scholarly journals Histopathology of Microvascular Anastomosis—Comparison of Patent and Nonpatent Anastomosis: An Experimental Study

2021 ◽  
Author(s):  
Dhaval Gohil ◽  
Nasser Mohammed ◽  
Anita Mahadevan ◽  
Nupur Pruthi
Keyword(s):  
Femoral Artery ◽  
Classical Method ◽  
Single Case ◽  
Microvascular Anastomosis ◽  
Sprague Dawley ◽  
Tunica Media ◽  
Skills Laboratory ◽  
The Mean ◽  
End To End ◽  
The Right

Abstract Objective To compare the histopathology of patent and nonpatent microvascular anastomosis using rat femoral artery end-to-end anastomosis model. Materials and Methods In 15 Sprague–Dawley rats, end-to-end anastomosis was performed on the right femoral artery. The classical method was used in four cases and one-way up method in 11 cases. The animals were sacrificed after 2 weeks and the anastomosis was subjected to histopathology. The pathological changes in patent and nonpatent cases were compared. Results The immediate patency rate and delayed patency (after 2 weeks) rate was 86.7% and 66.7%, respectively. The mean follow-up was 3 months. At sacrifice, 5/15 anastomosis were not patent. Marked subintimal thickening was noted in ⅘ (80%) of the nonpatent group, which was absent in the patent group. Severe loss or fibrosis of tunica media and marked adventitial inflammation were noted in all nonpatent cases (5/5, 100%). As much as ⅘ of the nonpatent cases had poor or indeterminate apposition; in contrast, good apposition was seen in 6/10 (60%) of the patent group. The mean clamp time and mean suturing time were significantly longer in the nonpatent group (69.2 minutes and 53.8 minutes, respectively) as compared with the patent group (48.8 minutes and 31.8 minutes, respectively). A single case that was initially nonpatent was found to have recanalized at 6 months. Conclusion Minimal intimal injury and reaction, minimal thinning of tunica media, mild-to-moderate adventitial changes, good apposition, and equidistant sutures were associated with a successful microvascular anastomosis. Short duration of vessel clamping time and suturing comes with experience and dedicated practice in a skills laboratory.

scholarly journals The effect of nano-hydroxyapatite/chitosan scaffolds on rat calvarial defects for bone regeneration

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Emmanouil Chatzipetros ◽  
Spyros Damaskos ◽  
Konstantinos I. Tosios ◽  
Panos Christopoulos ◽  
Catherine Donta ◽  
...  
Keyword(s):  
Bone Regeneration ◽  
Mean Value ◽  
Parietal Bone ◽  
Female Rats ◽  
Sprague Dawley ◽  
Post Surgery ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
The Right

Abstract Background This study aims at determining the biological effect of 75/25 w/w nano-hydroxyapatite/chitosan (nHAp/CS) scaffolds on bone regeneration, in terms of fraction of bone regeneration (FBR), total number of osteocytes (Ost), and osteocyte cell density (CD), as well as its biodegradability. Methods Two critical-size defects (CSDs) were bilaterally trephined in the parietal bone of 36 adult Sprague-Dawley rats (18 males and 18 females); the left remained empty (group A), while the right CSD was filled with nHAp/CS scaffold (group B). Two female rats died postoperatively. Twelve, 11, and 11 rats were euthanized at 2, 4, and 8 weeks post-surgery, respectively. Subsequently, 34 specimens were resected containing both CSDs. Histological and histomorphometric analyses were performed to determine the FBR, calculated as [the sum of areas of newly formed bone in lateral and central regions of interest (ROIs)]/area of the original defect, as well as the Ost and the CD (Ost/mm2) in each ROI of both groups (A and B). Moreover, biodegradability of the nHAp/CS scaffolds was estimated via the surface area of the biomaterial (BmA) in the 2nd, 4th, and 8th week post-surgery. Results The FBR of group B increased significantly from 2nd to 8th week compared to group A (P = 0.009). Both the mean CD and the mean Ost values of group B increased compared to group A (P = 0.004 and P < 0.05 respectively). Moreover, the mean value of BmA decreased from 2nd to 8th week (P = 0.001). Conclusions Based on histological and histomorphometric results, we support that 75/25 w/w nHAp/CS scaffolds provide an effective space for new bone formation.

scholarly journals A Novel Technique to Perform Microvascular Anastomosis Revisions without Clamps

