Diese Arbeit wurde zum Teil durch die National Institutes of Health Zuschuss R01-HL095498 sowie mit den Ressourcen und der Nutzung von Einrichtungen an der VA Healthcare System Connecticut, West Haven, CT unterstützt.

1. Anästhesie und Pre-operative Verfahren <ol><li> Induktion der Narkose Zulassung durch die zuständige Institutional Animal Care und Use Committee erhalten. Männlich C57/black Mäuse im Alter von 10 Wochen werden betäubt. Deliver 4% Isofluran mit 0,8 L / min Sauerstoff zu einer Plexiglas-Box über eine Isofluran Verdampfer und platzieren Sie die Maus im Inneren. Alternativ kann, wenn der Chirurg bevorzugt ist, kann intraperitoneal Anästhesie eingesetzt werden. </li><li> Erhaltung Anästhesie Nach Bestätigung der Anästhesie durch mangelnde Reaktion auf toe Prise wird die Maus auf dem Operationstisch in Rückenlage mit einem Silikon-Maske aufsetzen. Isofluran wird auf 2% reduziert, um geeignete Anästhesie zu halten. </li><li> Haarentfernung Ventral Haar ist vom Hals bis Unterleib mit einem Haarentferner entfernt. Haarentfernung ist bevorzugt, weil das Haar, das links mit einem Rasierer ist mit dem Doppler-Ultraschall stören könnten. </li></ol> 2. Präoperative Ultrasound <ol><li> Ziele des Ultraschalls Doppler-Ultraschall-Untersuchung vor der Operation AVF, um so die Basis-Ebene Erkenntnisse, die mit postoperativen Befunde verglichen werden, um anatomische und physiologische Veränderungen sehen können aufnehmen durchgeführt. </li><li> Punkte der Beobachtung Die Halsschlagader, supra-und infra-renal unteren Hohlvene (IVC) und abdominalen Aorta untersucht sowohl mit Puls-Doppler-und B-Modus. </li><li> Messungen Verwendung des B-Modus Durchmesser jedes Gefäß gemessen wird. Darüber hinaus werden Maximalgeschwindigkeit (systolische Spitzengeschwindigkeit in Arterien) und Wellenformen in jeder der Messpunkte oben beschrieben aufgezeichnet. </li></ol> 3. Operative Verfahren <ol><li> Maus Vorbereitung Bereiten Sie die Einstichstelle mit einem Antiseptikum und weiterhin angemessene aseptische Technik bei der Operation einschließlich der Verwendung eines Operationstuch, sterile Handschuhe und Instrumente etc. </li><li> Laparotomie Mittellinie Bauchschnitt ist f gemachtrom unteren Rand der Leber bis knapp über dem Schambein. </li><li> Die Exposition der Aorta und IVC. Eine Aufrollvorrichtung eingesetzt und alle Eingeweide werden aus der Bauchhöhle gezogen, um die rechte Seite und gehalten eingewickelt in Gaze mit Kochsalzlösung eingeweicht. Präparieren Sie die Membran, die das Retroperitoneum und unteren Dickdarm verbindet Großansicht der Aorta und der IVC bekommen. Üben Sie Druck auf die Blase, wenn es erweitert und bekommt in Weg. </li><li> Exposition der Einstichstelle Einstichstelle wird zwischen der Hälfte bis drei Viertel der Distanz sein von links Nierenvene zu Aortenbifurkation. (Abbildung 1) Präparieren Sie den linken Rand der Aorta, so dass es punktiert werden können. Beachten Sie, dass die Aorta etwa 45 Grad hinter der IVC positioniert ist, und es muss nach hinten neben dem linken seziert werden. (Abbildung 2) Der wichtigste Punkt dieser Operation ist nicht zwischen der Aorta und IVC sezieren. Halten Sie weit weg von ihnen. </li><li> Exposure der Klemme Website des AORta Präparieren Sie die infrarenalen Aorta aus den umliegenden Geweben. Achten Sie darauf, die IVC auf der linken und links Nierenvenen mit seinen Nebenflüssen auf der rechten Seite zu verletzen. </li><li> Spannen der Aorta Spannen Sie den proximalen Aorta durch Anlegen Mikrochirurgie Clips. </li><li> Rotation der Aorta Durch Ergreifen des Bindegewebes um die Aorta, drehen die Aorta, so dass die Punktion von leicht dorsale Seite der Aorta (2) hergestellt werden kann. </li><li> Die Punktion der Aorta bis zur IVC Halten Sie die Aorta in einer gedrehten Position, Punktion der Aorta bis zur IVC mit einer 25 G Nadel. (Abbildung 2) Wenn dies gelingt, kann die Nadel durch die dünne Wand IVC gesehen werden. </li><li> Hämostase Durch Ziehen der retroperitonealen Gewebe, einschließlich der Muskeln, wickeln Sie die Einstichstelle der Aorta. Nicht komprimieren die Aorta gegen die IVC, wie es wolle Gerinnsel die AVF (Abbildung 3). </li><li> De-Klemmen der Aorta Nach Bestätigungder primären Hämostase, de-klemmen die Aorta. Zusätzliche Blutungen auftreten, aber es kann mit weiteren Kompression vorstehend beschrieben, gestoppt werden. Nach de-Klemmung kann arterielle Blut gesehen, das in den IVC statt dunkel venösen Blutfluss werden. </li><li> Schließung des Bauches Bringen Sie die Eingeweiden in seiner natürlichen Position und schließen Sie den Bauch. </li></ol> 4. Post-operative Verfahren <ol><li> Post-operative Betreuung Nach Schließung des Bauches wird Isofluran gestoppt. Post-operative Versorgung einschließlich Analgesie und Wundversorgung wird in Übereinstimmung mit den Anweisungen von Institutional Animal Care und Use Committee empfohlen angewendet. Für Analgesie verwenden wir Buprenorphin bei 0,1 mg / kg alle 12 h intrasmuscularly für 24 Stunden nach den chirurgischen Eingriffen. </li><li> Post-operative Ultraschall Am ersten Tag nach der Operation wird Doppler-Ultraschall durchgeführt, um die AVF zu bestätigen. Darüber hinaus werden andere Variablen gemessen, um die Änderungen von der präoperativen überprüfenWerte. </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>

