Ryan Kelly

Date of Award

3-25-2008

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Amy L. Friedman

Abstract

Vascular occlusion techniques can be divided into two categories ¡V transfixion and non-transfixion. Transfixion techniques are defined by the passage of suture material or staples through the vascular tissue. Non-transfixion techniques are defined as suture, metal, or polymer material placed solely around the vascular tissue. The purpose of this study was to survey surgeons in various specialties to determine which vascular control technique they believe is safest and most appropriate to manage medium-sized arteries 6-10mm in diameter. A survey was distributed to surgeons in the following specialties: general surgery, urology, thoracic surgery, vascular surgery, obstetrics and gynecology, and colon and rectal surgery. Survey recipients were all members of the American College of Surgeons practicing in New York and New England. The survey asked questions focused on the use, perceived safety, and technical failure of vascular occlusion techniques applied to the renal, splenic, and cystic arteries. The smaller cystic artery was included as a control. 506 surgeons completed the survey. The survey found that more surgeons chose transfixion techniques vs. non-transfixion techniques to occlude the renal artery in both open and laparoscopic operations (open = 72% vs. 28%, p<0.0001; laparoscopic = 55% vs. 45%, p<0.01). More surgeons chose transfixion techniques vs. non-transfixion techniques to occlude the splenic artery (open = 68% vs. 32%, p<0.0001; laparoscopic = 60% vs. 40%, p<0.0001). In contrast, fewer surgeons chose transfixion techniques vs. non-transfixion techniques to occlude the cystic artery (open = 15% vs. 85%, p<0.0001; laparoscopic = 4% vs. 96%, p<0.0001). Respondents were asked to rate the safety of vascular occlusion techniques on a 5-point Likert scale ranging from 1 ¡§unsafe¡¨ to 5 ¡§extremely safe¡¨. Transfixion techniques were considered safer than non-transfixion techniques to occlude the renal artery (mean safety rating: 3.9 b 0.5 vs. 2.6 b 0.7). Transfixion techniques were considered safer than non-transfixion techniques to occlude the splenic artery (mean safety rating: 3.9 b 0.4 vs. 2.6 b 0.6). Transfixion and non-transfixion techniques were considered equally safe to occlude the cystic artery (mean safety rating: 3.9 b 0.5 vs. 3.8 b 0.5). Respondents reported more cases of technical failure and severe hemorrhage associated with non-transfixion techniques than transfixion techniques for all three arteries. Renal artery: 44 cases (89% non-transfixion, 11% transfixion; p<0.0001); splenic artery: 50 cases (74% non-transfixion, 26% transfixion; p<0.0001); cystic artery: 68 cases (96% non-transfixion, 4% transfixion; p<0.0001). In conclusion, to occlude blood vessels 6-10mm in diameter, surgeons chose transfixion techniques more frequently than non-transfixion techniques for both open and laparoscopic operations, considered transfixion techniques safer than non-transfixion techniques, and reported fewer cases of technical failure and severe hemorrhage associated with transfixion techniques than non-transfixion techniques.

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This is an Open Access Thesis.

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