2018 ◽  
Vol 03 (02) ◽  
pp. e58-e61
Author(s):  
Amro Harb ◽  
Maxwell Levi ◽  
Yelena Akelina ◽  
Rajendra Kadiyala ◽  
Jeffrey Ascherman
Keyword(s):  
Operating Time ◽  
Microvascular Anastomosis ◽  
Sprague Dawley ◽  
Surgical Experience ◽  
Novel Technique ◽  
Technical Errors ◽  
Sprague Dawley Rats ◽  
Leakage Site ◽  
The Mean ◽  
And Training

Background For surgeons learning microsurgery, uneven spacing between sutures while performing microvascular arterial anastomoses is one of the most common technical errors made that can lead to leakage. Based on the previous surgical experience and training of these surgeons, the first option chosen to prevent bleeding is to place a vascular clamp proximal to the anastomosis and an additional suture at the site of the leak. Because this technique may have technical and thrombosis concerns, our study proposes an alternative technique of performing post-anastomotic revisions without the use of clamps. Methods Our technique involves placing a cotton-tipped applicator under the artery and lifting it to partially occlude flow within the vessel as an additional suture is placed at the leakage site to complete the revision. One-hundred eighty-four microvascular anastomoses were performed on the femoral arteries of 92 Sprague-Dawley rats, and of the 184 anastomoses, 147 had a leak and required a post-anastomotic revision. All revisions were completed using our technique, and no clamps were used during any of the revisions. Results Of the 147 post-anastomotic revisions completed using our technique, 141 (95.9%) were patent 2 hours post-revision. The mean operating time for the revisions was 5:03 minutes (range, 1:44–6:30 minutes). Conclusion Our technique of partially occluding an artery with a cotton-tipped applicator while performing a post-anastomotic revision is a safe and effective alternative to using vascular clamps. Our technique may also reduce technical errors and have a low risk of causing thrombosis when completing post-anastomotic revisions.

A Novel Rat Model for Comprehensive Microvascular Training of End-to-End, End-to-Side, and Side-to-Side Anastomoses

2019 ◽  
Vol 35 (07) ◽  
pp. 499-504 ◽  
Author(s):  
Xiaoliang Yin ◽  
Gengfan Ye ◽  
Jun Lu ◽  
Lijun Wang ◽  
Peng Qi ◽  
...  
Keyword(s):  
Animal Model ◽  
Average Length ◽  
Proximal Part ◽  
Distal Portion ◽  
Left Renal Artery ◽  
Sprague Dawley ◽  
Anatomical Dissection ◽  
Sprague Dawley Rats ◽  
End To End ◽  
The Right

Background End-to-end, end-to-side, and side-to-side microvascular anastomoses are the main types of vascular bypass grafting used in microsurgery and neurosurgery. Currently, there has been no animal model available for practicing all three anastomoses in one operation. The aim of this study was to develop a novel animal model that utilizes the rat abdominal aorta (AA), common iliac arteries (CIAs), and the median sacral artery (MSA) for practicing these three types of anastomosis. Methods Eight adult Sprague–Dawley rats were anesthetized and then laparotomized. The AA, MSA, and bilateral CIAs were exposed and separated from the surrounding tissues. The length and diameter of each artery were measured. The relatively long segment of the AA without major branches was selected to perform end-to-end anastomosis. One side of the CIAs (or AA) and MSA were used for end-to-side anastomosis. The bilateral CIAs were applied to a side-to-side and another end-to-side anastomosis. Results Anatomical dissection of the AA, CIAs, and MSA was successfully performed on eight Sprague–Dawley rats; four arterial-to-arterial anastomoses were possible for each animal. The AA trunk between the left renal artery and right iliolumbar arteries was 15.60 ± 0.76 mm in length, 1.59 ± 0.15 mm in diameter, for an end-to-end anastomosis. The left CIA was 1.06 ± 0.08 mm in diameter, for an end-to-side anastomosis with the right CIA. The MSA was 0.78 ± 0.07 mm in diameter, for another end-to-side anastomosis with the right CIA or AA. After finishing end-to-side anastomosis in the proximal part of bilateral CIAs, the distal portion was juxtaposed for an average length of 5.6 ± 0.25 mm, for a side-to-side anastomosis. Conclusion This model can comprehensively and effectively simulate anastomosis used in revascularization procedures and can provide more opportunities for surgical education, which may lead to more routine use in microvascular anastomosis training.

