Name: microsurgical venous pouch arterial-bifurcation aneurysms in the rabbit model: technical aspects
Uploaded: 2011-05-11T13:00:00
Description: Watch this Scientific Journal Video about Microsurgical Venous Pouch Arterial-Bifurcation Aneurysms in the Rabbit Model: Technical Aspects at JoVE.com

This study was supported by the 'Medical Scientific Fund of the Major of the City of Vienna' and Ethicon Biosurgery, Inc. New Jersey, USA. The authors express their thanks to Professor Heber Ferraz-Leite, Director of the 'European Workshop on Microsurgery and Cerebral Revascularization' at the Medical University of Vienna, Austria, for his valuable microsurgical teaching.

1. Positioning and preparation of the animal
The experiments were approved by the responsible local ethical committee and performed according to the Felasa guidelines.
<ol>
	<li>Start general anesthesia of the female New Zealand White rabbit (2.5-3.5 kg) with intramuscular injection of Ketamin (30mg/kg) and Xylazine (6mg/kg) and continue after mechanical intubation (tube diameter 4mm, length 18mm) with gas anesthesia (Isoflurane) under ECG monitoring. Perform pain monitoring via toe pinch ...

<ol>
	<li>Molyneux, A., Kerr, R., Yu, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=International+subarachnoid+aneurysm+trial+(ISAT)+of+neurosurgical+clipping+versus+endovascular+coiling+in+2143+patients+with+ruptured+intracranial+aneurysms:+a+randomised+comparison+of+effects+on+survival,+dependency,+seizures,+rebleeding,+subgroups,+and+aneurysm+occlusion.">International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion.</a> Lancet. 366, 809-817 (2005).</li><li>Mitchell, P., Kerr, R., Mendelow, A., Molyneux, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Could+late+rebleeding+overturn+the+superiority+of+cranial+aneurysm+coil+embolization+over+clip+ligation+seen+in+the+International+Subarachnoid+Aneurysm+Trial.">Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in the International Subarachnoid Aneurysm Trial.</a> J Neurosur. 108, 437-442 (2008).</li><li>Bavinzski, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Histopathological+findings+in+experimental+aneurysms+embolized+with+conventional+and+thrombogenic/antithrombolytic+Guglielmi+coils.">Histopathological findings in experimental aneurysms embolized with conventional and thrombogenic/antithrombolytic Guglielmi coils.</a> Minim Invasive Neurosurg. 42, 167-174 (1999).</li><li>Bocher-Schwarz, H. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Histological+findings+in+coil-packed+experimental+aneurysms+3+months+after+embolization.">Histological findings in coil-packed experimental aneurysms 3 months after embolization.</a> Neurosurgery. 50, 379-384 (2002).</li><li>Sherif, C., Plenk, H., Grossschmidt, K., Kanz, F., Bavinzski, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computer-assisted+quantification+of+occlusion+and+coil+densities+on+angiographic+and+histological+images+of+experimental+aneurysms.">Computer-assisted quantification of occlusion and coil densities on angiographic and histological images of experimental aneurysms.</a> Neurosurgery. 58, 559-566 (2006).</li><li>Massoud, T., Guglielmi, G., Ji, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experiemental+saccular+aneurysms.+1.+Review+of+surgically+constructed+models+and+their+laboratory+applications.">Experiemental saccular aneurysms. 1. Review of surgically constructed models and their laboratory applications.</a> Neurorad. 36, 537-546 (1994).</li><li>Anidjar, S., Salzmann, J., Gentric, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Elastase+induced+experimental+aneurysms+in+rats.">Elastase induced experimental aneurysms in rats.</a> Circulation. 82, 973-981 (1990).</li><li>Wakhloo, A., Schellhammer, F., de Vries, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Self-expanding+and+balloon-expandable+stents+in+the+treatment+of+carotid+aneurysms:+an+experimental+study+in+a+canine+model.">Self-expanding and balloon-expandable stents in the treatment of carotid aneurysms: an experimental study in a canine model.</a> AJNR. 15, 493-502 (1994).</li><li>Dai, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Histopathologic+and+immunohistochemical+comparison+of+human,+rabbit,+and+swine+aneurysms+embolized+with+platinum+coils.">Histopathologic and immunohistochemical comparison of human, rabbit, and swine aneurysms embolized with platinum coils.</a> AJNR Am J Neuroradiol. 26, 2560-2568 (2005).</li><li>Shin, Y. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Creation+of+four+experimental+aneurysms+with+different+hemodynamics+in+one+dog.">Creation of four experimental aneurysms with different hemodynamics in one dog.</a> AJNR. 26, 1764-1767 (2005).</li><li>Abruzzo, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Histologic+and+morphologic+comparison+of+experimental+aneurysms+with+human+intracranial+aneurysms.">Histologic and morphologic comparison of experimental aneurysms with human intracranial aneurysms.</a> AJNR Am J Neuroradiol. 19, 1309-1314 (1998).</li><li>Bavinzski, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+bifurcation+aneurysm:+a+model+for+in+vivo+evaluation+of+endovascular+techniques.">Experimental bifurcation aneurysm: a model for in vivo evaluation of endovascular techniques.</a> Minim Invasive Neurosurg. 41, 129-132 (1998).</li><li>Spetzger, U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microsurgically+produced+bifurcation+aneurysms+in+a+rabbit+model+for+endovascular+coil+embolization.">Microsurgically produced bifurcation aneurysms in a rabbit model for endovascular coil embolization.</a> J Neurosurg. 85, 488-495 (1996).</li><li>Sherif, C., Marbacher, S., Erhardt, S., Fandino, J., J, . <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improved+microsurgical+creation+of+venous-pouch+arterial-bifurcation+aneurysms+in+rabbits.">Improved microsurgical creation of venous-pouch arterial-bifurcation aneurysms in rabbits.</a> AJNR. , .</li><li>Marbacher, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complex+Bi-Lobular,+Bi-Saccular,+and+Broad-Necked+Microsurgical+Aneurysms+Formation+in+the+Rabbit+Bifurcation+Model+for+the+Study+of+Upcoming+Endovascular+Techniques.">Complex Bi-Lobular, Bi-Saccular, and Broad-Necked Microsurgical Aneurysms Formation in the Rabbit Bifurcation Model for the Study of Upcoming Endovascular Techniques.</a> AJNR. , .</li><li>Sherif, C., Plenk, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+angiographic+and+histopathologic+evaluation+of+experimental+aneurysms.">Quantitative angiographic and histopathologic evaluation of experimental aneurysms.</a> AJNR. , .</li><li>Grunwald, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anticoagulation+regimes+and+their+influence+on+the+occlusion+rate+of+aneurysms:+an+experimental+study+in+rabbits.">Anticoagulation regimes and their influence on the occlusion rate of aneurysms: an experimental study in rabbits.</a> Neurosurg. 57, 1048-1054 (2005).</li><li>Forrest, M. D., O'Reilly, G. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Production+of+experimental+aneurysms+at+a+surgically+created+arterial+bifurcation.">Production of experimental aneurysms at a surgically created arterial bifurcation.</a> AJNR Am J Neuroradiol. 10, 400-402 (1989).</li></ol>

