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Vascular Closure Stapler Clips Versus Polypropylene Sutures in End-to-End Anastomoses of Growing Arteries and Veins

  • Clinical Research
  • Published:
Annals of Vascular Surgery

Abstract

Alternatives are still being sought in vascular surgery to avoid the complications caused in growing vessels by the various suture techniques and materials currently in use. A major complication is arrested growth following anastomosis. Opinions differ widely regarding the best approach to this problem, and research is currently underway at our center on the latest generation of clip appliers (vascular closure stapler, or VCS) and their potential application as an alternative to the conventional suture technique in pediatric vascular surgery. This study compared vascular growth and reendothelialization following anastomosis of growing arteries and veins using VCS clips versus the conventional interrupted polypropylene suture technique. Thirty 55–day-old lambs underwent end-to-end anastomosis of the carotid artery and jugular vein. Serial ultrasonography and angiography were carried out over the ensuing 6–month growth period, after which the lambs were euthanized. Gross examination of the anastomosis site was followed by histologic examination involving light microscopy, immunohistochemical techniques, and transmission electron microscopy. Although both VCS clips and polypropylene sutures allowed transverse vessel growth, the clips did not penetrate the intima and thus provided enhanced reendothelialization. The satisfactory results obtained here, as in earlier studies, increasingly point to VCS clips as the method of choice in pediatric vascular surgery.

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References

  1. A Brutel la Riviere Particlede JM Quaegebeur PJ Hennis et al. (1983) ArticleTitleGrowth of an aorta coronary anastomois J Thorac Cardiovasc Surg 86 393–399 Occurrence Handle6604197

    PubMed  Google Scholar 

  2. CH Töns J Armbrecht W Bircks (1986) ArticleTitleThe use of synthetic absorbable suture materials (polyglycolid and polydioxanone in the low pressure circulatory system of growing organims) Thorac Cardiovasc Surg 34 128–131 Occurrence Handle2424128

    PubMed  Google Scholar 

  3. JA Jiménez-Cossio PJ Magallon Ortin A Galindo Garcia (1996) ArticleTitleNuevas técnicas de anastomosis vasculares Patol Vasc 2 61–67

    Google Scholar 

  4. PB Samuels (1955) ArticleTitleMethod of blood vessel anastomosis by means of metal clips Arch Surg 70 29–38 Occurrence Handle1:STN:280:CyqD38bivFE%3D

    CAS  Google Scholar 

  5. MC Calles-Vázquez MA Lima FJ Viguera et al. (2001) ArticleTitleClips metálicos VCS, una novedosa técnica de sutura que permite el crecimiento longitudinal y transversal de los vasos: avance preliminar Patol Vasc 7 535–542

    Google Scholar 

  6. MC Calles MA Lima V Crisóstomo et al. (2002) ArticleTitleEnd-to-end anastomosis in growing vessels using a novel suturing technique: VCS metallic staples Ann Vasc Surg 16 345–352 Occurrence Handle11957007

    PubMed  Google Scholar 

  7. MA Lima MC Calles JR Lima et al. (2002) ArticleTitleUltrasonographic experimental study on the evolution of vascular anastomosis with metallic clips in growing sheep carotid artery Vet Radiol Ultrasound 43 171–177 Occurrence Handle11954813

    PubMed  Google Scholar 

  8. MC Calles Vázquez JM Usón Casaús MA Lima Rodríguez et al. (2003) ArticleTitleClips metálicos VCS: una técnica de sutura más rápida y fácil de utilizar que la sutura conventional en reconstrucciones de vasos en crecimiento Angiologia 55 497–509

    Google Scholar 

  9. LE Chen AV Seabzer JR Urbaniak (1993) ArticleTitleMicrovascular anastomoses in growing vessels: a long-term evaluation of nonabsorbable suture materials J Reconstr Microsurg 9 299–306 Occurrence Handle1:STN:280:ByuD3MngsFM%3D Occurrence Handle8410790 Occurrence Handle10.1055/s-2007-1006671

    Article  CAS  PubMed  Google Scholar 

  10. PB Dimakakos A Pafiti-Kondi A Doufas et al. (1999) ArticleTitleVenous repair with vascular clips and conventional suture: a comparative experimental study Phlebology 14 65–70 Occurrence Handle10.1007/s005230050046

    Article  Google Scholar 

  11. E Pikoulis P Rhee T Nishibe et al. (1998) ArticleTitleArterial reconstruction with vascular clips is safe and quicker than sutured repair Cardiovasc Surg 6 573–578 Occurrence Handle1:STN:280:DyaK1MzitFWrsw%3D%3D Occurrence Handle10395258