Large and Uneven Bites in End-to-End Anastomosis of the Rat Femoral Artery

2020 ◽  
Vol 36 (07) ◽  
pp. 486-493
Author(s):  
Yuan Dian Zheng ◽  
Celine F. Nicolas ◽  
John J. Corvi ◽  
Joey S. Kurtzman ◽  
Katherine H. Park ◽  
...  
Keyword(s):  
Blood Flow ◽  
Skill Acquisition ◽  
Femoral Artery ◽  
Sprague Dawley ◽  
Flow Measurements ◽  
Bite Size ◽  
Sprague Dawley Rats ◽  
Vessel Patency ◽  
End To End ◽  
Blood Flow Measurements

Abstract Background Successful microvascular anastomosis depends on sutures that adequately oppose both cut vessel edges. Trainees tend to take oversized or uneven bite. To improve early microsurgical skill acquisition using the rat, this study tests the belief that such bites compromise early patency by applying exaggerated bites to end-to-end arterial anastomoses. Methods Twelve Sprague–Dawley rats were randomly assigned to one of the four bite techniques to be applied to both femoral arteries (mean diameter, 0.8 mm). Large (L) and standard (S) bites measured 1.0 and 0.2 mm from the edge, respectively. Eight simple interrupted anastomoses were performed per bite technique, each labeled according to every proximal end bite size, followed by every distal end bite size: LL, LS, SL, and SS. Anastomosis time and blood flow rates were recorded and analyzed statistically. After sacrifice 5 days postoperation, anastomosis sections of each technique were examined histologically. Results All 24 anastomoses (100%) maintained patency for 5 days. There was no statistical difference between all postoperative blood flow measurements at any given time. Anastomosis times using LL, LS, SL, and SS bite techniques were 41.6, 33.2, 34.8, and 25.5 minutes, respectively. Anastomosis time for the traditional bite technique (SS) was significantly shorter than all other bite techniques (p < 0.05). Histological examination of the harvested segments from each group revealed similar pathophysiological features. Conclusion Oversized bites (1 mm), placed symmetrically and asymmetrically across the anastomosis, do not affect early patency in the rat femoral artery. A reduced reliance on conventional guidelines for suture bites appears acceptable during microarterial anastomoses if the goal is vessel patency. However, we believe clinical competence involves the ability to place small, even bites consistently and uniformly. During microsurgical training, the occasional large bite need not be replaced; however, the trainee should be encouraged to take standard bites.

scholarly journals CT Angiography Analysis of Axillary Artery Diameter versus Common Femoral Artery Diameter: Implications for Axillary Approach for Transcatheter Aortic Valve Replacement in Patients with Hostile Aortoiliac Segment and Advanced Lung Disease

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Rajiv Tayal ◽  
Humayun Iftikhar ◽  
Benjamin LeSar ◽  
Rahul Patel ◽  
Naveen Tyagi ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Axillary Artery ◽  
Common Femoral Artery ◽  
Mean Difference ◽  
Transcatheter Aortic Valve ◽  
The Mean ◽  
The Right ◽  
Almost All ◽  
Left Axillary Artery ◽  
Comparable Size

Objective.The use of the axillary artery as an access site has lost favor in percutaneous intervention due to the success of these procedures from a radial or brachial alternative. However, these distal access points are unable to safely accommodate anything larger than a 7-French sheath. To date no studies exist describing the size of the axillary artery in relation to the common femoral artery in a patient population. We hypothesized that the axillary artery is of comparable size to the CFA in most patients and less frequently diseased.Methods.We retrospectively reviewed 110 CT scans of the thoracic and abdominal aorta done at our institution to rule out aortic dissection in which the right axillary artery, right CFA, left axillary artery, and left CFA were visualized. Images were then reconstructed using commercially available TeraRecon software and comparative measurements made of the axillary and femoral arteries.Results.In 96 patients with complete data, the mean sizes of the right and left axillary artery were slightly smaller than the left and right CFA. A direct comparison of the sizes of the axillary artery and CFA in the same patient yielded a mean difference of 1.69 mm ± 1.74. In all patients combined, the mean difference between the axillary artery and CFA was 1.88 mm on the right and 1.68 mm on the left. In 19 patients (19.8%), the axillary artery was of the same caliber as the associated CFA. In 8 of 96 patients (8.3%), the axillary artery was larger compared to the CFA.Conclusions.Although typically smaller, the axillary artery is often of comparable size to the CFA, significantly less frequently calcified or diseased, and in almost all observed cases large enough to accommodate a sheath with up to 18 French.

