BRITISH 1005 MEDICAL JOURNAL joined together and the sutures tied consecutively. The proximal end of the artery, forming a cuff with the intima outside, is invaginated into the distal portion. (In suturing a vein the cuff is formed at the peripheral end of the vessel.) At the end of the operation the proximal clamp is first of all removed and then the distal one. The pressure of the blood passing through the cuff at the proximal end presses the latter closely against the intima of the distal end, thus ensuring a hermetic suture. The injured parts of the vascular wall, the suture material, and even the stitch-holes remain outside the lumen and are separated from it by a band of intact intima in close adhesion. All factors contribtuting to the formation of thrombosis are thus excluded, the force of the blood pressure now blocking and isolating the lumen of the vessel instead of causing haemorrhage.Out of a total of 52 experiments with the circular suture only two were followed by thrombosis at the site of operation. Vasographical and histological examination has shown that the slight constriction of lumen which occurs at the site of anastomosis completely disappears in a week or two, this process being due to atrophy of the media in those parts of the vascular wall which are isolated from the lumen of the vessel. Examination of the vascular nerves at the site of suture has shown that they grow through the outer adventitial coats across the line of anastomosis.This modification of the circular suture has been success-fLily used in uniting not only vessels of equal diameter but those of different diameters as well. In a number of experiments on dogs end-to-end anastomosis between the left subclavian and pulmonary arteries has also been successfully performed. It should be noted that in such cases one to three additional adventitial interrupted sutures are usually needed, but even then the operation takes no longer than eight to ten minutes.
ConclusionThe new modifications of the hand-made and mechanical sutures here described have been used to divert arteries in plastic operations on the large arterial trunks. By means of such an operation it is possible, for instance, to repair a defect of the femoral artery below the branching of the deep femoral artery in man over a distance of 7-10 cm. by anastomosing the intersected deep femoral artery to the distal portion of the femoral artery. Animal experiments have shown that the substitution of smaller arteries for arteries with a diameter 1 -2 times greater secures a renewal of the general blood circulation which is functionally adequate.The value of the methods of vascular suture, both hand-made and mechanical, elaborated in my department of operative surgery at the Medical Institute in Moscow has been amply proved both experimentally and in clinical practice. "Radiopage," a miniature personal radio-receiver using transistors instead of valves, was demonstrated recently in London. It is claimed to be " eminently suitable " for use in hospitals. The receiver fits into a p...