What suture material is used to ligate an artery and what suturing technique is recommended?

Arterial Ligation: Suture Material and Technique

For arterial ligation, use non-absorbable monofilament suture (such as polypropylene/Prolene) or slowly absorbable monofilament suture, employing either interrupted figure-of-eight, horizontal mattress, or running suture techniques—all are equally effective. 1

Suture Material Selection

The choice between absorbable and non-absorbable sutures depends on your clinical context:

Non-Absorbable Monofilament (Preferred for Most Situations)

• Polypropylene (Prolene) is the gold standard for vascular work
• Provides permanent, reliable arterial closure
• Minimal tissue reaction compared to braided materials
• Suitable for all vessel sizes and anastomoses 2

Absorbable Monofilament (Alternative Option)

• Polyglycolic acid (Vicryl) or polydioxanone (PDS) can be used effectively
• Causes less inflammation and granuloma formation than silk 3
• Polydioxanone shows superior results in small arterial anastomoses with no late flow surface changes 2
• Particularly useful when temporary ligation is needed 4

Critical caveat: Avoid silk sutures—they cause significantly more inflammation and granuloma formation around arterial tissues 3. Plain or chromic gut are unreliable for arterial ligation 4.

Suturing Technique

The guideline evidence indicates no significant difference between techniques when properly executed 1:

• Interrupted figure-of-eight sutures
• Horizontal mattress sutures
• Running/continuous sutures
• Double-layer repair

Technical Principles for Success

Regardless of which technique you choose:

1. Ensure exact adaptation of vessel ends without gaps or leaks 5
2. Avoid puncturing the posterior wall during suturing 5
3. Use atraumatic, gentle technique—this is the fundamental requirement for successful arterial closure 5
4. Maintain tension-free closure without traction, pressure, or shear forces 5

Vessel Size Considerations

For small vessels (<2mm diameter):

• Both continuous and interrupted sutures work equally well 6
• Suture ligation is safe at 0,1, and 2mm from parent vessels 7
• Bipolar cauterization only safe at ≥2mm distance 7
• Hemoclips are unreliable and should be avoided 7

Special Technique: Purse Suture for Femoral Access

For femoral artery closure after catheterization procedures, diamond-shaped hemostatic purse sutures offer advantages over conventional techniques:

• Significantly shorter closure time (6.5 vs 14.9 minutes)
• Lower bleeding/hematoma rates (1.7% vs 6.2%)
• No cross-clamping required
• Reduced hospital stay 8

Common Pitfalls to Avoid

1. Never use silk sutures for arterial work—excessive foreign body reaction
2. Avoid hemoclips for small vessel ligation—high failure rate at all distances 7
3. Don't use plain or chromic gut—unreliable for arterial occlusion 4
4. Ensure adequate distance from parent vessel when ligating branches (minimum 2mm for cautery) 7