    CAS  PubMed  Google Scholar 

  12. E Pikoulis P Rhee T Nishibe et al. (2000) ArticleTitleArterial repair with synthetic patch by using titanium clips J Trauma 48 292–295 Occurrence Handle10697089 Occurrence Handle1:STN:280:DC%2BD3c7mtVWlsA%3D%3D Occurrence Handle10.1097/00005373-200002000-00016

    Article  PubMed  CAS  Google Scholar 

  13. MS Baguneid S Goldner PE Fulford et al. (2001) ArticleTitleA comparison of para-anastomotic compliance profiles after vascular anastomosis: nonpenetrating clips versus standard sutures J Vasc Surg 33 812–820 Occurrence Handle1:STN:280:DC%2BD3M3kvVeqsg%3D%3D Occurrence Handle11296337

    CAS  PubMed  Google Scholar 

  14. O Gerbault C Arrouvel JM Servant et al. (1998) ArticleTitleVCS microclip anastomosis on blood vessels of less than 2 millimeters in diameter: preliminary experimental study in the rat Ann Chir Plast Esthet 43 27–39 Occurrence Handle1:STN:280:DyaK1cvktFajtg%3D%3D Occurrence Handle9768090

    CAS  PubMed  Google Scholar 

  15. MB Izzat APC Yim KCH Ho et al. (1999) ArticleTitleFavorable scanning electron microscopic findings of stapled saphenous vein-carotid artery anastomoses Ann. Thorac. Surg. 67 85–88 Occurrence Handle1:STN:280:DyaK1M7osVegsQ%3D%3D Occurrence Handle10086529

    CAS  PubMed  Google Scholar 

  16. A Leppäniemi N Rich E Pikoulis et al. (2000) ArticleTitleSutureless vascular reconstruction with titanium clips Int Angiol 23 239–243

    Google Scholar 

  17. T Shibata S Shigefumi S Yasuyuki et al. (2000) ArticleTitleArterial anastomosis using titanium clip Asian J Surg 23 239–243 Occurrence Handle10.1007/s101160050043

    Article  Google Scholar 

  18. F Lambert B Couturaud T Cruel et al. (1998) ArticleTitleVascular microanastomosis by eversion and stapling using VCS forceps: presentation of the technique and experimental evaluation of its reliability Ann Chir Plast Esthet 43 14–26 Occurrence Handle1:STN:280:DyaK1cvktFajsQ%3D%3D Occurrence Handle9768089

    CAS  PubMed  Google Scholar 

  19. CJ Zeebregts JJ Dungen Particlevan den D Kalicharan et al. (2000) ArticleTitleNonpenetrating vascular clips for small-caliber anastomosis Microsurgery 20 131–138 Occurrence Handle1:STN:280:DC%2BD3c3ltFWgsg%3D%3D Occurrence Handle10790176

    CAS  PubMed  Google Scholar 

  20. C Zeebregts J Dungen Particlevan den H Buikema et al. (2001) ArticleTitlePreservation of endothelial integrity and function in experimental vascular anastomosis with non-penetrating clips Br J Surg 88 1201–1208 Occurrence Handle1:STN:280:DC%2BD3MvovF2jsQ%3D%3D Occurrence Handle11531868

    CAS  PubMed  Google Scholar 

  21. SK Geevarghese AL Bradley J Atkinson et al. (1999) ArticleTitleComparison of arcuate-legged clipped versus sutured hepatic artery, portal vein, and bile duct anastomoses Am Surg 65 311–316 Occurrence Handle1:STN:280:DyaK1M3gsVKhtQ%3D%3D Occurrence Handle10190352

    CAS  PubMed  Google Scholar 

  22. S Deb B Martin L Sun et al. (2000) ArticleTitleComparison of titanium vascular closure staples with suture repair of the thoracic aorta in swine Chest 118 1762–1768 Occurrence Handle1:STN:280:DC%2BD3M%2FoslKktQ%3D%3D Occurrence Handle11115470

    CAS  PubMed  Google Scholar 

  23. JW Lee SJ Choo JH Oh et al. (2001) ArticleTitleAnastomosis of vessels less than 2 mm with the vascular clip system clip applier J Korean Med Sci 16 303–308 Occurrence Handle1:STN:280:DC%2BD3MzkslKmsg%3D%3D Occurrence Handle11410690

