Use of recombinant hirudin to increase the patency rate of microanastomosis in a rabbit model

Hubbard, Thomas; Olivier, Thomas; Bacher, Peter; Jm, Walenga; Galal, Hussein; Fareed, J.; Pifarré, R

doi:10.1097/00001721-199102000-00016

Cited by 8 publications

(2 citation statements)

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“…Before 1990, two microsurgical thrombosis models were reported, 1112 and were applied by other authors. 13 " 15 These two models will be discussed in detail below. Briefly, there is no ideal thrombosis model for experimental microsurgical use.…”

mentioning

confidence: 99%

Thrombosis and Thrombolysis in Crushed Arteries with or without Anastomosis: A New Microvascular Thrombosis Model

Chen¹,

Seaber²,

Urbaniak³

1996

J reconstr Microsurg

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This study introduces a new rat thrombosis model in which a 2-mm segment of femoral artery is crushed by an impact load. Ninety-five femoral arteries were divided into five groups. The vessels in Groups I and 2 underwent only crush injuries with a 15-kg and 25-kg load, respectively. Group 3 vessels were not crushed, but did undergo vessel anastomosis by a standard microsurgical technique. The vessels in Groups 4 and 5 were crushed by a 25-kg load, and then divided and anastomosed. During the procedure, the vessel lumina were topically irrigated with saline (Group 4) or heparin solution (Group 5). Thrombosis and thrombolysis were evaluated at set time points up to 56 days after operation. While all vessels in Groups 1 and 3 remained patent, the rate of occlusive thrombus formation in Group 2 significantly (p < 0.001) dropped from 85 percent at day 1 to 11 percent at day 7. The intima and media in Groups 4 and 5 were severely disrupted and often occluded the lumen, Group 5 had a significantly (p < 0.01 to 0.001) lower rate of occlusive thrombus formation (40 to 45 percent) at days 1 and 7 than Group 4 (90 percent). Histology in Groups 2, 4, and 5 at day 1 showed no intimnal and almost no medial tissue left in the crushed area. The adventitia and remaining external elastic lamina were adherent to thrombus in the occluded vessels or covered by fibrin and platelet mesh in the patent vessels. The results documented that spontaneous thrombolysis occurs in thrombosed arteries following crush injury alone, but not in thrombosed arteries after crush injury followed by suture anastomoses. The degree of disruption of the internal elastic lamina and the presence of sutures appear to contribute to occlusive thrombus formation following crush injury and anastomoses. Topical irrigation with heparin solution, at the concentration routinely used clinically, significantly reduces the thrombosis rate at the anastomosis site in crushed vessels, but does not promote thrombolysis.

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mentioning

confidence: 99%

Thrombosis and Thrombolysis in Crushed Arteries with or without Anastomosis: A New Microvascular Thrombosis Model

Chen¹,

Seaber²,

Urbaniak³

1996

J reconstr Microsurg

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“…No reversal agents exist for these agents, which can cause clinically significant bleeding. Hubbard et al 43 administered recombinant hirudin by intravenous pump for 5 to 7 days in a rabbit arterial inversion graft thrombosis model and found patency rates similar to those achieved using heparin. Other animal studies suggest that a single bolus of recombinant hirudin at the time of microvascular anastomosis results in patencies similar to those associated with heparin.…”

Section: Other Drugs Used In the Treatment Of Thrombosismentioning

confidence: 84%

Prevention and Treatment of Thrombosis in Microvascular Surgery

Hanasono

Butler

2008

J reconstr Microsurg

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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.

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Microvascular repair following crush‐avulsion type injury with vein grafts: Effect of direct inhibitors of thrombin on patency rate

et al. 2003

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The aim of this study was to develop a standardized effective thrombogenic arterial anastomosis model, as usually encountered in clinical practice, and to offer a detailed evaluation of the antithrombotic effect of thrombin's direct inhibitors, antithrombin III and hirudin, as locally applied. Wistar rats were divided into four groups of 12 animals each. The carotid artery sustained a standardized crush-avulsion-type injury (groups B-D). A segment of the afflicted area was removed and replaced by a microvenous graft. Group A had no crush-avulsion injury inflicted; a microvenous graft replaced a simple resection from the center of the carotid artery. During microvascular anastomoses, normal saline (groups A and B), recombinant hirudin (group C), or antithrombin III (group D) were locally applied. Bleeding times were recorded, and patency tests were performed 20 min, 48 h, and 1 week after blood flow reestablishment. All grafts were harvested and examined histologically. Patency tests, 1 week postrevascularization, demonstrated that this experimental crush-avulsion injury model ensured low patency in group B (25%), whereas group A, which had no injury inflicted, achieved a 100% patency rate. The local application of hirudin and antithrombin III significantly increased bleeding times as well as the patency rate (92% and 75%, respectively) compared to group B. These findings indicate the efficiency of the experimental model and the potential use of thrombin's direct inhibitors in microvascular surgery.

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Use of recombinant hirudin to increase the patency rate of microanastomosis in a rabbit model

Cited by 8 publications

References 0 publications

Thrombosis and Thrombolysis in Crushed Arteries with or without Anastomosis: A New Microvascular Thrombosis Model

Thrombosis and Thrombolysis in Crushed Arteries with or without Anastomosis: A New Microvascular Thrombosis Model

Prevention and Treatment of Thrombosis in Microvascular Surgery

Microvascular repair following crush‐avulsion type injury with vein grafts: Effect of direct inhibitors of thrombin on patency rate

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