Ozalp B, Canbaz S, Huseyinova G, Duran E
Department of Cardiovascular Surgery, Faculty of Medicine, Trakya University, Edirne, Turkey.
J Cardiovasc Surg (Torino). 2009 Aug;50(4):545-53.
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.
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.
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.
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.
几乎所有用于血管手术的血管夹，即使是无损伤血管夹，都已被证明会对血管壁造成机械损伤。近年来，有报道称使用腔内球囊技术的手术操作可作为一种替代的闭塞策略。本研究探讨了术后早期两种闭塞技术继发的血管壁损伤的组织病理学特征及比较。
将12只成年兔分为两个实验组：血管夹组（n = 6）和球囊组（n = 6）。血管夹组通过剖腹术对腹主动脉进行外部血管夹闭塞30分钟。在球囊组中，通过向经髂动脉插入并推进至腹主动脉内的导管球囊充气来进行30分钟的闭塞。随后在两组中取出适当的主动脉段，并通过光镜和电镜检查组织样本。最后，对样本的组织损伤程度进行评分。
在两个实验组中，组织损伤均很明显。在光镜下进行的研究中，观察到球囊闭塞造成的损伤明显小于血管夹技术造成的损伤。在球囊组中，8个组织样本（66.7%）有1级损伤。另一方面，5个组织样本有3级损伤，所有这些样本均在血管夹组。电镜检查显示，血管夹组样本的血管壁内膜、中膜和外膜损伤更严重，这也与免疫反应增加和腔内血栓形成有关。
对应用于主动脉的外部血管夹和内部球囊闭塞技术进行了比较，发现两种技术均存在广泛的内膜和中膜损伤。然而，在适当选择的病例中，主动脉腔内闭塞应作为首选技术，因为它导致的损伤程度较低，并且在外部血管夹应用技术困难时也应使用。
