ABSTRACT
The arteriovenous (AV) loop is a complex model and requires advanced microsurgical
skills. After several years of studies including characterization of the physiological
and molecular phenomena behind the process of neovascularization, we would like to
evaluate our experience from a microsurgical point of view. The AV loop operation
was performed in 612 male Lewis rats. Species, surgeon, previous microsurgical skills,
solid or soft consistency of matrix, weeks from implantation to explantation, experience,
and practice of surgeon as well length of operation and outcome (patent versus thrombosed)
upon evaluation were analyzed for each loop operation. Previous microsurgical skills,
matrix, and explantation interval were not significant predictors. There was a significant
correlation of experience, practice, and individual performance of microsurgical technicians
with the rate of thrombosis and duration of the procedure. Experimental microsurgical
operations on animals are best performed by especially trained technicians, rather
than microsurgeons working parallel to their clinical activities. The AV loop is an
excellent model in the arena of translational technologies, but due to its complexity
is unsuitable for screening purposes. Experience and practice are both significant
predictors of successful outcome. Possible applications of the model for research
purposes are discussed.
KEYWORDS
Microsurgery - arteriovenous loop - interpositional vein graft - microsurgical skills
REFERENCES
- 1
Lewis T, Drury A N.
Observations relating to arterio-venous aneurism. Part II. The immediate effects of
an arterio-venous anastomosis on the dog's circulation.
Heart.
1923;
10
365-389
- 2
Brescia M J, Cimino J E, Appel K, Hurwich B J.
Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula.
N Engl J Med.
1966;
275
1089-1092
- 3
Brookes M.
Blood supply of developing bone and its possible bearing on malformation of the limbs
and face in congenital haemangiomatous disorders.
Proc R Soc Med.
1972;
65
597-599
- 4
Kukita W.
[Effect of arteriovenous fistula in the lower extremity on the bone growth and changes
of blood gas components].
Igaku Kenkyu.
1969;
39
73-90
- 5
Hatt P Y, Rakusan K, Gastineau P, Laplace M.
Morphometry and ultrastructure of heart hypertrophy induced by chronic volume overload
(aorto-caval fistula in the rat).
J Mol Cell Cardiol.
1979;
11
989-998
- 6
Erol O O, Spira M.
New capillary bed formation with a surgically constructed arteriovenous fistula.
Surg Forum.
1979;
30
530-531
- 7
Hirasé Y, Valauri F A, Buncke H J.
Creation of neovascularised free flaps using vein grafts as pedicles: a preliminary
report on experimental models.
Br J Plast Surg.
1989;
42
216-222
- 8
Mooney D J, Mikos A G.
Growing new organs.
Sci Am.
1999;
280
60-65
- 9
Tanaka Y, Tsutsumi A, Crowe D M, Tajima S, Morrison W A.
Generation of an autologous tissue (matrix) flap by combining an arteriovenous shunt
loop with artificial skin in rats: preliminary report.
Br J Plast Surg.
2000;
53
51-57
- 10
Polykandriotis E, Euler S, Arkudas A et al..
Regression and persistence: remodelling in a tissue engineered axial vascular assembly.
J Cell Mol Med.
2009;
13
4166-4175
- 11
Will J, Melcher R, Treul C et al..
Porous ceramic bone scaffolds for vascularized bone tissue regeneration.
J Mater Sci Mater Med.
2008;
19
2781-2790
- 12
Bleiziffer O, Horch R E, Hammon M et al..
T17b murine embryonal endothelial progenitor cells can be induced towards both proliferation
and differentiation in a fibrin matrix.
J Cell Mol Med.
2009;
13
926-935
- 13
Arkudas A, Beier J P, Heidner K et al..
Axial prevascularization of porous matrices using an arteriovenous loop promotes survival
and differentiation of transplanted autologous osteoblasts.
Tissue Eng.
2007;
13
1549-1560
- 14
Hui K C, Zhang F, Shaw W W et al..
Learning curve of microvascular venous anastomosis: a never ending struggle?.
Microsurgery.
2000;
20
22-24
- 15
Gruel S M, Rao V K, Burris D E.
Selected abstracts from the fifth annual meeting of the society of microsurgical specialists,
September 12 and 13, 1988, Baltimore, Maryland. Cardiac Transplantation in Rats as
a Model for Allograft Rejection.
Microsurgery.
1989;
10
77-82
Elias PolykandriotisM.D.
Department of Plastic and Hand Surgery, University of Erlangen
Krankenhausstrasse 12, 91054 Erlangen, Germany
eMail: elias.polykandriotis@googlemail.com