scholarly journals 3 Years Expeimental Study on Abdominal Aortic Aneurysm Patients Who were Treated with Endovascular Aneurysm Repair at Dr. Mohammad Hoesin Hospital Palembang During 1st of January 2018 – 31st of December 2020

2021 ◽  
Vol 4 (2) ◽  
pp. 286-304
Author(s):  
Muhammad Febriandi Djunaidi ◽  
Kemas Muhammad Dahlan ◽  
Fahmi Jaka Yusuf
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Femoral Artery ◽  
Iliac Artery ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic ◽  
Mean Diameter ◽  
History Of ◽  
The Mean ◽  
The Right

Abdominal aortic aneurysm (AAA) is a focal dilatation of the aortic segment with an increase of 1.5 times the normal value or ≥3 cm. The risk increases in old age and requires alternative surgery such as EVAR. EVAR is more useful in AAA therapy than surgery with wide incisions. This research was descriptive in RSMH Palembang for 5 years in 1st of January 2018 - 31st of December 2020 with variables of patient clinical characteristics and patient CTA results. The results showed that AAA was more common in men, aged 60-69 years with high school education, risk factors such as a history of CHF, hypertension, CAD, and smoking habits. Angiographic CT result showed proximal diameter > 2 cm, PAU, calcification, iliac aneurysm, and lowest renal artery on the left side. All AAA patients had inferior limb thrombus and angulation > 600. The average of aneurysm is 5.8 cm in diameter and 9.23 cm in length. The mean diameter of the right iliac artery differs from the mean diameter of the left iliac artery. The diameter of the right femoral artery also differs from the diameter of the left femoral artery. AAA patients mostly had no history of CKD, COPD, and DM. The patients were hospitalized for an average of 7 days, especially in the ICU for 2 days.

scholarly journals Morphological Characteristics of Renal Artery and Kidney in Rats

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Atilla Yoldas ◽  
Mustafa Orhun Dayan
Keyword(s):  
Renal Artery ◽  
Wistar Rats ◽  
Three Dimensional ◽  
Morphological Characteristics ◽  
Gross Anatomy ◽  
Renal Arteries ◽  
Sprague Dawley ◽  
Body Weights ◽  
The Mean ◽  
The Right

The gross anatomy and morphometry of the kidney and renal arteries were studied in the strains of laboratory rat: Sprague-Dawley (Sp) and Wistar (W) rats. Total of 106 three-dimensional endocasts of the intrarenal arteries of kidney that were prepared using standard injection-corrosion techniques were examined. A single renal artery was observed in 100% of the cases. The renal arteries were divided into a dorsal and a ventral branch. The dorsal and ventral branches were divided into two branches, the cranial and caudal branch. Renal arteries were classified into types I and II, depending on the cranial and caudal branches and their made of branching. The present study also showed that the right kidney was slightly heavier than the left one and that the kidney of the male was generally larger than that of the female. The mean live weights of the Sprague-Dawley and Wistar rats were found to be 258.26 ± 5.9 and 182.4 ± 19.05 g, respectively. The kidney weights were significantly correlated (P<0.01) with body weights. The kidney weights were not found significantly correlated (P>0.01) with the length of renal arteries.

scholarly journals Gunshot model of junctional femoral artery hemorrhage in swine under ultrasonic guidance

2021 ◽  
Author(s):  
Hongliang Zhang ◽  
Guo Chengyu ◽  
Wang Junkang ◽  
Feng Cong ◽  
Li Tanshi
Keyword(s):  
Blood Loss ◽  
Femoral Artery ◽  
High Accuracy ◽  
Massive Hemorrhage ◽  
Shock Model ◽  
Portable Ultrasound ◽  
The Mean ◽  
The Right ◽  
Picco Monitoring ◽  
Uncontrolled Hemorrhage

