Effect of collagen and elastin content on the burst pressure of human blood vessel seals formed with a bipolar tissue sealing system

• Published in: The Journal of surgical research Vol. 186; no. 1; pp. 73 - 80
• Main Authors: Latimer, Cassandra A., MS, Nelson, Meghan, BS, Moore, Camille M., MS, Martin, Kimberly E., MSCS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2014
• Subjects: Adult; Animals; Bipolar vessel sealing; Blood Vessels - chemistry; Burst pressure; Collagen; Collagen - analysis; Elastin; Elastin - analysis; Electrosurgery - methods; Female; Human blood vessel; Humans; Male; Middle Aged; Pressure; Species Specificity; Surgery; Swine; Vascular Surgical Procedures - methods; Human blood vessel; Collagen; Elastin; Burst pressure; Bipolar vessel sealing
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2013.08.003

Abstract Background Bipolar devices are routinely used to seal blood vessels instead of sutures and clips. Recent work examining the impact of vascular proteins on bipolar seal performance found that collagen and elastin (CE) content within porcine arteries was a significant predictor of a vessel's burst pressure (VBPr). This study examined seal performance across a range of human blood vessels to investigate whether a similar relationship existed. In addition, we compared VBPr and CE content between porcine and human blood vessels. Our primary hypothesis is that higher collagen-to-elastin ratio will predict higher VBPr in human vasculature. Methods In six cadavers, 185 blood vessels from nine anatomic locations were sealed using a bipolar electrosurgical system. A linear mixed model framework was used to evaluate the impact of vessel diameter and CE content on VBPr. Results The effect of CE ratio on VBPr is modified by vessel size, with CE ratio having larger influence on VBPr in smaller diameter vessels. Seal burst pressure of vessels 2–5 mm in diameter was significantly associated with their CE content. Comparison of average VBPr between species revealed porcine carotid and iliac arteries (440–670 mmHg) to be the best vessel types for predicting the seal strength of most human blood vessels (420–570 mmHg) examined. Conclusions CE content significantly modified the seal strength of small to medium sized blood vessels but had limited impact on vessels >5 mm.