这项工作是由国家卫生部授予R01-HL095498在弗吉尼亚州，西黑文，CT康涅狄格卫生保健系统的资源和设施的使用，以及部分支持。

1。麻醉和手术前的程序<ol><li>全身麻醉诱导 获得由适当的机构动物护理和使用委员会的批准。男性C57/black小鼠，年龄10周，麻醉。提供4％的异氟醚0.8升/分钟氧气到一个有机玻璃框通过异氟醚蒸发器放置在鼠标内部。另外，如果由外科医生，优选，腹腔麻醉可以使用。 </li><li>保留麻醉 由缺乏反应脚趾捏麻醉确认后，鼠标被放置在手术台上用硅胶面罩在仰卧位。异氟醚减少至2％，以维持适当的麻醉水平。 </li><li>脱毛 腹取出头发从脖子到小腹使用头发卸妆。毛发去除是优选的，因为使用剃须刀留头发可能会干扰多普勒超声。 </li></ol> 2。术前Ultrasoun的ð <ol><li>超声波的目标 AVF手术前进行多普勒超声检查，以便记录发现可与手术后的结果看解剖和生理变化的基础水平。 </li><li>观测点 颈内静脉，超和肾红外线的下腔静脉（IVC）和腹主动脉，采用脉冲多普勒和B型检查。 </li><li>测量 使用B模式，每个血管直径进行了测量。此外，最大速度（在动脉的收缩期峰值流速）和波形记录，可在上述的各测量点。 </li></ol> 3。手术<ol><li>鼠标准备 准备切口部位的局部消毒剂，并继续在手术过程中，包括适当的无菌技术采用外科悬垂性，无菌手套和工具等</li><li>剖腹探查 中线腹部切口制F罗肝脏到稍高于耻骨下缘。 </li><li>曝光主动脉和下腔静脉。 一个拉钩插入所有的肠子被拉出腹腔的右侧，并不停地用生理盐水浸泡的纱布包裹。解剖膜连接后腹膜和结肠下得到充分的主动脉和下腔静脉的看法。如果是扩张和得到应用对膀胱的压力。 </li><li>穿刺部位的曝光 穿刺部位之间的一半到四分之三的距离主动脉分叉左肾静脉。 （ 图1）解剖主动脉的左页边，以便它可以被穿刺。请记住的位置大约45度，后面的下腔静脉和主动脉，它必须​​被向后剥离除到左边。 （ 图2），这种手术最重要的一点是不要解剖主动脉和下腔静脉之间。保持离他们很远。 </li><li>曝光的AOR钳站点TA 解剖腹主动脉周围组织。要小心，不要伤到左，左肾静脉及其支流在右边的下腔静脉。 </li><li>夹紧的主动脉 钳的近端主动脉通过应用显微片段。 </li><li>主动脉的旋转 通过抓住周围的结缔组织主动脉，主动脉旋转，从而使穿刺可从稍微的主动脉的背侧（ 图2）。 </li><li>至下腔静脉，主动脉穿刺 保持在一个旋转的位置，使用25 G针的穿刺至下腔静脉，主动脉主动脉。 （ 图2），如果成功的话，针可以通过下腔静脉壁薄。 </li><li>止血 拉腹膜后组织，包括肌肉，包裹主动脉穿刺部位。不要压缩对下腔静脉，主动脉，因为它可能血块AVF（ 图3）。 </li><li>夹紧主动脉 确认后主止血钳主动脉。附加可能发生出血，但它可以被进一步压缩上述停止。后夹紧中可以看出，动脉血流入下腔静脉，而不是黑暗的静脉血流。 </li><li>腹部闭幕 返回其自然位置接近腹部的肠子。 </li></ol> 4。手术后的程序<ol><li>手术后的护理 封闭的腹部后，异氟醚停止。手术后的护理包括镇痛和伤口护理是按照机构动物护理和使用委员会推荐的指示。镇痛，我们使用丁丙诺啡在0.1毫克/千克都intrasmuscularly 12小时24小时后，外科手术。 </li><li>手术后的超声 在手术后的第一天，多普勒超声检查确认AVF。此外，其他变量的测量，判断是否从手术前的变化值。 </li></ol>

