Dynamic behavior of suture-anastomosed arteries and implications to vascular surgery operations

Abstract

Background: Routine vascular surgery operations involve stitching of disconnected human arteries with themselves or with artificial grafts (arterial anastomosis). This study aims to extend current knowledge and provide better-substantiated understanding of the mechanics of end-to-end anastomosis through the development of an analytical model governing the dynamic behavior of the anastomotic region of two initially separated arteries. Methods: The formulation accounts for the arterial axial-circumferential deformation coupling and suture-artery interaction. The proposed model captures the effects of the most important parameters, including the geometric and mechanical properties of artery and sutures, number of sutures, loading characteristics, longitudinal residual stresses, and suture pre-tensioning. Results: Closed-form expressions are derived for the system response in terms of arterial radial displacement, anastomotic gap, suture tensile force, and embedding stress due to suture-artery contact interaction. Explicit objective functionalities are established to prevent failure at the anastomotic interface. Conclusions: The mathematical formulation reveals useful interrelations among the problem parameters, thus making the proposed model a valuable tool for the optimal selection of materials and improved functionality of the sutures. By virtue of their generality and directness of application, the findings of this study can ultimately form the basis for the development of vascular anastomosis guidelines pertaining to the prevention of post-surgery implications.