The Effect of Tirofiban on Microvascular Thrombosis: Crush Model

Background Determining the extent of damage in vascular avulsion type injuries still represents a challenge for the microsurgeon. Excision of the damaged section is critical for the success of anastomosis. The purpose of this study was to determine which among vascular endothelial and adventitia damage findings is most effective in determining the extent of avulsion injury. Methods Varying degrees of avulsion were applied to the aorta of 12 (n = 12) adult female New Zealand rabbits. Avulsion was first determined using adventitial findings and then with endothelial findings. The definitive extent of damage was determined histopathologically. Results The mean area of the histopathological sections was 16.7 ± 6.9 mm. The extent of damage measured from the adventitia was 15.8 ± 7.9 mm (the difference in histopathological examinations was not significant, p = 0.590, paired t-test), while the extent of damage from the lumen was 13.3 ± 8.2 mm (the difference in histopathological examinations was significant p = 0.004, paired t-test). Conclusion Excision based on adventitia findings is more effective in case of avulsion injury.

Section: Discussionmentioning

confidence: 99%

Evaluation of the Extent of Vessel Avulsion Injury: An Experimental Study Using a Rabbit Model

Uraloğlu

Ural

Sayğın

et al. 2018

“…Previous researches about prevention of microsurgical anastomotic thrombosis have focused on antiplatelet and anticoagulant drugs, since both platelet aggregation and the coagulation cascade play critical roles in microsurgical thrombosis formation. 11,15 Although plentiful laboratory and clinical studies have been performed, there remains no consensus on the efficacy and optimal dosage of various pharmacological agents available for the prevention of thrombosis in microvascular surgery. 16,17 Therefore, it is reasonable to develop novel agents for preventing microsurgical anastomotic thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous animal models have been developed to address microsurgical thrombosis. 11,13,15,18 This study was designed to test the antithrombotic effect of SDF-1α, which was proved as a key regulator of intimal regeneration. Hence, the crush Fig.…”

Section: Discussionmentioning

confidence: 99%

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Stimulation of Nitric Oxide Production Contributes to the Antithrombotic Effect of Stromal Cell–Derived Factor-1α in Preventing Microsurgical Anastomotic Thrombosis

Jia

Chen

Kang

et al. 2016

Background Intimal injury plays a critical role in initiating the pathogenesis of thrombosis formation after microsurgical anastomosis. Application of stromal cell-derived factor-1α (SDF-1α) is reported to promote early regeneration of injured intima through migration of endothelial cells and mobilization of endothelial progenitor cells. We therefore hypothesized that local transfer of SDF-1α gene would inhibit microsurgical anastomotic thrombosis. Methods Sixty Sprague-Dawley rats were used and divided randomly into three groups (SDF-1α group, plasmid group, and saline group) in this study. Plasmid DNA encoding SDF-1α, empty plasmid, and saline were injected into the left femoral muscles of rats from each group, respectively. Seven days after injection, peripheral blood samples were obtained to measure the plasma levels of SDF-1α and nitric oxide (NO). The left femoral artery of each rat was crushed, transected, and repaired by end-to-end microsurgical anastomosis. Vascular patency was assessed at 15, 30, and 120 minutes after reperfusion using milk test. Thrombosis formation was assessed with hematoxylin and eosin staining and scanning electron microscopy at 120 minutes postoperatively. Results The plasma levels of SDF-1α and NO in SDF-1α group were significantly higher than those in plasmid group and saline group (p < 0.01). The patency rate in SDF-1α group was significantly higher than that in control groups at 120 minutes after reperfusion (p < 0.05). Treatment of SDF-1α significantly reduced the size of thrombotic occlusion when compared with controls (p < 0.05). All SDF-1α recipients exhibited decreased thrombosis under scanning electron microscopy. Conclusions The current study demonstrated that local transfer of SDF-1α gene increases arterial patency and inhibits microsurgical anastomotic thrombosis in a crush model of femoral artery in rat. The antithrombotic effect of SDF-1α may be mediated through increased production of endogenous NO. These findings provide a novel approach for inhibition of microsurgical anastomotic thrombosis.

“…Yates et al 47 compared topical tirofiban, a nonpeptide glycoprotein IIb/IIIa inhibitor (50 mg/mL), with heparin (100 U/mL) and a combination of heparin (100 U/mL) and tirofiban (50 mg/mL) in a crush injury model using the rat femoral artery. Patency rates were 10% for the control group that received lactated Ringer's solution alone, 59% for the tirofiban group, 10% for the heparin group, and 80% for the tirofiban and heparin group.…”

Section: Other Drugs Used In the Treatment Of Thrombosismentioning

confidence: 99%

Prevention and Treatment of Thrombosis in Microvascular Surgery

Hanasono

Butler

2008

Microvascular free tissue transfer is associated with a 1 to 5% failure rate, most commonly as a result of thrombosis in the region of the vascular anastomosis or the distal flap microcirculation. Although many laboratory and clinical studies have been performed, there is no consensus on the efficacy and optimal dosage of various pharmacological agents available for the prevention and treatment of thrombosis in microvascular surgery. Some agents have potentially serious side effects; and all agents carry the risks of undesirable bleeding and hematoma formation. We review the current experimental and clinical evidence regarding the agents commonly used to prevent and treat thrombosis in microvascular surgery and make practical recommendations for the management of vascular compromise in free flaps.