Aviles A J, Theodorou S, Sekosen M, Schraufnagel D, Ramasastry S
Department of Surgery, Cook County Hospital, Chicago, IL, USA.
Neurol Res. 2004 Dec;26(8):809-15. doi: 10.1179/016164104X5129.
Alexis Carrel pioneered the full-thickness triangulated vascular repair technique, which led to a Nobel Prize in 1912. However, microvascular anastomotic techniques that do not violate the intima, such as the VCS microclip repair and partial-thickness suturing, limit trauma to the intima, thus minimizing the potential for thrombosis. Our study compares such techniques with the standard full thickness-anastomotic repair.
Thirty-two end-to-end anastomotic repairs were performed in rat femoral arteries 1 mm or less in diameter. Group I: thirteen full-thickness repairs were completed using 10-0 nylon on a BV75 microm needle. Nineteen extraluminal repairs were performed using either a partial thickness technique with an 11-0 nylon BV50 microm needle (Group II, n = 12) or VCS nonpenetrating clip (Group III, n=7). Casted samples, injected with methylmethacrylate, were harvested at 1 and 3 weeks for histopathological evaluation. The presence of thrombosis, inflammation, endothelialization, angiogenesis and intimal hyperplasia were described for each repair.
Statistical analysis revealed no difference between the intraluminal and extraluminal techniques. Patency rates were similar between both groups: 92% (12/13) for Group I and 94% (17/18) for the extraluminal Groups II and III combined. One-hundred per cent of partial thickness suture repairs were patent. Histology revealed localized inflammation to the adventitia and media, as well as endothelialization at 1 week for anastomoses in Groups II and III. The intima of Group I demonstrated proliferative characteristics in contrast to the extraluminal groups, where secretory myofibroblasts were prevalent. The anastomotic microcirculation did not originate from the repaired artery in any of the groups.
Patency rates with end-to-end anastomotic repairs using a partial thickness technique are comparable to the standard full-thickness technique. Repairs that do not include the intima revealed focal inflammatory responses to the outer layers and more rapid endothelialization, while neighboring vessels perfuse the healing anastomosis.
亚历克西斯·卡雷尔开创了全层三角形血管修复技术，该技术使他在1912年获得了诺贝尔奖。然而，不侵犯内膜的微血管吻合技术，如VCS微血管夹修复和部分厚度缝合，可限制对内膜的创伤，从而将血栓形成的可能性降至最低。我们的研究将此类技术与标准的全层吻合修复进行了比较。
在直径为1毫米或更小的大鼠股动脉中进行了32次端端吻合修复。第一组：使用10-0尼龙线在BV75微米针上完成了13次全层修复。使用11-0尼龙BV50微米针采用部分厚度技术（第二组，n = 12）或VCS非穿透夹（第三组，n = 7）进行了19次腔外修复。在第1周和第3周采集注入甲基丙烯酸甲酯的铸型样本，进行组织病理学评估。描述了每次修复中血栓形成、炎症、内皮化、血管生成和内膜增生情况。
统计分析显示腔内和腔外技术之间无差异。两组的通畅率相似：第一组为92%（12/13），腔外第二组和第三组合并为94%（17/18） 。100% 的部分厚度缝合修复通畅。组织学显示，第二组和第三组吻合处外膜和中膜有局部炎症，且在第1周出现内皮化。与腔外组相比，第一组的内膜表现出增殖特征，腔外组中分泌性肌成纤维细胞普遍存在。所有组的吻合微血管均非源自修复的动脉。
采用部分厚度技术进行端端吻合修复的通畅率与标准全层技术相当。不包括内膜的修复对外层显示出局部炎症反应，内皮化更快，而相邻血管为愈合的吻合处供血。