<ol>
	<li>Allon, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+management+of+vascular+access.">Current management of vascular access.</a> Clinical Journal of the American Society of Nephrology. 2 (4), 786-800 (2007).</li><li>Dixon, B. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Why+don't+fistulas+mature?.">Why don't fistulas mature?.</a> Kidney International. 70 (8), 1413-1422 (2006).</li><li>Roy-Chaudhury, P., Spergel, L. M., Besarab, A., Asif, A., Ravani, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Biology+of+arteriovenous+fistula+failure.">Biology of arteriovenous fistula failure.</a> Journal of Nephrology. 20 (2), 150-163 (2007).</li><li>Kudo, F. A., Muto, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Venous+identity+is+lost+but+arterial+identity+is+not+gained+during+vein+graft+adaptation.">Venous identity is lost but arterial identity is not gained during vein graft adaptation.</a> Arteriosclerosis, Thrombosis, and Vascular Biology. 27 (7), 1562-1571 (2007).</li><li>Muto, A., Yi, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Eph-B4+prevents+venous+adaptive+remodeling+in+the+adult+arterial+environment.">Eph-B4 prevents venous adaptive remodeling in the adult arterial environment.</a> The Journal of Experimental Medicine. 208 (3), 561-575 (2011).</li><li>Croatt, A. J., Grande, J. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterization+of+a+model+of+an+arteriovenous+fistula+in+the+rat:+the+effect+of+L-NAME.">Characterization of a model of an arteriovenous fistula in the rat: the effect of L-NAME.</a> The American Journal of Pathology. 176 (5), 2530-2541 (2010).</li><li>Misra, S., Fu, A. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+rat+femoral+arteriovenous+fistula+model:+increased+expression+of+matrix+metalloproteinase-2+and+-9+at+the+venous+stenosis.">The rat femoral arteriovenous fistula model: increased expression of matrix metalloproteinase-2 and -9 at the venous stenosis.</a> Journal of Vascular and Interventional Radiology. 19 (4), 587-594 (2008).</li><li>Kojima, T., Miyachi, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+relationship+between+venous+hypertension+and+expression+of+vascular+endothelial+growth+factor:+hemodynamic+and+immunohistochemical+examinations+in+a+rat+venous+hypertension+model.">The relationship between venous hypertension and expression of vascular endothelial growth factor: hemodynamic and immunohistochemical examinations in a rat venous hypertension model.</a> Surgical Neurology. 68 (3), 277-284 (2007).</li><li>Caplice, N. M., Wang, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neoangiogenesis+and+the+presence+of+progenitor+cells+in+the+venous+limb+of+an+arteriovenous+fistula+in+the+rat.">Neoangiogenesis and the presence of progenitor cells in the venous limb of an arteriovenous fistula in the rat.</a> American Journal of Physiology Renal Physiology. 293 (2), F470-F475 (2007).</li><li>Nath, K. A., Kanakiriya, S. K., Grande, J. P., Croatt, A. J., Katusic, Z. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increased+venous+proinflammatory+gene+expression+and+intimal+hyperplasia+in+an+aorto-caval+fistula+model+in+the+rat.">Increased venous proinflammatory gene expression and intimal hyperplasia in an aorto-caval fistula model in the rat.</a> The American Journal of Pathology. 162 (6), 2079-2090 (2003).</li><li>Karram, T., Hoffman, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Induction+of+cardiac+hypertrophy+by+a+controlled+reproducible+sutureless+aortocaval+shunt+in+the+mouse.">Induction of cardiac hypertrophy by a controlled reproducible sutureless aortocaval shunt in the mouse.</a> Journal of Investigative Surgery. 18 (6), 325-334 (2005).</li><li>Perry, G. J., Mori, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Genetic+variation+in+angiotensin-converting+enzyme+does+not+prevent+development+of+cardiac+hypertrophy+or+upregulation+of+angiotensin+II+in+response+to+aortocaval+fistula.">Genetic variation in angiotensin-converting enzyme does not prevent development of cardiac hypertrophy or upregulation of angiotensin II in response to aortocaval fistula.</a> Circulation. 103 (7), 1012-1016 (2001).</li><li>Guzman, R. J., Krystkowiak, A., Zarins, C. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early+and+sustained+medial+cell+activation+after+aortocaval+fistula+creation+in+mice.">Early and sustained medial cell activation after aortocaval fistula creation in mice.</a> The Journal of Surgical Research. 108 (1), 112-121 (2002).</li><li>Castier, Y., Lehoux, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterization+of+neointima+lesions+associated+with+arteriovenous+fistulas+in+a+mouse+model.">Characterization of neointima lesions associated with arteriovenous fistulas in a mouse model.</a> Kidney International. 70 (2), 315-320 (2006).</li></ol>

