A Novel Rat Model for Comprehensive Microvascular Training of End-to-End, End-to-Side, and Side-to-Side Anastomoses
29 August 2018
19 January 2019
05 March 2019 (online)
Background End-to-end, end-to-side, and side-to-side microvascular anastomoses are the main types of vascular bypass grafting used in microsurgery and neurosurgery. Currently, there has been no animal model available for practicing all three anastomoses in one operation. The aim of this study was to develop a novel animal model that utilizes the rat abdominal aorta (AA), common iliac arteries (CIAs), and the median sacral artery (MSA) for practicing these three types of anastomosis.
Methods Eight adult Sprague–Dawley rats were anesthetized and then laparotomized. The AA, MSA, and bilateral CIAs were exposed and separated from the surrounding tissues. The length and diameter of each artery were measured. The relatively long segment of the AA without major branches was selected to perform end-to-end anastomosis. One side of the CIAs (or AA) and MSA were used for end-to-side anastomosis. The bilateral CIAs were applied to a side-to-side and another end-to-side anastomosis.
Results Anatomical dissection of the AA, CIAs, and MSA was successfully performed on eight Sprague–Dawley rats; four arterial-to-arterial anastomoses were possible for each animal. The AA trunk between the left renal artery and right iliolumbar arteries was 15.60 ± 0.76 mm in length, 1.59 ± 0.15 mm in diameter, for an end-to-end anastomosis. The left CIA was 1.06 ± 0.08 mm in diameter, for an end-to-side anastomosis with the right CIA. The MSA was 0.78 ± 0.07 mm in diameter, for another end-to-side anastomosis with the right CIA or AA. After finishing end-to-side anastomosis in the proximal part of bilateral CIAs, the distal portion was juxtaposed for an average length of 5.6 ± 0.25 mm, for a side-to-side anastomosis.
Conclusion This model can comprehensively and effectively simulate anastomosis used in revascularization procedures and can provide more opportunities for surgical education, which may lead to more routine use in microvascular anastomosis training.
- 1 Ahmadi I, Herle P, Miller G, Hunter-Smith DJ, Leong J, Rozen WM. End-to-end versus end-to-side microvascular anastomosis: a meta-analysis of free flap outcomes. J Reconstr Microsurg 2017; 33 (06) 402-411
- 2 Cho EH, Garcia RM, Blau J. , et al. Microvascular anastomoses using end-to-end versus end-to-side technique in lower extremity free tissue transfer. J Reconstr Microsurg 2016; 32 (02) 114-120
- 3 Quiñones-Hinojosa A, Lawton MT. In situ bypass in the management of complex intracranial aneurysms: technique application in 13 patients. Neurosurgery 2008; 62 (06) (Suppl. 03) 1442-1449
- 4 Ferroli P, Ciceri E, Addis A, Broggi G. Self-closing surgical clips for use in pericallosal artery-pericallosal artery side-to-side bypass. J Neurosurg 2008; 109 (02) 330-334
- 5 Tayebi Meybodi A, Lawton MT, Yousef S, Mokhtari P, Gandhi S, Benet A. Microsurgical bypass training rat model: part 2-anastomosis configurations. World Neurosurg 2017; 107: 935-943
- 6 Alghoul MS, Gordon CR, Yetman R. , et al. From simple interrupted to complex spiral: a systematic review of various suture techniques for microvascular anastomoses. Microsurgery 2011; 31 (01) 72-80
- 7 Hall EJ. End-to-side anastomoses: a model and a technique with clinical application. J Microsurg 1980; 2 (02) 106-112
- 8 Watanabe H, Ueda K, Ohkouchi M, Kajikawa A, Suzuki Y. Posterior-wall-first continuous suturing combined with conventional interrupted suturing for microvascular anastomosis. J Reconstr Microsurg 2006; 22 (08) 617-623
- 9 Willis RE, Wiersch J, Adams AJ, Al Fayyadh MJ, Weber RA, Wang HT. Development and evaluation of a simulation model for microvascular anastomosis training. J Reconstr Microsurg 2017; 33 (07) 493-501
- 10 Mokhtari P, Tayebi Meybodi A, Lawton MT, Payman A, Benet A. Transfer of learning from practicing microvascular anastomosis on silastic tubes to rat abdominal aorta. World Neurosurg 2017; 108: 230-235
- 11 Trignano E, Fallico N, Zingone G, Dessy LA, Campus GV. Microsurgical training with the three-step approach. J Reconstr Microsurg 2017; 33 (02) 87-91
- 12 Newell DW, Vilela MD. Superficial temporal artery to middle cerebral artery bypass. Neurosurgery 2004; 54 (06) 1441-1448 , discussion 1448–1449
- 13 Abla AA, Lawton MT. Anterior cerebral artery bypass for complex aneurysms: an experience with intracranial-intracranial reconstruction and review of bypass options. J Neurosurg 2014; 120 (06) 1364-1377
- 14 Yu HL. Manageable microsurgical technique for creating an opening in small vessels for end-to-side anastomosis. J Reconstr Microsurg 2002; 18 (03) 169-172
- 15 Yang ST, Rodriguez-Hernandez A, Walker EJ, Young WL, Su H, Lawton MT. Adult mouse venous hypertension model: common carotid artery to external jugular vein anastomosis. J Vis Exp 2015; (95) 50472
- 16 Langer S, Heiss C, Paulus N. , et al; European Vascular Center Aachen-Maastricht. Functional and structural response of arterialized femoral veins in a rodent AV fistula model. Nephrol Dial Transplant 2009; 24 (07) 2201-2206
- 17 Pruthi N, Sarma P, Pandey P. Training in micro-vascular anastomosis using rat femoral vessels: comparison of immediate and delayed patency rates. Turk Neurosurg 2018; 28 (01) 56-61
- 18 García-Villalón AL, Roda JM, Alvarez F, Gómez B, Diéguez G. Carotid blood flow in anesthetized rats: effects of carotid ligation and anastomosis. Microsurgery 1992; 13 (05) 258-261
- 19 Matsumura N, Endo S, Hamada H, Kurimoto M, Hirashima Y, Takaku A. An experimental model for side-to-side microvascular anastomosis. J Reconstr Microsurg 1999; 15 (08) 581-583
- 20 Matsumura N, Hamada H, Yamatani K, Hayashi N, Hirashima Y, Endo S. Side-to-side arterial anastomosis model in the rat internal and external carotid arteries. J Reconstr Microsurg 2001; 17 (04) 263-266