Abstract Background In a combat setting, uncontrolled junctional hemorrhage constitutes a major source of potentially preventable deaths. It is very important to establish a model of massive hemorrhage of gunshot wound at junction area which can simulate field rescue conditions. Methods Picco monitoring was instrumented for the anesthetized Landrace pigs, and the right femoral artery was located by portable ultrasound. The pistol bullet hit the right femoral artery, resulting in an artery rupture. After 30 seconds of uncontrolled hemorrhage, the ballistic wound was filled with combat gauze (QuikClot) to stop bleeding in the BT group (n = 10). Combat gauze was used to stop bleeding when the mean arterial pressure (MAP) decreased by 30% in the MD group (n = 10). The sham-operated pigs (n = 10) underwent the same anesthetic and surgical procedures, but neither shooting nor gauze filling therapy was performed. Blood samples were taken 15 min before injury, and then 10 min, 30 min, and 60 min after the injury. Results Histologic anatomy indicated that the right femoral artery and vein were completely ruptured in all 20 swine of MD and BT groups. The blood loss of pre-tamponade (4.97 ± 2.47 mL/kg vs 18.26 ± 3.47 mL/kg, P < 0.001), pro-tamponade (4.58 ± 1.49 mL/kg vs 7.20 ± 1.99 mL/kg, P = 0.004) and the total amount of bleeding (9.54 ± 3.80 mL/kg vs 25.46 ± 3.68 mL/kg, P < 0.001) in MD group were more than those in BT group. There were differences in body temperature, PH, PT, LAC of MD group compared with BT and SHAM groups 60 minutes after injury (all P < 0.0167). The survival time of MD group was shorter than that of BT group (P = 0.029). Conclusion We established a reliable gunshot model of junctional hemorrhage in swine, which had high accuracy for femoral arterial rupture under ultrasonic guidance and provided consistent and reproducible field-simulation conditions. In this junctional hemorrhage model, blood loss of 30-second free bleeding did not meet the criteria for shock. The MAP decrease of 30% emerged as a better predictor of a successful shock model.

scholarly journals Technical success rate of uterine artery embolisation for treatment of uterine leiomyomas at the University of the Free State

2002 ◽  
Vol 6 (2) ◽  
pp. 26-28
Author(s):  
H. F. Potgieter ◽  
C. S. De Vries ◽  
E. Loggenberg
Keyword(s):  
Success Rate ◽  
Femoral Artery ◽  
Uterine Artery ◽  
Free State ◽  
Uterine Artery Embolisation ◽  
Technical Success ◽  
Technical Success Rate ◽  
The Mean ◽  
The Right ◽  
The University

The technical success rate of uterine artery embolisations at the Department of Diagnostic Radiology, University of the Free State (UFS) is reported. From November 1998 to July 2001, 67 women, aged 35 - 75 years, received uterine artery embolisation. The procedure was usually performed through a single 4-French sheath set which was introduced into the right femoral artery using a 4- French catheter and injecting PVC particles (150 - 550 micron). Embolisation was performed successfully in 85.5% of the women. The mean total fluoroscopy time was 16.8 minutes, ranging from 4.8 minutes to 47.3 minutes.

The Double Stitch Everting Technique in the End-to-Side Microvascular Anastomosis: Validation of the Technique Using a Randomized N-of-1 Trial

2020 ◽  
Author(s):  
George C. Dindelegan ◽  
Ruben Dammers ◽  
Alex V. Oradan ◽  
Ramona C. Vinasi ◽  
Maximilian Dindelegan ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Randomized Trial ◽  
Analysis Of Variance ◽  
Femoral Artery ◽  
Vessel Wall ◽  
Microvascular Anastomosis ◽  
Classic Technique ◽  
The Mean ◽  
Confounder Adjustment ◽  
Different Levels

Abstract Background The double stitch everting (DSE) technique, in which time is won by leaving the needle inside the vessel wall in-between stitching, is a modification of the end-to-side (ETS) anastomosis in the interest of reducing anastomosis time. This ensures proper wall eversion, intima-to-intima contact, and improved suture symmetry. Materials and Methods We designed an N-of-1 randomized trial with each microsurgeon as their own control. We included 10 microsurgeons of different levels of experience who were then asked to perform classic and DSE ETS anastomoses on the chicken leg and rat femoral models. Every anastomosis was cut and evaluated using blinded assessment. Two-way analysis of variance (ANOVA) and multivariable logistic regression were used to analyze the results and for confounder adjustment. Results A total of 210 anastomoses were performed, of which 177 on the chicken leg and 43 on the rat femoral artery and vein. From the 210 anastomoses, 111 were performed using the classic technique and 99 using the DSE technique. The mean anastomosis time was 28.8 ± 11.3 minutes in the classic group and 24.6 ± 12 minutes in the DSE group (p < 0.001, t-test). There was a significant reduction (p < 0.001, two-way ANOVA) in the number of mistakes when using the DSE technique (mean 5.5 ± 2.6) compared with those using the classic technique (mean 7.7 ± 3.4). Conclusion The DSE technique for ETS anastomoses improves anastomoses times in experienced and moderately experienced microsurgeons while also improving or maintaining suture symmetry and lowering the number of mistakes.

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