有几个报告所描述的动静脉瘘管的影响，包括股骨AVF，6，7颈颈AVF 8和主动脉腔AVF。9，10，将大鼠比鼠标大几倍，允许更容易的手术相比，在大鼠鼠标。然而，为了利用小鼠遗传品系和变体的步骤，必须扩大到包括小鼠模型。几个先前公布的报告介绍了AVF的小鼠模型中，但这些报告一般都在开发一个模型右路心脏衰竭的背景下，使用较大尺寸的针头。11-13古斯曼我?...

终末期肾病患者肾脏替代治疗在选择最常用的选项是血液透析。访问进行血液透析动静脉瘘（AVF），动静脉移植物，或临时导管置入。 AVF虽然是首选的访问模式，AVF还不够完善。一年主要AVF通畅率只有60-65％，许多次的失败，由于内膜增生。正常AVF的形成和适应不良形成的分子生物学和生理学仍然很差的特点。因此，很多得到改善AVF结果与随附增益理解瘘形成的调控。1-3 曝光静脉动脉血流通常研究的背景下静脉移植旁路手术是直接模式，4，5，虽然静脉移植和AVF同样暴露静脉动脉的环境，有几个关键的二它们之间fferences。首先，前端径流床的电阻是低得多的动静脉瘘，，AVF下水道右心房，而静脉移植水渠往往病变远侧小动脉，导致血流增加和剪切应力，在动静脉瘘。第二，血液中的动静脉瘘的静脉肢体可导致比纯粹的动脉静脉移植物中的含量较低的氧合静脉和动脉血液的混合物中。三，静脉AVF不会删除从它的床上，导致其venorum血管和神经支配保存，移植静脉完全性动脉床。最后，在静脉移植物吻合的数量通常是两个，而AVF通常只有一个。在这项研究中，我们将介绍的小鼠模型中aortocaval瘘，可用于AVF研究。

<table border="1">
	<tbody>
		<tr>
			<td>Name of equipment</td>
			<td>Company</td>
			<td>Catalog number</td>
			<td>Comments (optional)</td>
		</tr>
		<tr>
			<td>Vevo 770 ultrasound machine</td>
			<td>Visualsonics</td>
			<td>20-60 Mhz scan head; RMV-704</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Vascular clamp</td>
			<td>Roboz Surgical Instrument Co.</td>
			<td>RS-5424</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Clamp applying forceps</td>
			<td>Roboz Surgical Instrument Co.</td>
			<td>RS-5410</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>25 Gauge Needle</td>
			<td>Becton Dickinson</td>
			<td>BD PrecisionGlide Needle 25 G x 7/8 #305124</td>
			<td>&nbsp;</td>
		</tr>
	</tbody>
</table>

technical aspects of the mouse aortocaval fistula

技术方面创建鼠标的动静脉瘘的讨论。在全身麻醉，腹部切口，暴露主动脉和下腔静脉（IVC）。腹主动脉近端和远端主动脉解剖钳安置和针的穿刺，分别。特别注意的是，以避免夹层主动脉和下腔静脉之间。夹紧主动脉后，25 G针用于穿刺的主动脉两壁的进入下腔静脉。周围的结缔组织用于止血压缩的。成功创建AVF将显示下腔静脉搏动的动脉血流。成功AVF可以通过多普勒超声手术后进一步确认。

