Download PDF
CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2022; 11(01): 007-012
DOI: 10.1055/s-0040-1719237
Original Article

Histopathology of Microvascular Anastomosis—Comparison of Patent and Nonpatent Anastomosis: An Experimental Study

Dhaval Gohil 
1   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Nasser Mohammed 
2   Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, United States
,
Anita Mahadevan 
3   Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Nupur Pruthi
1   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective To compare the histopathology of patent and nonpatent microvascular anastomosis using rat femoral artery end-to-end anastomosis model.

Materials and Methods In 15 Sprague–Dawley rats, end-to-end anastomosis was performed on the right femoral artery. The classical method was used in four cases and one-way up method in 11 cases. The animals were sacrificed after 2 weeks and the anastomosis was subjected to histopathology. The pathological changes in patent and nonpatent cases were compared.

Results The immediate patency rate and delayed patency (after 2 weeks) rate was 86.7% and 66.7%, respectively. The mean follow-up was 3 months. At sacrifice, 5/15 anastomosis were not patent. Marked subintimal thickening was noted in ⅘ (80%) of the nonpatent group, which was absent in the patent group. Severe loss or fibrosis of tunica media and marked adventitial inflammation were noted in all nonpatent cases (5/5, 100%). As much as ⅘ of the nonpatent cases had poor or indeterminate apposition; in contrast, good apposition was seen in 6/10 (60%) of the patent group. The mean clamp time and mean suturing time were significantly longer in the nonpatent group (69.2 minutes and 53.8 minutes, respectively) as compared with the patent group (48.8 minutes and 31.8 minutes, respectively). A single case that was initially nonpatent was found to have recanalized at 6 months.

Conclusion Minimal intimal injury and reaction, minimal thinning of tunica media, mild-to-moderate adventitial changes, good apposition, and equidistant sutures were associated with a successful microvascular anastomosis. Short duration of vessel clamping time and suturing comes with experience and dedicated practice in a skills laboratory.

histopathology - microvascular anastomosis - patency


Publication History

Article published online:
19 April 2021

© 2021. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Cushing H. The special field of neurological surgery. Bull Johns Hopkins Hosp 1905; 16: 77-87
    PubMedGoogle Scholar
  • 2 Pruthi N, Gohil D, Somanna S. Inverted (buried) reef knot in microsurgery – A technical note. Turk Neurosurg 2019; 29 (04) 615-619
    PubMedGoogle Scholar
  • 3 Nupur P, Dhaval G, Sampath S. Microvascular anastomosis using only 2-throw reef knots: a technical note. Turk Neurosurg 2019; 29 (06) 961-963
    PubMedGoogle Scholar
  • 4 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
    PubMedGoogle Scholar
  • 5 Hayhurst JW, O’Brien BM. An experimental study of microvascular technique, patency rates and related factors. Br J Plast Surg 1975; 28 (02) 128-132
    CrossrefPubMedGoogle Scholar
  • 6 Chow SP. The histopathology of microvascular anastomosis: a study of the incidence of various tissue changes. Microsurgery 1983; 4 (01) 5-9
    CrossrefPubMedGoogle Scholar
  • 7 Acland RD, Trachtenberg L. The histopathology of small arteries following experimental microvascular anastomosis. Plast Reconstr Surg 1977; 60 (06) 868-875
    CrossrefPubMedGoogle Scholar
  • 8 Romansky R. Christova: structural change in rat femoral wall after micro surgical anastomosis. Dokl Bulg Akad Nauk 2004; 57 (12) 123-126
    PubMedGoogle Scholar
  • 9 Lemson MS, Tordoir JH, Daemen MJ A P, Kitslaar PJEHM. Intimal hyperplasia in vascular grafts. Eur J Vasc Endovasc Surg 2000; 19 (04) 336-350
    CrossrefPubMedGoogle Scholar
  • 10 Lohman R, Siemionow M, Lister G. Advantages of sharp adventitial dissection for microvascular anastomoses. Ann Plast Surg 1998; 40 (06) 577-585
    CrossrefPubMedGoogle Scholar
  • 11 Wang S, Marini CP, Baso S, Maughan RE, Cunningham JN, Jacobitz IJ. Optimal number of sutures for microvascular anastomosis. Microsurgery 1992; 13: 161
    PubMedGoogle Scholar
  • 12 Colen LB, Gonzales FP, Buncke HJ. The relationship between the number of sutures and the strength of microvascular anastomoses. Plast Reconstr Surg 1979; 64 (03) 325-329
    CrossrefPubMedGoogle Scholar
  • 13 Robertson JH, Robertson JT. The relationship between suture number and quality of anastomoses in microvascular procedures. Surg Neurol 1978; 10 (04) 241-245
    PubMedGoogle Scholar