Experimental microvenous thrombosis following anastomosis with a knotted suture

Tonken, Heidi P.; Zhang, Feng; Yim, Kenneth K.; Gençosmanoğlu, Reha; Sudekum, Anthony E.; Campagna-Pinto, Dante; Newlin, Leonard; Buncke, Harry J.; Lineaweaver, William C.

doi:10.1002/micr.1920160211

Cited by 7 publications

(7 citation statements)

References 17 publications

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“…In our model the animals were followed up for 8 to 12 postoperative weeks, which period was supposedly enough for the shunt maturation 11, 14. Although previous studies demonstrated patency rates differences between immediate after anastomosis, 20 min, 24 hours, and 7 days, and recanalization rate of thrombosed vessel in three weeks in rats,35–37 we wished to wait for a sufficient time for having mature shunts and compensated circulatory situations. Langer et al,20 using ultrasound‐based functional and morphometric analyses, demonstrated the fistula vein's alterations in rat distal femoro‐femoral AV anastomosis during the maturation period: on the 1st, 2nd, 3rd, 6th, 12th, and 20th postoperative weeks.…”

Section: Discussionmentioning

confidence: 99%

Morphological, hemodynamical and hemorheological changes of mature artificial saphenous arterio‐venous shunts in the rat model

Hever¹,

Németh

Bráth³

et al. 2010

Microsurgery

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Artificial femoral arterio-venous (AV) shunts are widely used in rodent models for studying shunt maturation and to optimize various surgical techniques. However, little is known about complex circulatory, microcirculatory, and hemorheological effects of end-to-side saphenous AV shunts. We aimed to study these parameters in mature AV shunts. Studying these questions in CD rats, end-to-side anastomoses were made between the left saphenous artery and vein. On the right-side the nonoperated saphenous vessels served as own control. Furthermore healthy control animals were also investigated. On the 8th to 12th postoperative week microcirculatory and blood flow measurements were performed and blood samples were taken both from the shunt's arterial and venous limbs and from the nonoperated side vessels. Hematological parameters, erythrocyte aggregation, and deformability were determined. The entire shunt and the control vessels were removed for histological examinations. The skin microcirculation on shunt side slightly increased on thigh and decreased on paws versus the nonoperated side. Blood flow measurements made directly on the vessels showed that arterial to venous blood flow rate ratio was 1.59 ± 0.29 on nonoperated side and 1.2 ± 0.13 on the shunt side, and 1.49 ± 0.05 in control animals. Erythrocyte aggregation and deformability worsened on the shunt side. Histologically increased number of smooth muscle elements and connective tissue were found in venous limb of the shunts. The artificial AV shunt between the saphenous artery and vein seems to be a suitable model for further functional-morphological and hemorheological examinations of hemodialysis in various states and diseases.

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Section: Discussionmentioning

confidence: 99%

Morphological, hemodynamical and hemorheological changes of mature artificial saphenous arterio‐venous shunts in the rat model

Hever¹,

Németh

Bráth³

et al. 2010

Microsurgery

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“…The milking test subjectively revealed the occlusion of the vessel lumen and is related to the degree of anastomotic vessel constriction caused by thrombosis and affected mainly by the surgeon's skill. 13,24 Results of early and late milking tests were not compromised in any of the anastomoses (p > 0.05; Table 2). In terms of quality of filling, however, C suture technique was inferior compared with the other suture techniques.…”

Section: Anastomotic Leakage and Patencymentioning

confidence: 94%

Vertical Mattress Suture Technique: An Alternative Vascular Anastomosis

Aygün

Yıldırım

2008

J reconstr Microsurg

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The objective of this study was to introduce the vertical mattress (VM) suture technique and compare its patency and postoperative healing with other commonly used suture techniques. Thirty-two Sprague-Dawley rats were randomly assigned to one of four suture techniques to be applied to both femoral arteries: continuous (C), interrupted (I), VM, and VM with flap (VMF) sutures. The operating time and the degree of postanastomotic leakage were recorded. The milking test was employed 5 and 15 minutes and 14 days after the operation to attain patency. Blood flow velocity was determined using ultrasonography at 1 hour and on days 1 and 14 postoperation. Rats then were sacrificed, and anastomotic lining tissues were harvested for histopathologic examination. Anastomoses by C and I were executed in 12.06 and 18.31 minutes. Modified suture techniques took longer to execute anastomosis (23.09 minutes for VM and 32.44 minutes for VMF). VM suture technique was superior to other suture techniques in terms of anastomotic leakage, quality of filling, and blood flow velocity. Also, absence of the luminal closure or constriction, intimal injury and hyperplasia, foreign body inflammation, and inversion were noted in histopathology. In conclusion, the VM suture technique could be considered for microvascular surgery.

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“…2,5 Evaluation was performed by direct visual examination, by the milking test, 6 and by cutting the vein downstream to the anastomosis at 24 h.…”

Section: Methodsmentioning

confidence: 99%

“…The influences upon patency of twisting the vessel's ends prior to anastomosis, 1 of wall mechanical damage, 2 of epigastric flap creation and distal femoral vessel ligation, 3 and of prolonged clamping and vascular stasis 4 have all been reported. To the best of the authors' knowledge, no experiment has been reported dealing specifically with the effects on vessel patency of what is probably the most common mistake in microsurgical anastomosis: the twowall stitch (TWS).…”

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confidence: 97%

Effect of the two‐wall‐stitch mistake upon patency of rat femoral vein anastomosis: Preliminary observations

2004

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Anastomotic patency is believed to be the most important factor in microvascular surgery. The two-wall stitch is a technical error commonly considered to cause thrombosis of the anastomosis, especially on the venous side. In order to demonstrate the real effect on vein patency of the two-wall stitch, the authors performed a standardized mistake after correct microanastomosis on the femoral vein of 15 rats, with one stitch passing through the whole thickness of the two walls of the vein. Traditional correct anastomoses on the contralateral side were used as controls. Patency was assessed at 5, 20, and 60 min and at 24 h by the milking test, and by direct section of the vessel at 24 h. The results showed no statistically significant difference between the two techniques. Histological examination confirmed the clinical judgment about the vessel's patency, and ultrastructural microscopy evidenced only mild signs of endothelial activation. In conclusion, this study indicates that the occasional two-wall stitch does not necessarily increase the risk of venous occlusion in anastomoses of the rat femoral vein.

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Experimental microvenous thrombosis following anastomosis with a knotted suture

Cited by 7 publications

References 17 publications

Morphological, hemodynamical and hemorheological changes of mature artificial saphenous arterio‐venous shunts in the rat model

Morphological, hemodynamical and hemorheological changes of mature artificial saphenous arterio‐venous shunts in the rat model

Vertical Mattress Suture Technique: An Alternative Vascular Anastomosis

Effect of the two‐wall‐stitch mistake upon patency of rat femoral vein anastomosis: Preliminary observations

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