Yüksel E, Safak T, Ozcan G, Keçik A, Shenaq S M
Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, USA.
J Reconstr Microsurg. 1999 Jan;15(1):31-5. doi: 10.1055/s-2007-1000068.
The problem of vessel-size discrepancy is still unsolved in microvascular-free tissue transfers. In an effort to develop a technique perioperatively to dilate smaller vessel diameters, the authors utilized a catheter customarily used in coronary angioplasties, the percutaneous transluminal coronary angioplasty (PTCA) catheter. Twenty New Zealand rabbits were divided into two groups: Group 1 consisted of 14 experimental animals; Group 2 of six control animals. In both groups, a segmental defect of 2 cm was created in the proximal portion of the femoral artery just below the inguinal ligament, where the vessel diameter is 2.0+/-0.1 mm. In Group 1 animals, an arterial graft was harvested from the superficial femoral artery in the contralateral lower extremity, where the vessel diameter is 1.0+/-0.1 mm. The arterial graft along its entire length was dilated, using a PTCA catheter up to 2 mm in diameter. The duration of dilation was 3 min with pressure applied at 2.5 atm. Before and following dilation, sections were obtained from both ends of the graft for histologic comparison. The grafts were then interposed within the defect and microvascular anastomoses were performed. In the control group, an arterial graft of the same length as in the experimental group was harvested from the contralateral upper femoral region, where the vessel diameter is 2.0+/-0.1 mm. These grafts were then interposed within the defect and microsurgically anastomosed. Seven days later, the patency of the anastomoses was evaluated in both groups. In 13 of 14 rabbits in the experimental group, the anastomoses were patent and the arterial grafts maintained their dilated diameters (2 mm). In all six control animals, the anastomoses were patent. A statistical comparison of vessel patency using Fischer's exact chi-square test showed no significant differences between the experimental and control groups (p = 0.7). Histologically, the dilated arteries demonstrated intact endothelial layers.
在游离微血管组织移植中，血管尺寸差异的问题仍未得到解决。为了开发一种在围手术期扩张较小血管直径的技术，作者使用了冠状动脉血管成形术中常用的导管，即经皮腔内冠状动脉血管成形术（PTCA）导管。将20只新西兰兔分为两组：第1组由14只实验动物组成；第2组由6只对照动物组成。在两组中，在腹股沟韧带下方股动脉近端制造一个2cm的节段性缺损，此处血管直径为2.0±0.1mm。在第1组动物中，从对侧下肢的股浅动脉获取动脉移植物，此处血管直径为1.0±0.1mm。使用直径达2mm的PTCA导管对动脉移植物的全长进行扩张。扩张持续时间为3分钟，压力为2.5个大气压。在扩张前后，从移植物两端获取切片进行组织学比较。然后将移植物置于缺损处并进行微血管吻合。在对照组中，从对侧上股区域获取与实验组相同长度的动脉移植物，此处血管直径为2.0±0.1mm。然后将这些移植物置于缺损处并进行显微外科吻合。7天后，评估两组吻合口的通畅情况。实验组14只兔中有13只的吻合口通畅，动脉移植物保持其扩张后的直径（2mm）。所有6只对照动物的吻合口均通畅。使用费舍尔精确卡方检验对血管通畅情况进行统计学比较，结果显示实验组和对照组之间无显著差异（p = 0.7）。组织学检查显示，扩张后的动脉内皮细胞层完整。
