A mathematical assessment of suture line stress in the end-to-side anastomosis-II. Pulsatile flow

For pulsatile intra-arterial pressure, the tensile stress acting on the suture line connecting a synthetic graft to a host artery in an end-to-side anastomosis is shown to be directly related to the angle of the anastomosis. For an increase of this angle from 40° to 90°, the suture line tensile stress increases 56%. This stress is also very dependent on the ratio of the graft to host artery areas, and doubling this ratio doubles the suture line stress. Based on our findings, we recommend that the angle of the end-to-side anastomosis be as small as possible, that the area of graft be chosen smaller than the area of the host artery; and that sutures with yield strengths greater than 5 × 10⁹ dyn/cm² be used in the construction of these anastomosis.