经过实践，生存在第一次手术后的一天通常是超过95％，在手术后第7天，存活率为91.3％。 图1和图2显示了理想的穿刺点在冠状面和剖视图;放置穿刺现场没有过多出血，取得了良好的生存是至关重要的。出血通常是由于手术中的死亡和手术后早期死亡。这往往会发生过多的夹层之间的主动脉和下腔静脉，或从止血压力不足， 图3示出了示意性的重要性与结缔组织包裹穿刺?...

Watch this Scientific Journal Video about Technical Aspects of the Mouse Aortocaval Fistula at JoVE.com

Technical Aspects of the Mouse Aortocaval Fistula

我们的目标是产生一个动静脉瘘，操作简便，重现。此方法不使用缝线或胶水粘合。因此，样品可以用最少的异物的量进行分析。

在的鼠标Aortocaval瘘的技术方面

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta ...

technical-aspects-of-the-mouse-aortocaval-fistula

Research

JoVE Journal

Medicine

16.3K 次观看.  Yale University. 我们的目标是产生一个动静脉瘘，操作简便，重现。此方法不使用缝线或胶水粘合。因此，样品可以用最少的异物的量进行分析。

视频: Technical Aspects of the Mouse Aortocaval Fistula

Microsurgical Venous Pouch Arterial-Bifurcation Aneurysms in the Rabbit Model: Technical Aspects

For ruptured human cerebral aneurysms endovascular embolization has become an equivalent alternative to aneurysm clipping.1 However, large clinical trials have shown disappointing long-term results with unacceptable high rates of aneurysm recanalization and delayed aneurysm rupture.2 To overcome these problems, animal experimental studies are crucial for the development of better endovascular devices.3-5
Several animal models in rats, rabbits, canines and swine are available.6-8 Comparisons of the different animal models showed the superiority of the rabbit model with regard to hemodynamics and comparability of the coagulation system and cost-effectiveness.9-11 
The venous pouch arterial bifurcation model in rabbits is formed by a venous pouch sutured into an artificially created true bifurcation of both common carotid arteries (CCA). The main advantage of this model are true bifurcational hemodynamics.12 The major drawbacks are the sofar high microsurgical technical demands and high morbidity and mortality rates of up to 50%.13 These limitations have resulted in less frequent use of this aneurysm model in the recent years. These shortcomings could be overcome with improved surgical procedures and modified peri- and postoperative analgetic management and anticoagulation.14-16 Our techniques reported in this paper demonstrate this optimized technique for microsurgical creation of arterial bifurcation aneurysms.

An optimized technique for the microsurgical creation of arterial bifurcation aneurysms mimicking bifurcation human cerebral aneurysms is described. A venous pouch is sutured into an artificially created true bifurcation of both common carotid arteries. Facilitated microsurgical techniques and aggressive postoperative anticoagulation and analgesia lead to minimized morbidity rates and high aneurysm patency rates.

显微静脉袋分岔动脉瘤在兔模型：技术问题

For ruptured human cerebral aneurysms endovascular embolization has become an equivalent alternative to aneurysm clipping.1 However, large clinical trials ...

科研

医学

The Rabbit Blood-shunt Model for the Study of Acute and Late Sequelae of Subarachnoid Hemorrhage: Technical Aspects

Early brain injury and delayed cerebral vasospasm both contribute to unfavorable outcomes after subarachnoid hemorrhage (SAH). Reproducible and controllable animal models that simulate both conditions are presently uncommon. Therefore, new models are needed in order to mimic human pathophysiological conditions resulting from SAH.
This report describes the technical nuances of a rabbit blood-shunt SAH model that enables control of intracerebral pressure (ICP). An extracorporeal shunt is placed between the arterial system and the subarachnoid space, which enables examiner-independent SAH in a closed cranium. Step-by-step procedural instructions and necessary equipment are described, as well as technical considerations to produce the model with minimal mortality and morbidity. Important details required for successful surgical creation of this robust, simple and consistent ICP-controlled SAH rabbit model are described.

