University of Colorado Anschutz Medical Campus, Aurora, Colorado; Covidien Energy Based Devices, Boulder, Colorado.
J Surg Res. 2013 Dec;185(2):485-92. doi: 10.1016/j.jss.2013.06.027. Epub 2013 Jul 4.
Bipolar energy ligation of vessels in surgery is common. Although rare, serious failures occur. Atherosclerosis may contribute to seal failures by altering vascular compressibility and collagen content; however, no data exist.
Femoral and iliac arteries of six Yucatan swine with an identified genetic locus predisposing them to atherosclerosis were denuded with a Fogarty catheter. Animals were fed a high-fat diet for 28 wk. A Yorkshire pig was used as a normal control and fed a standard diet. At 28 wk, arteries were measured for their diameters, sealed, and divided in vivo with LigaSure. The sealed artery sections were excised and subjected to burst pressure testing. Half of the seal distal to the aorta was kept intact for histology and collagen and elastin quantification. A multiple linear regression model was used to assess variables contributing to burst pressure. Covariates included were vessel diameter, degree of atherosclerosis, and collagen content.
Experimental animals were hypercholesterolemic. Atherosclerosis occurred in 90% of seals in induced animals, with severe atherosclerosis in 62% of seals. There was site-selective deposition of atherosclerotic plaques in larger diameter iliac vessels. A model including collagen and size best predicted burst pressure. Every 10-U increase in collagen resulted in 15% increase in burst pressure (95% confidence interval = 0.2%-32%, P = 0.047, R(2) = 0.36). Atherosclerosis was unrelated to burst pressure controlling for collagen and size.
Collagen and size provide the best model fit for predicting burst pressure. Quantitative research in human vasculature is warranted to better understand the influence of atherosclerosis and collagen content on seal failures.
手术中使用双极能量结扎血管很常见。尽管很少见，但确实会发生严重的故障。动脉粥样硬化可能通过改变血管可压缩性和胶原蛋白含量而导致密封失效；然而，目前尚无相关数据。
对六只易患动脉粥样硬化的 Yucatan 猪的股动脉和髂动脉进行了球囊血管内膜切除术。这些动物被喂食高脂肪饮食 28 周。一只 Yorkshire 猪被用作正常对照，并喂食标准饮食。在 28 周时，测量了动脉的直径，用 LigaSure 进行密封，并在体内将其切开。取出密封的动脉段进行爆裂压力测试。将主动脉远端的一半密封段保持完整，用于组织学和胶原蛋白及弹性蛋白定量。使用多元线性回归模型评估对爆裂压力有贡献的变量。协变量包括血管直径、动脉粥样硬化程度和胶原蛋白含量。
实验动物患有高胆固醇血症。在诱导动物中，90%的密封处发生了动脉粥样硬化，62%的密封处发生了严重的动脉粥样硬化。较大直径的髂血管中存在斑块的选择性沉积。包括胶原蛋白和尺寸的模型最能预测爆裂压力。胶原蛋白每增加 10U，爆裂压力增加 15%（95%置信区间为 0.2%至 32%，P=0.047，R(2)=0.36）。在控制胶原蛋白和尺寸的情况下，动脉粥样硬化与爆裂压力无关。
胶原蛋白和尺寸是预测爆裂压力的最佳模型。有必要对人类血管进行定量研究，以更好地了解动脉粥样硬化和胶原蛋白含量对密封失效的影响。
