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Arterial Anastomosis (arterial + anastomosis)
Selected AbstractsThe Hemodynamic Behavior of Arterial Anastomosis Using Fibrin Sealant: Experimental Study in SwineARTIFICIAL ORGANS, Issue 11 2008Eduardo A.V. Rocha Abstract The wide use of biological sealants as a reinforcement for arterial sutures and the small experimental base in literature motivated this study. Our aim was to evaluate the flow, tear pressure, and the need of reinforcement stitches in sutured arteries after a cross-section. This research project complied with the Helsinki convention. The Tissucol (Baxter) fibrin sealant was used in all experiments. The femoral and carotid arteries of 17 swine from the same breed (weighing from 15 to 20 kg) were cross-sectioned after heparinization and subjected to anastomoses using a single continuous plane of 7-0 prolene. We worked with 68 artery samples, 34 in the treatment group and 34 in the control group. For each animal, one carotid and one femoral artery randomly received fibrin sealant with the contralateral side being used as a control. The need and the number of reinforcement stitches were recorded. Ten minutes after protamine infusion, the animals were sacrificed and the arteries were catheterized respecting 1 cm proximal and distal. The arteries were measured and placed on a flow meter to evaluate the flow rate of 10 mL of 0.9% NaCl in a 50 cm high column. The arteries were then subjected to air infusion at increasingly higher pressures (stepwise increases of 25 mm Hg), the grafts were dipped in 0.9% NaCl solution, the first air leakage was observed, and the tear pressure recorded. Data was analyzed with EpiInfo 6 data manager. The external diameters and thickness of the arteries were similar in both the treatment and control group. There was no significant difference between the groups regarding the tear pressure (P = 0.329), flow rate (P = 0.943), and the number of samples with a tear pressure above 200 mm Hg. However, the sealant reduced the number of reinforcement stitches necessary (P = 0.029). We conclude that fibrin sealant reduces the need of additional stitches; however, it does not change the tear pressure nor significantly reduces the flow. [source] Arterial anastomosis in a pediatric patient receiving a right extended split liver transplant: A case reportPEDIATRIC TRANSPLANTATION, Issue 4 2009Roberto Verzaro Abstract:, We report a case of a pediatric patient who received a right-extended liver transplant. The size of the recipient hepatic artery did not match with the donor right hepatic arterial stump. Moreover, recipient arterial anatomy made the direct anastomosis difficult or at increased risk for complications. The recipient's splenic artery was then mobilized, divided and anastomosed to the donor's right hepatic artery. The spleen was preserved and revascularization through collaterals is demonstrated by Angio CT Scan. Doppler US of the transplanted liver demonstrated good flow through the liver and the patient was discharged with perfect liver function. Splenic artery is perfectly suited for hepatic artery anastomosis. The use of splenic artery is favored in particular situations as in the case of a pediatric recipient receiving a right-extended liver graft with small caliber artery. [source] Our experience with third renal transplantation: Results, surgical techniques and complicationsINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2007Mohammad Hossein Nourbala Background: Despite the popularity of kidney transplantation in the current era, second and third kidney transplantation are not yet widely accepted and practiced. Each center has its own regulations and experiences and there is no accepted protocol for third kidney transplantation. We report here our 15 years of experience with third kidney transplantation. Methods: This is a report of all the third kidney transplantations performed in Baqiyatallah Hospital, Tehran, Iran, between 1991 and 2006. Demographic data, surgical techniques, complications and outcomes are reported. Results: Of the nine third kidney transplant patients, six were male. The median age was 43 years (32,52). All of the patients received kidney from living donors. All operations were performed by a midline incision and the grafts were placed at the midline, in the intraperitoneal space. For arterial anastomosis, we used internal iliac, right common iliac and both the right external iliac and inferior mesenteric artery in 4, 4 and 1 case(s), respectively. For venous anastomosis, we used vena cava, common iliac and external iliac veins in 3, 5 and 1 case(s), respectively. During the follow up period (38 months), 6 grafts (66.6%) were functioning. None of the graft rejections were due to surgical complications. Wound dehiscence occurred in two patients. No other surgical complications including infection, lymphocele or hemorrhage were observed. Conclusion: Third kidney transplantation is a field that has not been fully explored. The rate of complications seems to be not much higher than the first transplantation. Defining a standard protocol seems necessary. [source] Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causesLIVER TRANSPLANTATION, Issue 2 2001Sabrina Pastacaldi Hepatic artery thrombosis (HAT) is one of the principal causes of morbidity and graft loss following liver transplantation. There are several risk factors for the development of HAT; technical aspects of the arterial anastomosis are important particularly for early thrombosis, but the improvement of surgical technique has lessened this problem. Apart from technical causes, other risk factors include a variety of conditions such as low donor/recipient age ratio, immunologic factors, clotting abnormalities, tobacco use, and infections. In particular, cytomegalovirus (CMV) infection of endothelial cells has been recently suggested as an infective cause of HAT, as it is known to be followed by a rapid procoagulant response. Thus, latent CMV in an allograft may become activated and promote or contribute to