[Insertion of autografts after acute damage of the common carotid artery. Experimental microvascular anastomoses after balloon dilatation].
The objective of our investigation was to study the patency rates of anastomoses in arteries, damaged by a balloon dilatation, in a training model of microvascular surgery. In general anaesthesia, a balloon dilatation was repeated 5 times in 31 left common carotid arteries of female Wistar rats (body weight: 250 to 350 g). A common carotid artery autograft of 4 mm was harvested 1 minute after reflow, turned 180 degrees, and reinserted into the artery. The reflow of the vessels was investigated by micro-Doppler ultrasound equipment. Autografts without balloon dilatation or any other intended damage were performed in further 26 common carotid arteries. In addition, in further 14 common carotid arteries the balloon dilatation was the sole damage. The vessels were harvested and investigated postoperatively after perfusion with 3% glutaraldehyde at 1 day, 7 days, and 1 month. The balloon dilatation in no instance caused an occlusion of the vessel as judged by the micro-Doppler ultrasound. One vessel was found to be occluded after reflow was allowed following insertion of the autograft in the group without balloon dilatation. However, this vessel proved to be patent after explantation (patency rate: 100%). In the group with balloon dilatation preceding the autograft insertion, by micro-Doppler ultrasound, 16 vessels were occluded and 14 were patent. At different times of follow-up, in this group the summarized patency rates were 50%. The patency differences in both groups with autografts proved to be significant, both after micro-Doppler imaging and by histological evaluation (p < 0.001). For clinical use the balloon dilatation is recommended to remove a thrombus or to dilate a spastic vessel segment in anastomized vessels threatening the success of microvascular flaps. In this training model of microvascular surgery we demonstrated the thrombogenic effect of balloon dilatation.
Friedrich
R E
RE
Klinik für Mund-, Kiefer- und Gesichtschirurgie, Nordwestdeutsche Kieferklinik, Universitätskrankenhaus Eppendorf, Universität Hamburg.
Plambeck
K
K
Bartel-Friedrich
S
S
Hellner
D
D
Schmelzle
R
R
D000714:Anastomosis, Surgical / Q000295:instrumentation*; D000818:Animals; D020212:Carotid Artery Injuries; D017536:Carotid Artery, Common / Q000473:pathology / Q000601:surgery; D002404:Catheterization / Q000295:instrumentation*; D005260:Female; D005352:Fibromuscular Dysplasia / Q000473:pathology; D006083:Graft Occlusion, Vascular / Q000473:pathology*; D051381:Rats; D012092:Replantation / Q000295:instrumentation; D018608:Ultrasonography, Doppler / Q000295:instrumentation; D014945:Wound Healing / Q000502:physiology