The authors recommend to considerate the following critical surgical key steps to achieve good results and patent aneurysms:
<ol>
 <li>Careful dissection of a long segment of the left CCA for easy anastomosis without destruction of nerves and small vessels.</li>
 <li>Careful removal of the highly thrombogenic periadventitial fibrous tissue prior to the creation of the anastomosis.</li>
 <li>Creation of a tensionless anastomosis. </li>
 <li>Fewer sutures: The proposed sequence of anastomsis sites beginning at the back...

<table border="1">
	<tbody>
		<tr>
			<th>Name of the reagent</th>
			<th>Company</th>
			<th>Catalogue number</th>
			<th>Comments</th>
		</tr>
		<tr>
			<td>Vicryl4-0 polyfilament restorable sutures </td>
			<td>Ethicon Inc</td>
			<td>J386H</td>			
			<td>&nbsp;</td>			
		</tr>
		<tr>
			<td>Ethilon 10-0 monofil non resorbable sutures </td>
			<td>Ethicon Inc</td>
			<td>2814</td>
			<td> taper point needle</td>
		</tr>
		<tr>			
			<td>Evicel Bioglue </td>
			<td>Ethicon Biosurgery Inc.</td>
 			<td>3901</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Fentanyl dermal patch 12.5 &mu;g/h</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Any genericon</td>
		</tr>
		<tr>
			<td>Heparin</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Any genericon</td>
		</tr>
		<tr>
			<td>0.9% Saline</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Any genericon</td>
		</tr>			
		<tr>
			<td>4% Papaverin HCl</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Any genericon</td>
		</tr>
		<tr>
			<td>Neomycin sulfate 5 mg/ml</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Any genericon</td>
		</tr>
		<tr>
			<td>Ketamin 50mg/ml</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Any genericon</td>
		</tr>
 		<tr>
 			<td>Xylazine 20mg/ml</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Any genericon</td>
		</tr>
	</tbody>
</table>

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.

Watch this Scientific Journal Video about Microsurgical Venous Pouch Arterial-Bifurcation Aneurysms in the Rabbit Model: Technical Aspects at JoVE.com

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

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.

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

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