The experimental intracranial pressure-controlled blood shunt subarachnoid hemorrhage (SAH) model in the rabbit combines the standard procedures &#8212; subclavian artery cannulation and transcutaneous cisterna magna puncture, which enables close mimicking of human pathophysiological conditions after SAH. We present step-by-step instructions and discuss key surgical points for successful experimental SAH creation.

蛛网膜下腔出血急性和后遗症的研究兔血分流型号：技术问题

Early brain injury and delayed cerebral vasospasm both contribute to unfavorable outcomes after subarachnoid hemorrhage (SAH). Reproducible and ...

A Murine Model of Arterial Restenosis: Technical Aspects of Femoral Wire Injury

Cardiovascular disease caused by atherosclerosis is the leading cause of death in the developed world. Narrowing of the vessel lumen, due to atherosclerotic plaque development or the rupturing of established plaques, interrupts normal blood flow leading to various morbidities such as myocardial infarction and stroke. In the clinic endovascular procedures such as angioplasty are commonly performed to reopen the lumen. However, these treatments inevitably damage the vessel wall as well as the vascular endothelium, triggering an excessive healing response and the development of a neointimal plaque that extends into the lumen causing vessel restenosis (re-narrowing). Restenosis remains a major cause of failure of endovascular treatments for atherosclerosis. Thus, preclinical animal models of restenosis are vitally important for investigating the pathophysiological mechanisms as well as translational approaches to vascular interventions. Among several murine experimental models, femoral artery wire injury is widely accepted as the most suitable for studies of post-angioplasty restenosis because it closely resembles the angioplasty procedure that injures both endothelium and vessel wall. However, many researchers have difficulty utilizing this model due to its high degree of technical difficulty. This is primarily because a metal wire needs to be inserted into the femoral artery, which is approximately three times thinner than the wire, to generate sufficient injury to induce prominent neointima. Here, we describe the essential surgical details to effectively overcome the major technical difficulties of this model. By following the presented procedures, performing the mouse femoral artery wire injury becomes easier. Once familiarized, the whole procedure can be completed within 20 min.

The mouse femoral artery wire injury model of restenosis is technically challenging. In this protocol we show the key technical details essential for successfully performing wire injury to induce consistent&#160;neointima for studies of restenosis.

动脉再狭窄小鼠模型：股导线损伤的技术方面

Cardiovascular disease caused by atherosclerosis is the leading cause of death in the developed world. Narrowing of the vessel lumen, due to ...

A Novel Murine Model of Arteriovenous Fistula Failure: The Surgical Procedure in Detail

The arteriovenous fistula (AVF) still suffers from a high number of failures caused by insufficient remodeling and intimal hyperplasia from which the exact pathophysiology remains unknown. In order to unravel the pathophysiology a murine model of AVF-failure was developed in which the configuration of the anastomosis resembles the preferred situation in the clinical setting. A model was described in which an AVF is created by connecting the venous end of the branch of the external jugular vein to the side of the common carotid artery using interrupted sutures. At a histological level, we observed progressive stenotic intimal lesions in the venous outflow tract that is also seen in failed human AVFs. Although this procedure can be technically challenging due to the small dimensions of the animal, we were able to achieve a surgical success rate of 97% after sufficient training. The key advantage of a murine model is the availability of transgenic animals. In view of the different proposed mechanisms that are responsible for AVF failure, disabling genes that might play a role in vascular remodeling can help us to unravel the complex pathophysiology of AVF failure.

Here we present a murine model of arteriovenous fistula (AVF) failure in which a clinically relevant anastomotic configuration is incorporated. This model can be used to study the pathophysiology and to test possible therapeutic interventions.

动静脉内瘘失败的新型小鼠模型：在详细介绍手术过程

The arteriovenous fistula (AVF) still suffers from a high number of failures caused by insufficient remodeling and intimal hyperplasia from which the ...