vascular thrombosis. This review evaluates these aspects, focusing on data relating CMV infection or viremia to HAT following liver transplantation. [source] The intrinsic transit time of free microvascular flaps: Clinical and prognostic implicationsMICROSURGERY, Issue 2 2010Charlotte Holm M.D., Ph.D. Background: Microscope-integrated indocyanine green near-infrared videoangiography (ICGA) is a new method for the intraoperative assessment of vascular flow through microvascular anastomoses. The intrinsic transit time (ITT) describes the time period from the dye appears at the arterial anastomosis (t1) till it reaches the suture line of the venous anastomosis (t2). As the transit time reflects blood flow velocity within the flap, prolonged ITT might correlate with low blood flow and a higher rate of postoperative thrombosis. We performed a clinical trial evaluating the association between intraoperative free flap transit time and early anastomotic complications in elective microsurgery. Methods: One hundred consecutive patients undergoing elective microsurgical procedures underwent intraoperative ICG angiography (ICGA). In patients with anastomotic patency, angiograms were retrospectively reviewed and the intrinsic transit time was calculated. Postoperative outcome was registered and compared with the ITT. End points included early reexploration surgery and flap loss within the first 24 hours after surgery. Results: Fourteen patients were excluded from the study due to technical anastomotic failure. The overall flap failure rate was 6% (5/86); the incidence of early re-exploration surgery was 10% (9/86). With a median of 31 seconds patients with an uneventful postoperative course showed significantly shorter ITTs than patients with flap loss or early postoperative reexploration (median: >120 seconds). An optimal cut-off value of ITT > 50 seconds was determined to be strongestly associated with a significantly increased risk of at least one positive end point. Conclusions: This study demonstrates a significant predictive value of the intrinsic flap transit time for the development of flap compromise and early re-exploration surgery. © 2009 Wiley-Liss, Inc. Microsurgery, 2010. [source] Microsurgical lip replantation: Evaluation of functional and aesthetic results of three casesMICROSURGERY, Issue 4 2004F. Duroure M.D. Lip amputations are rare, and microsurgical replantation must be systematically tried to restore form and function in one step. The authors present a series of three cases. Revascularization of the amputated segment was obtained by arterial anastomosis with the corresponding labial coronary artery. No venous anastomosis was carried out, because no vein could be identified. Venous drainage was obtained by inducing bleeding and by postoperative application of leeches for 6 days. Anticoagulant therapy and antibiotherapy were used for 10 days. With this approach, two lip amputations were completely saved, and a third amputation only suffered partial necrosis. Aesthetic and functional results were evaluated as being good, with reestablishment of labial continence and recovery of protective sensitivity. © 2004 Wiley-Liss, Inc. [source] Incidence and significance of microscopic pathological lesions found in pedicle and recipient vessels used in microsurgical breast reconstructionMICROSURGERY, Issue 1 2003H.H. El-Mrakby M.D. The purpose of this study was to assess the incidence of abnormal vascular histology and to determine whether or not this was correlated with the incidence of postoperative microvascular problems. The microvascular histology of both donor and recipient vessels was studied in 38 patients (40 flaps) undergoing breast reconstruction with free TRAM flaps. Preoperative risk factors were assessed and correlated with histological changes in vessels, and both were tested against anastomotic complications. Thrombosis of either the artery or the vein of the flap was seen in 6 cases (15%), and of these, two flaps failed completely and one suffered partial necrosis. The occlusion affected the arterial anastomosis in 3 patients, and the venous anastomosis in 2 patients, while both the artery and the vein were thrombosed in one case. Preoperative risk factors such as smoking, obesity, radiotherapy, and chemotherapy were not associated with a significantly higher incidence of thrombosis or with significant histological abnormalities in vessels (P value varied between 0.3,0.06). Microvascular histology showed variable degrees of pathological changes in six flaps (15%); nevertheless, in this group, only one flap suffered a venous thrombosis, which ended in total flap loss. Among those with one or more risk factors (24 patients), only 2 had some evidence of histological abnormality of the blood vessels used for the microvascular anastomosis (P = 0.2). © 2003 Wiley-Liss, Inc. MICROSURGERY 23:6,9 2003 [source] The effect of dobutamine on blood flow of free tissue transfer flaps during head and neck reconstructive surgery*ANAESTHESIA, Issue 10 2009A. Scholz Summary In view of the controversy over the use of inotropes in free tissue transfer surgery, we assessed the effect of different intra-operative dobutamine infusion rates on blood flow in the anastomosed recipient artery. Twenty patients undergoing head and neck tumour resection and immediate reconstructive surgery with free tissue transfer were recruited. After completion of the microvascular anastomoses, patients received dobutamine infusions of 2, 4 and 6 ,g.kg,1.min,1 in a randomised order. After steady state dobutamine concentration was achieved, mean and maximum blood flow in the arterial anastomosis was measured at each concentration, using the Medi-Stim Butterfly Flowmeter system. Systemic haemodynamic parameters were simultaneously recorded using a pulse contour cardiac output system. Both mean and maximum blood flow increased significantly in the anastomosed artery at dobutamine infusions of 4 and 6 ,g.kg,1.min,1 and this was accompanied by increased cardiac output. This may improve free flap perfusion. [source] | ||||||||||