Philippine Journal of Surgical Specialties Vol. 74, No. 1, January-June 2019, pp 1-8

A Comparison of Distal Endoluminal Graft Fixation Methods: Healing Characteristics of Metallic Stents and the Endoluminal Suture Technique

Author(s): Ricardo Jose T. Quintos II, MD, FPCS, Takao Ohki, MD and Frank J. Veith, MD

Endoluminal grafts (EG) are a promising alternative to conventional open surgical approaches in the treatment of aneurysmal and occlusive arterial diseases. These devices generally employ metallic stents to secure the proximal and distal EG extents. However, the problem of intimal hyperplasia at the distal EG anastomotic ends similarly affect long-term outcomes as in conventional interposition grafting methods. A technique of distal EG anastomosis using handsewn endoluminal sutures is described and its effects on subsequent development of intimal hyperplasia compared with that of metallic endoluminal stents

Ten adult mongrel dogs underwent bilateral common iliac artery endoluminal grafting procedures. On one side, the distal EG anastomosis was anchored with metallic stents while on the contralateral side the distal EG was secured with endoluminal sutures. The grafts were harvested after one month and the intimal characteristics were observed using histopathological methods.

Distal EG metallic stents and endoluminal sutures resulted in similar patency rates of 90%. The average time to deploy distal EG metallic stents was 56 seconds, while the average time to secure the distal EG anastomosis using endoluminal sutures was 3 minutes 42 seconds. Metallic stents induced the development of intimal hyperplasia to a degree greater than endoluminal sutures (316 ± 12 μm vs. 245 ± 30 μm, p< 0.05), but did not affect patency.

Hand sewn endoluminal suture technique results in a lesser degree of intimal hyperplasia compared with that produced by endoluminal metallic stents, while the patency rates are comparable.

Key words: hyperplasia, stents, suture techniques, arterial occlusive disease