Ulus Travma Acil Cerrahi Derg. 2009; 15(6): 535-540

Comparison of cyanoacrylate-assisted arteriotomy closure with conventional closure technique

Omer Faik Ersoy¹, Huseyin Ayhan Kayaoglu¹, Alper Celik¹, Namik Ozkan¹, Nese Lortlar², Suna Omeroglu^2
1Department Of General Surgery, Gaziosmanpasa Unýversity Faculty Of Medicine, Tokat, Turkey
²Department Of Histology And Embryology,gazi Unýversity Faculty Of Medicine, Ankara, Turkey

BACKGROUND
We aimed to compare conventional suture closure of arteriotomy with N-butyl-cyanoacrylate-assisted suture closure.
METHODS
Forty Wistar rats were randomly divided into two groups. Standard arteriotomy was performed to the abdominal aorta through a midline incision. In the first group, arteriotomy was closed by 3 stitches with 45° between each and in the second by two stitches with 0.1 ml (12-12.5 mg) cyanoacrylate. Amount of blood loss, operation time and severity of myointimal hyperplasia by immunohistochemistry on aorta segments were measured on postoperative days 7 and 30.
RESULTS
Mean anastomotic time was 13.5±1.64 in the first and 13.0±1.75 min in the second group (p=0.356). Operation time was 23.45±3.63 in the control and 21.0±3.09 min in the second group (p=0.027). Mean amount of bleeding was 473.75± 260.5 in the first and 327.5± 155.36 μl in the second group (p=0.037). Intimal thickness on the 7th day was 80.62±7.92 in the first and 83.24±3.42 μm in the second group, and on the 30th day was 81.64±5.11 in the first and 88.77±11.03 μm in the second group. The early and late intimal thicknesses were similar (p=0.35 and 0.87, respectively).
CONCLUSION
Reconstruction of arteriotomies with fewer sutures in combination with cyanoacrylate is a safe method associated with less blood loss and shorter operation time. It also does not lead to increased myointimal hyperplasia.

Keywords: Arteriotomy closure, N-butyl 2 cyanoacrylate; myointimal hyperplasia; operation time; vascular injury.

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Siyanoakrilat yardýmlý arteriyotomi kapama tekniðinin konvansiyonel kapama tekniði ile karþýlaþtýrýlmasý

Omer Faik Ersoy¹, Huseyin Ayhan Kayaoglu¹, Alper Celik¹, Namik Ozkan¹, Nese Lortlar², Suna Omeroglu^2
1Gaziosmanpaþa Üniversitesi Týp Fakültesi, Genel Cerrahi Ana Bilimdalý, Tokat
²Gazi Üniversitesi Týp Fakültesi, Histoloji Ve Embriyoloji Ana Bilimdalý, Ankara

AMAÇ
Arteriyotomi sonrasý, konvansiyonel dikiþ tekniði ile n-bütil-2-siyanoakrilat yardýmlý kapama tekniði karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Kýrk adet Wistar sýçan randomize olarak 2 gruba ayrýldý. Orta hat kesisiyle abdominal aortaya standart arteriyotomi uygulandý. Arteriyotomi, birinci grupta aralarýnda 45° açýyla 3 adet; ikinci grupta ise 60° açýyla 2 adet dikiþle kapatýldý. Ýkinci gruba 0,1 ml (12-12,5 mg) siyanoakrilat uygulandý. Operasyon zamaný, kanama miktarý ve aortanýn çýkarýlan anastomotik segmentinde cerrahi sonrasý 7. ve 30. günlerde immünohistokimyasal olarak miyointimal hiperplazinin þiddeti deðerlendirildi.
BULGULAR
Ortalama anastomoz zamaný 1. grupta 13,5±1,64 dk, 2. grupta 13,0±1,75 dk idi (p=0,356). Ameliyat süresi kontrol grubunda 23,45±3,63 dk, tedavi grubunda 21,0±3,09 dk olarak saptandý (p=0,027). Ortalama kanama miktarý 1. grupta 473,75±260,5 μl, 2. grupta 327,5±155,36 μl idi (p=0,037). Yedinci günde yapýlan ölçümde intima kalýnlýðý 1. grupta 80,62±7,92 μm, 2. grupta 83,24±3,42 μm; 30. günde 1. grupta 81,64±5,11 μm, 2. grupta 88,77±11,03 μm olarak bulundu. Erken ve geç ölçümlerde intima kalýnlýklarý benzer düzeylerdeydi (sýrasýyla p=0,35 ve p=0,87).
SONUÇ
Arteriyotomilerin daha az dikiþle, n-bütil-2-siyanoakrilat birleþimiyle rekonstrüksiyonu, daha az kanama ve daha kýsa ameliyat süreleri ile seyreden güvenilir bir yöntemdir. Ayrýca, miyointimal hiperplazide artýþa neden olmamýþtýr.

Anahtar Kelimeler: Arteriyotomi, n-bütil 2 siyanoakrilat; miyointimal hiperplazi; ameliyat süresi; kanama miktarý.

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