![]() ![]() Needle curvature is expressed in degrees of the subtended arc. Needle diameter is the width of the wire of the finished needle in combination with the thickness of the coating. Suture variables include the needle diameter and length, needle curvature, suture size, the needle and suture coating, needle-tip geometry and the swage area and needle:suture ratio (N:S ratio). Surgeon variables include the stability of posture, hand, needle holder and needle, rotational capacity of the needle holder by the surgeon, motion when unlocking the needle holder, the needle angle and entry/exit pathway curve and control and anastomotic technique. Patient variables include the level of anticoagulation or antiaggregation, blood pressure, vessel wall and stability of the anastomotic site. The trauma and bleeding of the blood vessel are influenced by patient, surgeon, needle and suture material variables. Additionally, the need for blood transfusion is a risk factor for surgical-site and general infection. The most frequently cited immunological reactions after blood transfusions are acute and delayed haemolytic reactions, febrile non-haemolytic reactions, allergic reactions, post-transfusion purpura and transfusion-associated acute lung injury. ![]() Bleeding that results in the need for transfusion may have immunological and infectious consequences, which may be significant and are known to increase the risk of the procedure and the cost of hospitalization. Bleeding through the suture holes is a more quantifiable early surrogate for trauma, visible in real time. Each time a needle penetrates a blood vessel, trauma is created in the wall, often only visible decades later when intimal proliferation has occurred. ![]()
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