison in anastomotic compliance was not performed in veno‐venous anastomoses. Second, the reduction in the anastomotic area seemed to be greater in the continuous suture technique, but this difference did not have any hemodynamic significance and did not affect flow rates and/or patency 12, 16. Also, studies that performed histological evaluation showed no difference in re‐endothelialization between either of the two techniques 7, 9, 13, 15.…”

“…Several animal studies have since evaluated the interrupted and continuous suture techniques using arterial, venous, and arterio‐venous anastomoses5, 7–18, 36 (Table 1). Data were obtained using multiple conventional methods, including arteriogram, Doppler ultrasonography, and histological studies.…”

“…Lee et al measured the blood velocity profile in two studies using high frequency pulsed Doppler ultrasonography 12, 16. Blood flow velocities were measured in both arterial and arterio‐venous anastomoses in dogs and did not show any significant hemodynamic differences between either the continuous and/or interrupted suture techniques.…”

“…Currently, there are numerous suture techniques for microsurgical anastomoses described in the literature. These include the standard interrupted suture,6 continuous suture,5, 7–17 locking continuous suture,13, 18 interrupted horizontal mattress suture,19, 20 continuous horizontal mattress suture,21, 22 posterior‐wall‐first suture,23–25 and the sleeve anastomosis 26–30. To determine the optimal technique, numerous investigations have been performed comparing varying endpoints such as operative time, blood flow velocity, anastomotic compliance, anastomotic histology, and patency rates.…”

Use of a Novel Penetrating, Sutureless Anastomotic Device in Arterial Microvascular Anastomoses

“…In addition to decreased operative times, multiple studies have demonstrated significant advantages including improved flow rates and compliance in small-vessel anastomoses performed via interrupted technique compared with continuous suture. [8][9][10][11][12][13][14][15] Nitinol is a nickel and titanium alloy with the unique characteristics of ''superelasticity'' and ''shape memory.'' This shape memory is due to a crystalline phase change occurring as the metal is heated, resulting in the self-closing nature of U-clips.…”