Intraluminal Drug Delivery to the Mouse Arteriovenous Fistula Endothelium

Delivery of therapeutic agents to enhance arteriovenous fistula (AVF) maturation can be administered either via intraluminal or external routes. The simple murine AVF model was combined with intraluminal administration of drug solution to the venous endothelium at the same time as fistula creation. Technical aspects of this model are discussed. Under general anesthesia, an abdominal incision is made and the aorta and inferior vena cava (IVC) are exposed. The infra-renal aorta and IVC are dissected for clamping. After proximal and distal clamping, the puncture site is exposed and a 25 G needle is used to puncture both walls of the aorta and into the IVC. Immediately after the puncture, a reporter gene-expressing viral vector was infused in the IVC via the same needle, followed by 15 min of incubation. The intraluminal administration method enabled more robust viral gene delivery to the venous endothelium compared to administration by the external route. This novel method of delivery will facilitate studies that explore the role of the endothelium in AVF maturation and enable intraluminal drug delivery at the time of surgical operation.

After puncturing the aorta through the inferior vena cava (IVC) to create an aorto-caval fistula in the mouse, solution containing a drug is infused into the IVC via the same needle, followed by incubation. This method enables more robust drug delivery to the venous endothelium compared to the external route.

腔内药物输送到鼠标动静脉瘘内皮

Delivery of therapeutic agents to enhance arteriovenous fistula (AVF) maturation can be administered either via intraluminal or external routes. The ...

Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test

Cardiovascular disease is the primary cause of mortality and a major cause of disability worldwide. The dysfunction of the vascular endothelium is a pathological condition characterized mainly by a disruption in the balance between vasodilator and vasoconstrictor substances and is proposed to play an important role in the development of atherosclerotic cardiovascular disease. Therefore, a precise evaluation of endothelial function in humans represents an important tool that could help better understand the etiology of multiple cardio-centric pathologies.
Over the past twenty-five years, many methodological approaches have been developed to provide an assessment of endothelial function in humans. Introduced in 1989, the FMD test incorporates a forearm occlusion and subsequent reactive hyperemia that promotes nitric oxide production and vasodilation of the brachial artery. The FMD test is now the most widely utilized, non-invasive, ultrasonic assessment of endothelial function in humans and has been associated with future cardiovascular events.
Although the FMD test could have clinical utility, it is a physiological assessment that has inherited several confounding factors that need to be considered. This article describes a standardized protocol for determining FMD including the recommended methodology to help minimize the physiological and technical issues and improve the precision and reproducibility of the assessment.

The flow mediated dilation (FMD) test is the most commonly utilized, non-invasive, ultrasound assessment of endothelial function in humans. Although the FMD test has been related with the prediction of future cardiovascular disease and events, it is a physiological assessment with many inherent confounding factors that need to be considered.

血管内皮功能的超声评估：血流介导的舒张试验的技术指导原则

Cardiovascular disease is the primary cause of mortality and a major cause of disability worldwide. The dysfunction of the vascular endothelium is a ...

Murine Model of Central Venous Stenosis using Aortocaval Fistula with an Outflow Stenosis

Central venous stenosis is an important entity contributing to arteriovenous fistula (AVF) failure. A murine AVF model was modified to create a partial ligation of the inferior vena cava (IVC) in the outflow of the fistula, mimicking central venous stenosis. Technical aspects of this model are introduced. The aorta and IVC are exposed, following an abdominal incision. The infra-renal aorta and IVC are dissected for proximal clamping, and the distal aorta is exposed for puncture. The IVC at the midpoint between the left renal vein and the aortic bifurcation is carefully dissected to place an 8-0 suture beneath the IVC. After clamping the aorta and IVC, an AVF is created by puncturing the infra-renal aorta through both walls into the IVC with a 25 G needle, followed by ligating a 22 G intra-venous (IV) catheter and IVC together. The catheter is then removed, creating a reproducible venous stenosis without occlusion. The aorta and IVC are unclamped after confirming primary hemostasis. This novel model of central vein stenosis is easy to perform, reproducible, and will facilitate studies on AVF failure.

