title: Arterial intimal flaps: a comparison of primary repair, aspirin, and endovascular excision in an experimental model.
abstract: The optimal management for traumatic arterial intimal injuries is unresolved. Three therapeutic options were compared in an experimental model employing a standard intimal flap created in 51 canine superficial femoral arteries. Group 1 (14 arteries) underwent resection with end-to-end repair. Group 2 (19 arteries) received acetylsalicylic acid (ASA) and observation only. Group 3 (21 arteries) underwent endovascular excision of the flap with angioscopic guidance. Control intimal flaps (18 arteries) were created and observed without further intervention. Patency in group 1 (primary repair) and group 2 (ASA) was 100%; the patency in both was significantly (p < 0.05) greater than in the controls, which was 67%. Patency in group 3 (endovascular excision) was 79%. Residual luminal defects were observed in only 8% of the arteries repaired primarily, but in 76% of the aspirin-treated arteries. Residual luminal defects following endovascular excision were present in 53% of the arteries remaining patent. Although resection and primary repair (group 1) provided better results than observation alone (control), addition of ASA (group 2) also sustained patency. However, a high incidence of residual intimal defects occurred, the natural history of which is unknown. While endovascular excision (group 3) may become a feasible alternative, current technology provided inferior patency with frequent residual intimal defects. These results suggest that observation alone supplemented with antiplatelet medication (ASA) may be adequate treatment, but longer follow-up is necessary for confirmation.
authors: Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark 07103-6601.
authors: J J
authors: JJ
authors: Hernández-Maldonado
authors: F T
authors: FT
authors: Padberg
authors: E
authors: E
authors: Teehan
authors: R
authors: R
authors: Neville
authors: D
authors: D
authors: DeFouw
authors: W N
authors: WN
authors: Durán
authors: R W
authors: RW
authors: Hobson
mesh_terms: D017546:Angioscopy; D000818:Animals; D001158:Arteries / Q000293:injuries* / Q000601:surgery; D001241:Aspirin / Q000627:therapeutic use*; D004285:Dogs; D004730:Endothelium, Vascular / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D005263:Femoral Artery / Q000293:injuries / Q000601:surgery; D008297:Male; D016896:Treatment Outcome; D017539:Tunica Intima / Q000293:injuries* / Q000601:surgery; D014654:Vascular Patency; D014947:Wounds and Injuries / Q000188:drug therapy / Q000601:surgery
chemical_list: D001241:Aspirin