Friedrich R E
Department of Oral and Maxillofacial Surgery, Nordwestdeutsche Kieferklinik, Eppendorf University Hospital, University of Hamburg, Germany.
Br J Oral Maxillofac Surg. 1998 Oct;36(5):365-70. doi: 10.1016/s0266-4356(98)90648-9.
To study the patency rates of anastomoses in damaged common carotid arteries in a training model of microvascular surgery (Wistar rats).
Under general anaesthesia with xylazine (Rompun) and ketamine (Ketanest) balloon dilatation was repeated five times in 31 left common carotid arteries of female Wistar rats. One minute after reflow an autograft of 4 mm was harvested, turned 180 degrees, and reinserted into the artery. The flow through the vessels was investigated by micro-Doppler ultrasound (60 s after balloon dilatation and 30 min after insertion of the autograft). Autografts were fashioned in a further 26 common carotid arteries but left undamaged. A further 14 arteries were dilated, but no autografts were inserted. The vessels were harvested after perfusion with 3% glutaraldehyde after one day, seven days, and one month. The specimens were evaluated by light microscopy in longitudinal sections of 1.5 microm slides embedded in Epon. In addition, cross-sections were taken from arteries treated by balloon dilatation.
In no instance did dilatation lead to occlusion of the vessel as judged by micro-Doppler ultrasound. In the group with autografts that were not dilated, one vessel was occluded after flow had restarted. However, this vessel proved to be patent after perfusion and examination. In this group, therefore, all arteries were patent after perfusion. In the group in which dilatation preceded the insertion 13 vessels were occluded and 13 were patent on micro-Doppler ultrasound. At different perfusion times, 14 vessels were patent, and 12 vessels were completely thrombosed. The differences in patency in both groups with autografts was significant, both after Doppler imaging and on histological evaluation (P < 0.001).
Balloon dilatation is recommended for the removal of a thrombus or to dilate a spastic vessel segment in anastomosed vessels that threaten the success of microvascular flaps. For experimental research, balloon dilatation of the common carotid artery is an established model for the study of wound healing after angioplasty. In this study we have clearly shown the thrombogenic effect of balloon dilatation. Caution should therefore be exercised when using a balloon catheter for the dilatation of occluded arteries.
在微血管手术训练模型（Wistar大鼠）中研究受损颈总动脉吻合口的通畅率。
在使用甲苯噻嗪（隆朋）和氯胺酮（凯他敏）进行全身麻醉的情况下，对31只雌性Wistar大鼠的左侧颈总动脉进行5次球囊扩张。再灌注1分钟后，采集4毫米的自体移植物，旋转180度，然后重新插入动脉。通过微型多普勒超声（球囊扩张后60秒和自体移植物插入后30分钟）研究血管内的血流情况。另外在26条颈总动脉中制作自体移植物，但不进行损伤处理。另外14条动脉进行扩张，但不插入自体移植物。1天、7天和1个月后用3%戊二醛灌注后收获血管。将标本在包埋于Epon的1.5微米切片的纵切面上进行光学显微镜评估。此外，对经球囊扩张处理的动脉进行横切面取材。
微型多普勒超声判断，扩张在任何情况下均未导致血管闭塞。在未扩张的自体移植物组中，1条血管在血流重新开始后闭塞。然而，经灌注和检查后该血管被证明是通畅的。因此，在该组中，所有动脉在灌注后均通畅。在扩张后插入自体移植物的组中，微型多普勒超声显示13条血管闭塞，13条通畅。在不同的灌注时间，14条血管通畅，12条血管完全血栓形成。两组有自体移植物的通畅情况差异显著，无论是在多普勒成像后还是组织学评估中（P<0.001）。
对于威胁微血管皮瓣成功的吻合血管中的血栓清除或痉挛血管段的扩张，建议使用球囊扩张。对于实验研究，颈总动脉球囊扩张是血管成形术后伤口愈合研究的成熟模型。在本研究中，我们清楚地显示了球囊扩张的致血栓形成作用。因此，在使用球囊导管扩张闭塞动脉时应谨慎。
