Development of an anastomotic device for distal anastomosis to achieve marked improvement of total arch replacement

[目的]主动脉弓部动脉瘤的远端吻合必须在无出血、短时间内完成，才能使人工血管置换术取得明显的效果。我们研制了一种用于远端吻合的吻合器，并进行了基础实验以证实其有效性。[方法]吻合器具有便于褥式缝合的机构。使用牛胸主动脉和移植物（外径20 mm和26 mm）。EPTFE毡用于主动脉外侧。缝合针长度为9.0 mm，使用直缝线迹的缝合线。[结果] 1.主动脉壁厚及交针的确定性：主动脉壁厚4.6mm时，吻合器交针准确，但壁厚4.8mm以上的病例交针困难。2.相邻褥式缝合线之间的距离：在2.0 mm的情况下，发现相邻褥式缝合线之间存在间隙，并且在注水试验中发现吻合部位泄漏。在1.0 mm和1.0 mm重叠的情况下，在相邻褥式缝合之间没有发现穿透空间。3.吻合器的针距：针距为5.0 mm，交针机构无问题，褥式缝合间无间隙。针间距离为7.5 mm时，由于主动脉弯曲面和组织硬度，在某些情况下，针弯曲且交接机制受到干扰。当相邻褥式缝合线没有重叠时，褥式缝合线之间会产生间隙。[结论]该吻合器针距为5.0 mm，相邻褥式缝合间距为1.0 mm，具有良好的临床应用前景。

[Purpose]To achieve marked improvement of graft replacement for aortic arch aneurysm, distal anastomosis must be performed without hemorrhage and in a short time. We developed an anastomotic device for distal anastomosis and conducted a basic experiment to confirm its efficacy. [Methods]The anastomotic device has a mechanism to facilitate mattress sutures. Bovine thoracic aorta and grafts (20 mm and 26 mm in outer diameter) were used. EPTFE felts were used for the outer side of the aorta. The suture needle was 9.0 mm in length and suture threads with straight stitches were used. [Results]1.Thickness of the aortic wall and the certainty of handing over of the needle : Although the needle was handed over accurately by the anastomotic device up to aortic wall thickness of 4.6 mm, difficulties were encountered in some cases with wall thicknesses of 4.8 mm or more. 2.Distance between adjacent mattress sutures : In the case of 2.0 mm, a space between adjacent mattress sutures was found and leakage from the anastomosis site was found in water infusion test. In the cases of 1.0 mm and of 1.0 mm overlap, no penetrating space was found between adjacent mattress sutures. 3.Inter-needle distance of the anastomotic device : With the inter-needle distance of 5.0 mm, there was no problem in the mechanism of needle handing over and no spaces were found between the mattress sutures. With an inter-needle distance of 7.5 mm, the needle bent and the handing over mechanism was disturbed in some cases due to the aortic curvature face and the hardness of the tissues. When there was no overlap of adjacent mattress sutures, spaces were produced between the mattress sutures themselves. [Conclusions]With an inter-needle distance of 5.0 mm and adjacent mattress suture interval of 1.0 mm, the development of anastomotic device in the present study suggested that a clinically useful anastomotic device could be made in the future.