title: Histopathological comparison of vascular wall damage created by external cross-clamp and endoluminal balloon occlusion techniques.
abstract: OBJECTIVE
  Almost all cross-clamps utilized in vascular surgery, even atraumatic clamps, have been shown to cause mechanical damage to the vascular wall. In recent years, surgical procedures using an endoluminal balloon technique have been reported as an alternative occlusion strategy. This study discusses the histopathological characteristics and comparison between vascular wall damage secondary to the two occlusion techniques in the early postoperative period.
  
  
  METHODS
  Twelve adult rabbits were divided into two experimental groups: the clamp group (N. = 6) and the balloon group (N. = 6). External cross-clamp occlusion was applied to the abdominal aorta for 30 minutes via laparotomy in the clamp group. In the balloon group, occlusion was applied for 30 minutes by inflating the catheter balloon, which was inserted through the iliac artery and advanced into the abdominal aorta. The appropriate aortic segments were subsequently extracted in both groups and tissue samples were examined by light and electron microscopy. Finally, the samples were scored for grade of tissue damage.
  
  
  RESULTS
  In both experimental groups, tissue damage was apparent. In the investigations carried out under light microscopy, it was observed that the damage caused by balloon occlusion was remarkably less than the damage caused by the cross-clamp technique. In the balloon group, eight tissue samples (66.7%) had grade 1 damage. On the other hand, five tissue samples had grade 3 damage, all of which were in the clamp group. Investigation by electron microscopy revealed that greater intimal, medial, and adventitial damage occurred in the vascular walls of the clamp group samples, and this also corresponded with an increase in immune response and intraluminal thrombosis.
  
  
  CONCLUSIONS
  External clamp and internal balloon occlusion techniques applied to the aorta were compared, and widespread intimal and medial damage were observed in both techniques. However, endoluminal occlusion of the aorta should be the technique of choice in properly selected cases, since it results in lower damage grades, and it should also be used if application of an external clamp is technically difficult.
authors.affiliation: Department of Cardiovascular Surgery, Faculty of Medicine, Trakya University, Edirne, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Ozalp
authors.forename: S
authors.initials: S
authors.lastname: Canbaz
authors.forename: G
authors.initials: G
authors.lastname: Huseyinova
authors.forename: E
authors.initials: E
authors.lastname: Duran
mesh_terms: D000818:Animals; D001012:Aorta, Abdominal / Q000276:immunology / Q000293:injuries* / Q000648:ultrastructure; D021721:Balloon Occlusion / Q000009:adverse effects*; D003250:Constriction; D023421:Models, Animal; D011817:Rabbits; D013927:Thrombosis / Q000209:etiology; D017539:Tunica Intima / Q000276:immunology / Q000293:injuries* / Q000648:ultrastructure; D017540:Tunica Media / Q000276:immunology / Q000293:injuries* / Q000648:ultrastructure; D014656:Vascular Surgical Procedures / Q000009:adverse effects*