Es gibt mehrere Berichte, die AVF beschrieben wurden an Ratten, einschließlich femoralis AVF, 6, 7 Halsschlagader zu AVF 8 und aorto-Kava AVF Halsschlagader. 9, 10 Die Ratte ist um ein Mehrfaches größer als die Maus, die einen leichteren Chirurgie an der Ratte im Vergleich zu die Maus. Um dennoch die Vorteile der Maus genetischen Stämme und Varianten, das Verfahren muss erweitert werden, um Maus-Modellen erweitert werden. Mehrere bisher veröffentlichten Berichte führte die AVF-Mode...

Die häufigste Option für Nierenersatztherapie bei Patienten mit terminaler Niereninsuffizienz ist die Hämodialyse gewählt. Zugang für die Hämodialyse wird durch arteriovenöse Fistel (AVF), arteriovenöse Transplantats oder temporäre Katheterplatzierung durchgeführt. Obwohl AVF der bevorzugte Modus des Zugangs sind, AVF weitem noch nicht perfekt. Ein-Jahres-Primär AVF Durchgängigkeitsraten sind nur 60-65%, mit vielen Ausfällen aufgrund Neointimahyperplasie. Die Molekularbiologie und Physiologie der normalen AVF Bildung und maladaptive Bildung bleibt schlecht charakterisiert. Als solches ist es wesentlich zu verbessern AVF Ergebnisse mit zugehörigen Verstärkung in Verständnis der Regulation der Fistel gewonnen werden. 1-3 Belichtung einer Vene arteriellen Fluss häufig in Zusammenhang mit Venentransplantaten die direkte Modelle von chirurgischen Bypass sind. 4, 5 untersucht Obwohl Venentransplantaten und AVF ähnlich Setzen einer Vene zu einem arteriellen Umgebung gibt es mehrere kritische differences zwischen ihnen. Erstens ist der Widerstand des distalen Abfluss Bett wesentlich niedriger AVF, die AVF Drains in den rechten Vorhof während die Venentransplantat Drains der oft erkrankten distalen kleinen Arterien, was zu einer erhöhten Durchblutung und Schubspannung in der AVF. Zweitens kann das Blut im venösen Teil des AVF eine Mischung von venösen und arteriellen Blut, was zu niedrigeren Sauerstoffversorgung im Vergleich zu den rein arteriellen Inhalt in die Vene Transplantat. Drittens wird die Ader in der AVF nicht von seinem Bett entfernt, was zu Erhaltung seiner vaso venorum und nervös Innervationen, verglichen mit der vollständigen Umsetzung der Venentransplantat in den arteriellen Bett. Schließlich ist die Anzahl der in der Regel zwei Anastomosen bei Gefäßplastiken während ein AVF typischerweise nur einen. In dieser Studie stellen wir ein Mausmodell aortokavaler Fistel, die für die Untersuchung von AVF verwendet werden können.

