Ultrasonographic Assessment of Metallic Clip Carotid Anastomosis in Sheep

Abstract

The aim of this study was to use ultrasonography to assess an experimental carotid arteriotomy followed by end-to-end anastomosis in the lamb. Animals were subjected to an experimental surgical procedure consisting of a right carotid artery arteriotomy and subsequent end-to-end anastomosis with nonpenetrating metallic clips. Left side arteries were used as control. Duplex ultrasonography was performed postoperatively to assess the evolution of the experimental anastomosis. Measurements were made on the right carotid to assess blood flow, peak systolic velocity, and end diastolic velocity, as well as arterial diameter. Animals were periodically checked during the six-month postoperative period. Operated vessels appeared normal during follow up, with pulsatile movements and size similar to non operated carotid arteries. A hyperechoic band, perpendicular to the vessel main axis, was seen on the longitudinal image in operated arteries, but not in the control group. This band corresponded to the anastomosis area, where the clips were positioned. No image suggestive of thrombosis was observed in any operated artery, and blood flow was maintained through the experiment. Finally, a decrease of vessel lumen diameter was evidenced at the level of the anastomosis during the first 30 postoperative days, but it was not present after the 90th postsurgical day. Duplex ultrasonography is a useful imaging technique for the assessment of anatomical details, acoustical properties of the vascular lumen, and study of the intimal surface and vessel wall in growing arteries subjected to surgery. Metallic clips as suturing technique in arterial anastomosis allow for normal vascular growth, as shown by the evolution of flow velocity and vessel diameter.