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  • Influence of two wall stitch mistake of microanastomosis on velocity, flow and Pulsatility index (PI)

    Final Number:
    1081

    Authors:
    Jiri Fiedler MD, PhD; Simona Polakova Mgr.; Vladimir Priban; Vladimir Smrcka

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: The aim of this study was to evaluate Microvascular Doppler ultrasonography (MDS) and Transit Time flow measurement (TTFM) in the prediction of a technical mistake during microanastomosis creation. Two wall stitch (TWS) standardized mistake was used in a novel controlled model of the common iliac artery in rats.

    Methods: A total of 18 Wistar rats (randomized to Standard or TWS groups) underwent measurements. TWS mistake anastomosis or Standard anastomosis was done in right iliac artery. The pulsatile flow curve, mean flow values and PI were obtained using TTFM probe Transonic HT 331. Velocity values and PI were obtained using 16 MHz probe MultiDopT. Flow in left iliac artery was measured with flowprobe just before every measurement in right iliac artery to check rats circulation. Paired t - test, two - way ANOVA and repeat measures ANOVA were used for analysis.

    Results: All bypasses were patent. MDS in TWS group demonstrated a significant increase of velocity and decrease of PI in the area surrounding the anastomosis. Multiplicative influence of wall thrombus occurrence as well as classification to TWS group was proved using TTFM by decrease in volume flow measured within 5 mm in front of anastomosis. Flow volumes in bigger distance from anastomosis were not infulenced by mural thrombus or TWS mistake. Significant decrease in flow in left iliac artery was detected during measurement. This decrease of rats aorta flow could have influenced measurements.

    Conclusions: More experiments will be useful.

    Patient Care: Research might improve specificity of intraoperative Doppler techniques in anastomosis technical mistake prediction.

    Learning Objectives: To improve understanding of MDS and TTFM during bypass suergery

    References: 1. Pignatti M, Benati D, Cavadas P. Effect of the two-wall-stitch mistake upon patency of rat femoral vein anastomosis: Preliminary observations. Microsurgery [serial online] 2004;24(4): 339-344 2. Nasir S, Aydin MA, Ozguner M. Thrombotic effect of purposeful back-wall stitch for different suture locations and vessels in rats. Ann Plast Surg 2005;55(5): 508-511. 3. Badie B, Lee FT Jr, Pozniak MA, Strother CM. Intraoperative sonographic assessment of graft patency during extracranial-intracranial bypass. AJNR 2000;21: 1457-1459. 4. Amin-Hanjani S, Du X, Mlinarevich N, Meglio G, Zhao M, Charbel F. The cut flow index: an intraoperative predictor of the success of extracranial-intracranial bypass for occlusive cerebrovascular disease. Neurosurgery 2005;56(1 Suppl): 75-85.

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