Clinical evaluation of the mechanical suture in vascular operations in end stage renal failure and posttransplant patients with coagulopathy - an own exerience
Ann Transplant 2009; 14(1): 52-52
Mechanical suture is still not a standard mean of vascular anastomosis, mostly due to price of a set of 25 staplers which is 50 times of a standard prolene suture. There are situations, however when this cost may be fully compensated by a final effect of the use of staplers. This is the case in patients with coagulopathy whose, the use of non penetrating staplers for anastomosis that do not make holes in the prosthesis, protects from serious bleeding which always happens as a result of needle punctures made in PTFE during standard suture. Therefore, despite higher cost of no penetrating staplers, their application in patients with coagulopathy is fully justified as a method of avoiding serious complications like hematoma, infection and even PTFE graft loss. We used vascular sutures in 47 dialysed or transplant patients while engrafting PTFE prosthesis in the following operations:
- 31 straight arteriovenous (a-v) PTFE on arm*1,
- 5 PTFE bridges (Femoro - femoral suprapubicus, ilio-iliac or ilio-femoral*2),
- 6 PTFE loops on the arm or the femur*3,
- 5 PTFE bridges (a-v fi stula or in-arterial anastomosis after renal transplantation) *4.
Out of 47 vascular grafts 39(83%) survived 12 months. Eight grafts have been
removed (17%): 6 due to infection in diabetic patients, 2 for thrombosis. Five patients with thrombosis have been treated operatively with good result, some of them several times, including 1 patient with an aneurysm of the venous end of a-v fistula. Not a single complication related to staplers themselves, including septic cases was observed. Very careful inspection of staplers proved that even in cases requiring finally the removal of PTFE, location and function of staplers was uncompromised.
Conclusions: No penetrating vascular staplers, despite their high cost are
strongly recommended in vascular operations with the use of PTFE, especially in patients with coagulopathy such as haemodialysis and post transplant patients.
Keywords: Kidney Transplantation