    CAS  PubMed  Google Scholar 

  24. E Ducasse F Basseau P Puppinck et al. (2001) ArticleTitleCan minimal arterial aggressions using nonpenetrating mechanical clip suture prevent myo-intimal hyperplasia? Preliminary results J Mal Vasc 26 50–54 Occurrence Handle1:STN:280:DC%2BD3MzjvFWhtg%3D%3D Occurrence Handle11240530

    CAS  PubMed  Google Scholar 

  25. RH Heijmen P Hinchliffe C Borst et al. (1999) ArticleTitleA novel one-shot anastomotic stapler prototype for coronary bypass grafting on the beating heart: feasibility in the pig J Thorac Cardiovasc Surg 117 117–125 Occurrence Handle1:STN:280:DyaK1M7gt1Ggtw%3D%3D Occurrence Handle9869765

    CAS  PubMed  Google Scholar 

  26. WD Boeckx O Darius VD Hof et al. (1997) ArticleTitleScanning electron microscopic analysis of the stapled micro vascular anastomosis in the rabbit Ann Thorac Surg 63 S128–S134 Occurrence Handle1:STN:280:ByiA2cjislw%3D Occurrence Handle9203617

    CAS  PubMed  Google Scholar 

  27. A Leppäniemi D Wherry E Pikoulis et al. (1997) ArticleTitleArterial and venous repair with vascular clips: comparison with suture closure J Vasc Surg 26 24–28 Occurrence Handle9240317

    PubMed  Google Scholar 

  28. WM Kirsch YH Zhu Z Boukouvalas RA Hardesty (1993) Microvascular anastomoses: surgical technique Lee Sun (Eds) editor. Color Atlas of Microsurgery EditionNumber1 St. Louis Ishiyaku EuroAmerica 73–78

    Google Scholar 

  29. WM Kirsch YH Zhu D Gaskill et al. (1992) ArticleTitleTissue reconstruction with nonpenetrating arcuate-legged clips: potential endoscopic applications J Reprod Med 37 581–586 Occurrence Handle1:STN:280:By2A1Mrmt1w%3D Occurrence Handle1522566

    CAS  PubMed  Google Scholar 

  30. P Nataf W Kirsch AC Hill et al. (1997) ArticleTitleNonpenetrating clips for coronary anastomosis Ann Thorac Surg 63 S135–S137 Occurrence Handle1:STN:280:ByiA2cjisl0%3D Occurrence Handle9203618

    CAS  PubMed  Google Scholar 

  31. F Rampillon YM Hailaud G Malka et al. (1996) ArticleTitleSutures microchirurgicales par agrafes non transfixiantes: étude experimentale sur quinze aortes de rat Ann Chir Plast Esthet 41 376–380 Occurrence Handle1:STN:280:ByiA38jhtVQ%3D Occurrence Handle9183887

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are especially grateful to the “Fondo de Investigación Sanitario” (F.I.S), Spain, for financing this research.

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Authors and Affiliations

  1. Department of Microsurgery, Minimally Invasive Surgery Centre, Cáceres, Extremadura, and Salamanca, Spain, Cáceres, Spain

    María Carmen Calles-Vázquez DVM, PhD, Francisco Javier Viguera MD, PhD, Fei Sun MD & Jesús Usón-Gargallo DVM, PhD

  2. Department of Surgical Pathology and Surgery, College of Veterinary Medicine, University of Extremadura, Cáceres, Spain

    Jesus M. Usón DVM, PhD

  3. Department of Histology and Pathological Anatomy, Faculty of Medicine, University of Salamanca, Salamanca, Spain

    Jose Ignacio Paz MD, PhD

  4. Department of Microsurgery, Minimally Invasive Surgery Centre, Avenida/Universidad s/n., 10071, Cáceres, Spain

    María Carmen Calles-Vázquez DVM, PhD

Authors
  1. María Carmen Calles-Vázquez DVM, PhD
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  2. Jesus M. Usón DVM, PhD
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  3. Francisco Javier Viguera MD, PhD
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  4. Fei Sun MD
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  5. Jose Ignacio Paz MD, PhD
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  6. Jesús Usón-Gargallo DVM, PhD
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Corresponding author

Correspondence to María Carmen Calles-Vázquez DVM, PhD.

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Calles-Vázquez, M.C., Usón, J.M., Viguera, F.J. et al. Vascular Closure Stapler Clips Versus Polypropylene Sutures in End-to-End Anastomoses of Growing Arteries and Veins. Ann Vasc Surg 19, 320–327 (2005). https://doi.org/10.1007/s10016-005-0004-6

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  • DOI: https://doi.org/10.1007/s10016-005-0004-6

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