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A NOVEL, ONE-SHOT ANASTOMOTIC DEVICE FOR PROSTHETIC VASCULAR GRAFTS
Willem J. Suyker1, Paul T. Suyker2.
1Isala, Zwolle, Netherlands, 2iiTech BV, Amsterdam, Netherlands.

OBJECTIVE: A novel, one-shot device for the construction of angled end-to-side anastomoses, suitable for facilitating minimally invasive procedures where relatively large prosthetic vascular grafts are involved, was compared in vitro to conventionally sutured anastomoses.
METHODS: Using the concept of endoluminal device expansion followed by staple closure for tissue bonding, as previously described for the S2 distal coronary microstapler, an anastomotic device for making 30° angled end-to-side anastomoses between prosthetic vascular grafts and large blood vessels was developed. In a laboratory test setup, a 14 mm prosthetic vascular graft was anastomosed to porcine aorta either using the device or using conventional suturing (video). Anastomosis construction times, need for additional sutures and pressurized leak rates were assessed in vitro using colored water for 10 device constructed and 8 conventionally sutured anastomoses.
RESULTS: Successful anastomoses were obtained in all, consecutive cases. For device anastomoses versus sutured anastomoses, the mean construction time was 3’±4 versus 20’±6 (p<0.001), the mean number of required additional stitches was 0.6, median 0, versus 1.7, median 1 (p=0.20), the mean leak rate at 120mmHg was 8±6mL/min versus 19±7mL/min (p<0.01) and at 200 mmHg 21±11mL/min versus 32±13mL/min (p=0.10).
CONCLUSIONS: Anastomoses involving relatively large prosthetic vascular grafts could be constructed significantly quicker by using the anastomotic device than by hand suturing. The device constructed anastomoses showed significantly lower leak rates at physiologic pressures. These results bode well for minimally invasive procedures.


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