An aortocaval fistula was created by puncturing the murine infra-renal aorta through both walls into the inferior vena cava and was followed by creation of a stenosis in its outflow via partial ligation of the inferior vena cava. This reproducible model can be used to study central venous stenosis.

中央静脉狭窄病的Murine模型,使用具有流出狭窄病的动脉静脉瘘管病

Central venous stenosis is an important entity contributing to arteriovenous fistula (AVF) failure. A murine AVF model was modified to create a partial ...

Technical Detail for Robot Assisted Pancreaticoduodenectomy

Since its first report in 2003, robotic pancreaticoduodenectomy (RPD) has gained popularity among pancreatic surgeons. Inherent advantages of the robotic platform, including three-dimensional vision, wristed instruments, and improved ergonomics, allow the surgeon to recapitulate the principles of open pancreatoduodenectomy allowing safe oncologic dissection, hemostasis, and meticulous reconstruction. Over the course of the past decade, significant strides have been achieved in outlining the safety, feasibility, and learning curve of the robotic Whipple. When performed by high volume pancreatic surgeons experienced in RPD, recent comparative effectiveness studies show potential advantages compared to the open technique, including reductions in hospital stay and morbidity. National data also show reductions in conversion rates compared to its laparoscopic counterpart. Although long-term oncologic data are still needed, short-term oncologic surrogates of margin resection and lymph node harvest suggest no compromise in oncologic outcomes. As pancreatic surgeons increasingly integrate robotics into their practice, proficiency-based training and credentialing will be necessary for the safe application and dissemination of RPD. Here, we provide the detailed steps of a robotic pancreaticoduodenectomy performed at the University of Pittsburgh Medical Center.&#160;

The following manuscript details a stepwise approach to the robot-assisted pancreaticoduodenectomy performed at the University of Pittsburgh Medical Center.

机器人辅助胰腺切除术的技术细节

Since its first report in 2003, robotic pancreaticoduodenectomy (RPD) has gained popularity among pancreatic surgeons. Inherent advantages of the robotic ...

Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Upper tract urothelial carcinoma (UTUC) accounts for 5%&ndash;10% of all urothelial tumors. Radical nephroureterectomy is the standard treatment procedure. At present, different choices still exist for treating the ureteral end during laparoscopic ureteral bladder sleeve resection. Our center has adopted a new method for treating the ureteral end. This new method can increase the operating space and reduce the difficulty of the surgery compared with current methods.

Here, we present a protocol to increase the surgical field of view and reduce the difficulty of total transperitoneal laparoscopic nephroureterectomy surgery by precutting the umbilical ligament before treating the terminal ureter.

上尿道泌尿管在上尿道泌尿管切除术期间的技术改造

Upper tract urothelial carcinoma (UTUC) accounts for 5%&ndash;10% of all urothelial tumors. Radical nephroureterectomy is the standard treatment ...

Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique

Autologous arteriovenous fistula (AVF) is the primary and best option to obtain vascular access for hemodialysis treatment; other options are arteriovenous graft (AVG) and central venous catheterization (CVC). The implementation of radio-cephalic autologous arteriovenous fistula (RC-AVF) in the forearm was preferred among patients with superior vascular conditions. However, there is a high rate of early fistula failure. The chosen surgical method is understood to have an effect on the maturation of the fistula. New surgical procedures such as radial artery deviation and reimplantation (RADAR) have been significantly improved for juxta-anastomotic stenosis. Nevertheless, new problems such as stenosis of arteries and narrowing of surgical indication were also found. In this report, we presented a modified no-touch technique (MNTT) to create an RC-AVF, in which the venous and arterial wall avoid devascularization and the radial artery does not sever.

We present a modified no-touch technique (MNTT) to create a radio-cephalic arteriovenous fistula (RC-AVF) in which the venous and arterial wall avoid devascularization and the radial artery does not sever.