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The elimination of anastomosis in open trauma vascular reconstruction: A novel technique using an animal model

Tang, Andrew L. MD; Diven, Conrad MD; Zangbar, Bardiya MD; Lubin, Dafney MD; Joseph, Bellal MD; Green, Donald J. MD; Kulvatunyou, Narong MD; Vercruysse, Gary MD; Friese, Randall S. MD; O’Keeffe, Terence MB, ChB; Rhee, Peter MD, MPH

Journal of Trauma and Acute Care Surgery: December 2015 - Volume 79 - Issue 6 - p 937–942
doi: 10.1097/TA.0000000000000861
WTA Plenary Papers
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BACKGROUND The standard approach to vascular trauma involves arterial exposure and reconstruction using either a vein or polytetrafluoroethylene graft. We have developed a novel technique to repairing arterial injuries by deploying commercially available vascular stents through an open approach, thus eliminating the need for suture anastomosis. The objective of this study was to evaluate the feasibility, stent deployment time (SDT), and stent patency of this technique in a ewe vascular injury model.

METHODS After proximal and distal control, a 2-cm superficial femoral arterial segment was resected in 8 Dorper ewes to simulate an arterial injury. Two stay sutures were placed in the 3- and 9-o’clock positions of the transected arterial ends to prevent further retraction. Ten milliliters of 10-IU/mL heparinized saline was flushed proximally and distally. An arteriotomy was then created 2.5 cm from the transected distal end through which we deployed Gore Viabahn stents with a 20% oversize and at least 1-cm overlap with the native vessel on either end. The arteriotomy was then closed with 3 (1) interrupted 6-0 Prolene sutures. The ewes were fed acetylsalicylic acid 325 mg daily. Duplex was performed at 2 months postoperatively to evaluate stent patency. SDT was defined as time from stay suture placement to arteriotomy closure.

RESULTS The 8 ewes weighed a mean (SD) of 34.4 (4.3) kg. The mean (SD) superficial femoral arterial was 4.3 (0.6) mm. Six 5 mm × 5 cm and two 6 mm × 5 cm Gore Viabahn stents were deployed. The mean (SD) SDT was 34 (19) minutes, with a trend toward less time with increasing experience (SDTmax, 60 minutes; SDTmin, 10 minutes). Duplex performed at 2 months postoperatively showed stent patency in five of eight stents. There was an association between increasing SDT and stent thrombosis.

CONCLUSION Open deployment of commercially available vascular stents to treat vascular injuries is a conceptually sound and technically feasible alternative to standard open repair. Larger studies are needed to refine this technique and minimize stent complications, which are likely technical in nature.

From the Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson, Arizona.

Submitted: February 17, 2015; Revised: April 3, 2015; Accepted: August 11, 2015, Published online: October 19, 2015.

This study was presented at the 45th Western Trauma Association Annual Meeting, March 1–6, 2015, Telluride, Colorado.

Address for reprints: Andrew L. Tang, MD, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, 1501 N Campbell Ave, Room 5411, PO Box 245063 Tucson, AZ 85724; email: atang@surgery.arizona.edu.

© 2015 Lippincott Williams & Wilkins, Inc.