Hemodynamic Analysis of a Three-Point Suture During Tapering Technique for Microanastomosis Using Computational Fluid Dynamics

The tapering technique is one of the useful methods of anastomosing 2 vessels with large discrepancies during microanastomoses. When the tapering technique is used, a three-point suture is always present. The authors analyzed the most appropriate suture technique for this using computational fluid dynamics. This aspect has not previously been addressed. Three different suture techniques were simulated:

1. (1)

   Three single-knot sutures (Type I);

2. (2)

   Two single-knot sutures forming an X-shape (Type II); and

3. (3)

   A single continuous ligature through the vascular wall (Type III).

Vascular models of these 3 types were created. The streamline, wall shear stress, and oscillatory shear index at the anastomosis site were measured using a previously prepared venous model. Streamline disruption was most severe for Type II. In all 3 types, the highest wall shear stress was recorded at the suture peak protruding into the vessel. The maximum oscillatory shear index was highest in Type II, and lowest in Type III. The present results suggest that Type III is the best three-point suturing method for the tapering technique.