Application of intestinal staplers to aortoiliac surgery

Although intestinal stapling devices have become an accepted part of the contemporary gastrointestinal surgeon's armamentarium, little attention has been given to their application to vascular surgical operative techniques. We have found the TA stapler helpful in surgery of the abdominal aorta, the iliac arteries, and their branches. It is most applicable to aortic bypass surgery for both atherosclerotic occlusive and aneurysmal disease. The TA 30, 50, and 90 devices designed to introduce a double row of overlapping staples effect a secure, hemostatic, and watertight bowel closure. These staples can likewise achieve a secure, bloodtight closure when used appropriately in aortic surgery. In aortofemoral bypass grafting performed with a proximal end-to-end anastomosis, the TA 30 or 55 is ideal for expeditious closure of the transected, distal aortic stump. The stapling technique also greatly simplifies obliteration of common, external, and internal iliac aneurysms to prevent back-bleeding when these aneurysms are excluded from the main reconstructed arterial stream. In the resection of abdominal aortic aneurysms associated with multiple iliac branch aneurysms, the technique eliminates the necessity of placing sutures in deep, inaccessible areas. Tangential staple occlusion of common iliac aneurysms, allowing retrograde flow from the distal femoral anastomosis into the internal iliac artery, preserves pelvic visceral perfusion. Our experience in approximately 50 cases, employing the TA stapling device in a variety of aortoiliac artery operative situations, is outlined.