Thrombolysis in microvascular surgery using tissue-type plasminogen activator.
Thrombosis at the microanastomotic site is the primary cause of free flap failure. Tissue-type plasminogen activator, a potent thrombolytic agent, effectively lyses vessel thromboses. This study examined the efficacy of tissue-type plasminogen activator in a microvascular model using a modified vascular inversion graft in rabbits. Seventeen rabbits underwent this procedure with formation of thromboses in all but one inversion graft. Ten rabbits were locally infused with 1 mg of tissue-type plasminogen activator over a period of 4 hours; 6 control rabbits received normal saline infusions. Blood flow across the graft was reestablished in all 10 rabbits receiving tissue-type plasminogen activator and in none of those with normal saline infusions. Systemic fibrinolysis was not significantly altered. We conclude that local infusion of tissue-type plasminogen activator is effective in lysing thromboses that may occur at the venous microvascular anastomotic site without significant activation of systemic fibrinolysis.
Romano
J E
JE
Department of Otolaryngology, University of Minnesota, Minneapolis.
Biel
M A
MA
D000818:Animals; D001777:Blood Coagulation / Q000187:drug effects; D008866:Microsurgery / Q000379:methods*; D011817:Rabbits; D013524:Surgical Flaps / Q000379:methods*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000494:pharmacology*; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods*
D010959:Tissue Plasminogen Activator