Interrupted pledgeted proximal anastomosis for open abdominal aortic aneurysm repair

Abstract

The proximal anastomosis is a crucial step during open repair of an abdominal aortic aneurysm. A technically sound anastomosis decreases intraoperative blood loss, as well as the operative time needed for suture line repair. Traditionally, a continuous running suture is used for the construction of this anastomosis. At the author's institution, the technique of an interrupted pledgeted proximal anastomosis is selectively used when the quality of the aortic tissue is suboptimal. This report describes the technique of the interrupted pledgeted proximal aortic anastomosis and compares outcomes to the traditional continuous technique. Among 60 pledgeted and 48 continuous anastomoses, we found equivalent clamp time, operative time, and intraoperative estimated blood loss for the two techniques. However, patients with a continuous anastomosis had higher risks of additional reinforcement during hospitalization (43.3% pledgeted vs 72.9% continuous; P = .002). The interrupted anastomotic technique presented here is a valuable option in open abdominal aortic aneurysm repair when faced with friable aortic tissue.