Absorbable suture improves growth of venous anastomoses

Growth of vascular anastomoses is desirable in pediatric vascular surgery, especially in pediatric organ transplantation. Although absorbable suture has been shown to be superior to nonabsorbable suture in permitting growth of arterial anastomoses, the optimal suture material for venous anastomoses has not been established. To examine this in a porcine model, we performed bilateral primary end-to-end anastomoses of transected external jugular veins in 10, 4-week-old piglets. In each piglet one anastomosis was constructed with continuous absorbable 8-0 polyglyconate suture, whereas the contralateral anastomosis was constructed with continuous nonabsorbable 8-0 polypropylene suture. After 6 months the veins were excised, pressure fixed at 15 mm Hg for 2 hours, and examined grossly and histologically. Vein diameter was measured by contrast radiography at the anastomosis and 1 cm proximal and distal to the anastomosis. Vein cross-sectional area 1 cm from the anastomosis was similar in the two groups: polyglyconate 95.7 ±12.3 mm2 versus polypropylene 95.3 ± 9.7 mm2. However, polyglyconate anastomoses had greater cross-sectional area (polyglyconate 72.8 ± 7.9 mm2 vs polypropylene 51.8 ± 6.0 mm2; p < 0.05). In addition, at 6 months polyglyconate anastomoses had a greater percentage of growth (polyglyconate 207% vs polypropylene 118%;p < 0.05) compared with native vein cross-sectional area (23.7 ± 0.39 mm2) from control pigs at 4 weeks of age. On histologic examination, polyglyconate had dissolved entirely in six cases and was present but in varying degrees of dissolution in the other four; in contrast, polypropylene was identifiable at all anastomoses. These results suggest that absorbable suture is superior to nonabsorbable suture for construction of venous anastomoses when anastomotic growth is important. (J Vasc Surg 1992;769–73.)