<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>
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technical aspects of the mouse aortocaval fistula

Technische Aspekte der Erstellung eines arteriovenösen Fistel in der Maus werden diskutiert. Unter Vollnarkose wurde Bauchschnitt vorgenommen und der Aorta und Vena cava inferior (IVC) ausgesetzt sind. Die proximalen infrarenale Aorta und die distale Aorta für Klammer Platzierung und Punktion seziert, beziehungsweise. Besondere Aufmerksamkeit wird bezahlt, um zwischen Dissektion der Aorta und der IVC vermeiden. Nach dem Einspannen der Aorta wird eine 25 G Nadel zu durchstechen beide Wände der Aorta in die IVC verwendet. Das umgebende Bindegewebe ist für blutstillende Kompression verwendet. Erfolgreiche Gründung des AVF zeigt pulsatile arterielle Durchblutung der IVC. Eine weitere Bestätigung der erfolgreichen AVF kann durch postoperative Doppler-Ultraschall erreicht werden.

Nach dem Training, ist das Überleben am ersten postoperativen Tag in der Regel über 95%; bei postoperativen Tag 7 war die Überlebensrate 91,3% Abbildungen 1 und 2 zeigen die ideale Einstichstelle in koronalen und Querschnitte;. Platzierung der Punktion Website ist entscheidend für die Erzielung guter Überleben ohne übermäßige Blutung. Intra-operative Todesfälle und frühen postoperativen Todesfälle sind in der Regel aufgrund von Blutungen. Dies neigt dazu, mit übermäßiger Dissektion zwische...

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

Technical Aspects of the Mouse Aortocaval Fistula

Das Ziel ist es, eine arteriovenöse Fistel, die einfach und reproduzierbar herzustellen. Diese Methode verwendet keine Nähte oder Kleber. Daher können die Proben mit der geringsten Menge an Fremdmaterialien für die Analyse verwendet werden.

Technische Aspekte der Maus aortokavaler Fistel

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 Aufrufe.  Yale University. Das Ziel ist es, eine arteriovenöse Fistel, die einfach und reproduzierbar herzustellen. Diese Methode verwendet keine Nähte oder Kleber. Daher können die Proben mit der geringsten Menge an Fremdmaterialien für die Analyse verwendet werden.

Serie: 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.

Mikrochirurgische venöse Pouch Arterial-Bifurcation Aneurysmen in the Rabbit Modell: Technische Aspekte

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

Forschung

Medizin

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.

Das Kaninchen Blut-Shunt-Modell für die Untersuchung von akuten und Spätfolgen Subarachnoidalblutung: Technische Aspekte

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.

Ein Mausmodell von arterieller Restenose: Technische Aspekte der Femoral Draht Injury

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.

A Novel Mausmodell der arteriovenöse Fistel Ausfall: Der chirurgische Eingriff im Detail

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.

Intraluminale Drug Delivery auf die Maus arteriovenöse Fistel Endothel

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.

Ultraschall Beurteilung der Endothelfunktion: A Technische Richtlinie der Fluss-vermittelten Dilatation-Test

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.

Murine Modell der zentralen venösen Stenose mit Aortocaval Fistel mit einem Abfluss Stenose

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.

Technisches Detail für Roboter assistierte Pankreaticoduodenektomie

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.

Technische Modifikation des Terminal Ureter während der totalen transperitonalen laparoskopischen Nephrourrektomie für den oberen Harntrakt Urothelianomen

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.