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

Abstract Purpose: Anastomotic compliance is an important predictive factor for long-term patency of small diameter vascular reconstruction. In this experimental study we compare the compliance of continuous and interrupted sutured vascular 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 measured with a Millar Mikro-tip transducer, and vessel wall motion was determined with duplex ultrasound equipped with an echo-locked wall-tracking system. Diametrical compliance was determined. Environmental scanning electron microscopy was performed on explanted anastomoses. Results: There was a reduction in anastomotic compliance and associated proximal and distal para-anastomotic hypercompliant zones with the use of all techniques. However, compliance loss was significantly less in those anastomoses with clips and interrupted sutures when compared with continuous suture ( P P P P Conclusion: Anastomoses performed with nonpenetrating clips resulted in improved 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 hyperplasia. (J Vasc Surg 2001;33:812-20.)