Orthopedic Department, First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Department of Pharmacology, Fujian Medical University, Fuzhou, China.
Int Wound J. 2022 Feb;19(2):294-304. doi: 10.1111/iwj.13630. Epub 2021 Jun 4.
Sympathectomy of arteries has been adopted for the treatment of peripheral arterial disease and Raynaud's disease. However, the exact route for sympathetic axons to reach peripheral arteries awaits further investigation that could pave the way for development of new surgical strategies. In this study, saphenous neurovascular bundles from 10 neonatal Sprague-Dawley rats first were harvested for whole-mount immunostaining to show sympathetic innervation pattern of the artery. Secondly, 40 Sprague-Dawley male rats weighing 350 to 400 g were assigned to five groups, receiving either sham, perivascular sympathectomy, nerve-artery separation, nerve transection in the saphenous neurovascular bundle, or lumbar sympathectomy surgery that removes the lumbar sympathetic trunks. Immediately after surgery, the arterial perfusion and diameter were measured using laser speckling contrast imaging, and 1 week later the saphenous neurovascular bundles were harvested for immunostaining using antibodies against TH, neuron-specific β-tubulin (Tuj 1), and α-SMA to show the presence or absence of the TH-immuopositive staining in the adventitia. The differences among the five groups were determined using one-way analysis of variance (ANOVA). We found that an average of 2.8 ± 0.8 branches with a diameter of 4.8 ± 1.2 μm derived from the saphenous nerve that morphed into a primary and a secondary sympathetic trunk for innervation of the saphenous artery. Nerve-artery separation, nerve transection, and lumbar sympathectomy could eradicate TH-immunopositive staining of the artery, resulting, respectively, in a 12%, 36%, and 59% increase in diameter (P < .05), and a 52%, 63%, and 201% increase in perfusion compared with sham surgery (P < .01). In contrast, perivascular sympathectomy did not have a significant impact on the TH-immunopositive staining, the diameter, and perfusion of the distal part of the artery (P > .05). We conclude that the sympathetic innervation of an artery derives from segmental branches given off from its accompanying nerve. Nerve-artery disconnection is a theoretic option in sympathectomy of an artery.
交感神经切除术已被用于治疗外周动脉疾病和雷诺氏病。然而，交感神经轴突到达外周动脉的确切途径仍有待进一步研究，这可能为新的手术策略的发展铺平道路。在这项研究中，首先从 10 只新生 Sprague-Dawley 大鼠的隐静脉血管神经束中采集全组织免疫染色标本，以显示动脉的交感神经支配模式。其次，将 40 只体重 350 至 400 克的雄性 Sprague-Dawley 大鼠分为五组，分别接受假手术、血管周围交感神经切除术、神经-动脉分离术、隐静脉血管神经束中的神经切断术或腰交感神经切除术，以切除腰交感干。手术后立即使用激光散斑对比成像测量动脉灌注和直径，1 周后采集隐静脉血管神经束，用 TH、神经元特异性β-微管蛋白（Tuj1）和α-SMA 抗体进行免疫染色，以显示是否存在TH 免疫阳性染色在动脉外膜。使用单向方差分析（ANOVA）确定五组之间的差异。我们发现，来自隐神经的平均 2.8±0.8 条直径为 4.8±1.2μm 的分支形成了一级和二级交感干，为隐动脉提供神经支配。神经-动脉分离、神经切断和腰交感神经切除术可消除动脉的 TH 免疫阳性染色，导致直径分别增加 12%、36%和 59%（P<0.05），灌注分别增加 52%、63%和 201%（P<0.01）与假手术相比。相比之下，血管周围交感神经切除术对动脉远端的 TH 免疫阳性染色、直径和灌注没有显著影响（P>0.05）。我们得出结论，动脉的交感神经支配来源于其伴行神经发出的节段性分支。神经-动脉分离是动脉交感神经切除术的一种理论选择。
