Este trabajo fue apoyado en parte por el Instituto Nacional de Salud de subvención R01-HL095498, así como con los recursos y el uso de instalaciones de la VA Connecticut Healthcare System, West Haven, CT.

1. Procedimientos de anestesia y pre-operatorio <ol><li> La inducción de la anestesia general Se obtiene la aprobación por el Cuidado de Animales institucional apropiado y el empleo. C57/black ratones macho, de 10 semanas, se anestesian. Entregar 4% de isoflurano con 0,8 l / min de oxígeno a una caja de plexiglás a través de un vaporizador de isoflurano y colocar el ratón en el interior. Alternativamente, si se prefiere por el cirujano, la anestesia intraperitoneal se puede utilizar. </li><li> Preservar la anestesia Después de la confirmación de la anestesia por la falta de reacción ante pizca dedo del pie, el ratón se pone en la mesa de operaciones en posición supina con una máscara de silicona. El isoflurano se disminuyó a 2% para mantener el nivel de anestesia apropiada. </li><li> Depilación Pelo ventral se retira desde el cuello a la parte inferior del abdomen utilizando un removedor de pelo. Removedor de pelo se prefiere debido a que el cabello que se deja el uso de una máquina de afeitar puede interferir con el ultrasonido Doppler. </li></ol> 2. Ultrasoun preoperatoriad <ol><li> Objetivos de la ecografía Ecografía Doppler se lleva a cabo antes de la cirugía FAV con el fin de registrar los resultados de nivel de base que se pueden comparar con los resultados postoperatorios para ver cambios anatómicos y fisiológicos. </li><li> Puntos de observación La vena yugular, supra e infra-renal vena cava inferior (IVC), y la aorta abdominal se examinan usando tanto pulso Doppler y modo B.. </li><li> Mediciones Usando el modo B, diámetro de cada vasculatura se mide. Además, la velocidad máxima (velocidad sistólica máxima en las arterias) y formas de onda se registran en cada uno de los puntos de medición descritos anteriormente. </li></ol> 3. Procedimientos Operativos <ol><li> Ratón Preparación Prepare el sitio de la incisión con un antiséptico tópico y seguir una técnica aséptica apropiada durante la cirugía, incluyendo el uso de un paño quirúrgico, guantes e instrumentos estériles, etc </li><li> Laparotomía Incisión de línea media abdominal se hace fROM borde inferior del hígado hasta justo por encima del pubis. </li><li> La exposición de la aorta y la vena cava inferior. Un retractor se inserta y todos los intestinos se sacó de la cavidad abdominal en el lado derecho y se mantuvo envuelto en una gasa empapada con una solución salina. Disección de la membrana que conecta el retroperitoneo y la parte inferior del colon para tener una vista completa de la aorta y la vena cava inferior. Aplique presión sobre la vejiga si se dilata y se mete en camino. </li><li> La exposición del sitio de la punción El sitio de punción será de entre media y tres cuartos de la distancia de la vena renal izquierda a la bifurcación aórtica. (Figura 1) diseccionar el margen izquierdo de la aorta de manera que pueda ser perforado. Tenga en cuenta que la aorta se coloca sobre 45 grados detrás de la vena cava inferior y debe ser diseccionada posterior, además de la izquierda. (Figura 2) El punto más importante de esta cirugía no es para diseccionar entre la aorta y la vena cava inferior. Mantener lejos de ellos. </li><li> La exposición del sitio de abrazadera de la AORta Diseccionar la aorta infrarrenal de los tejidos circundantes. Tenga cuidado de no dañar el IVC en las venas renales derecha e izquierda con sus afluentes por la derecha. </li><li> De sujeción de la aorta Sujete la aorta proximal mediante la aplicación de clips de microcirugía. </li><li> La rotación de la aorta Por agarrar el tejido conectivo que rodea la aorta, girar la aorta de manera que la punción se puede hacer de un lado ligeramente dorsal de la aorta (Figura 2). </li><li> La punción de la aorta a través de IVC Mantener la aorta en una posición girada, la punción de la aorta a través de la VCI para el uso de una aguja de 25 G. (Figura 2) Si tiene éxito, la aguja puede ser visto a través de la delgada pared IVC. </li><li> Hemostasia Al tirar de los tejidos retroperitoneales, incluyendo los músculos, envolver el sitio de la punción de la aorta. No comprima la aorta contra la VCI, ya que se puede coagular la FAV (Figura 3). </li><li> De-sujeción de la aorta Después de la confirmaciónde la hemostasia primaria, de-sujetar la aorta. Sangrado adicional puede ocurrir pero puede ser detenido con una mayor compresión se ha descrito anteriormente. Al de-sujeción, la sangre arterial se puede ver que desemboca en la vena cava inferior en lugar del flujo sanguíneo venoso oscuro. </li><li> Clausura del abdomen Volver al intestino a su posición natural y cerrar el abdomen. </li></ol> 4. Procedimientos postoperatorios <ol><li> El cuidado post-operatorio Tras el cierre del abdomen, isoflurano se detiene. Cuidados postoperatorios incluyendo la analgesia y cuidado de la herida se aplica de acuerdo con las instrucciones recomendadas por el Cuidado de Animales institucional y el empleo. Para la analgesia usamos buprenorfina a 0,1 mg / kg intrasmuscularly cada 12 horas durante 24 horas después de los procedimientos quirúrgicos. </li><li> Ecografía postoperatoria En el primer día después de la operación, la ecografía Doppler se lleva a cabo para confirmar la FAV. Además, otras variables se miden para comprobar los cambios de pre-operatoriovalores. </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>

Hay varios informes que han descrito FAV en ratas, incluyendo FAV femoral, 6, 7 carótida para yugular FAV 8 y aortocava FAV. 9, 10 La rata es varias veces más grande que el ratón, lo que facilita la cirugía en comparación con la rata el ratón. Sin embargo, con el fin de tomar ventaja de las cepas y variantes genéticos de ratón el procedimiento debe ser extendida para incluir modelos de ratón. Varios informes publicados anteriormente presentó el modelo de AVF en ratones, pero es...

La opción más común elegido para la terapia de reemplazo renal en pacientes con enfermedad renal en fase terminal es la hemodiálisis. Acceso para la hemodiálisis se realiza mediante una fístula arteriovenosa (FAV), injerto arteriovenoso o la colocación del catéter temporal. Aunque AVF son el modo preferido de acceso, AVF todavía están lejos de ser perfecto. Un año de primaria las tasas de permeabilidad AVF son sólo 60 a 65%, con muchas fallas debido a la hiperplasia neointimal. La biología molecular y la fisiología de la formación de AVF normal y la formación de mala adaptación sigue siendo mal caracterizado. Como tal, es mucho más que ganar para mejorar los resultados FAV con la ganancia de acompañamiento en la comprensión de la regulación de la formación de fístulas. 1-3 La exposición de una vena para el flujo arterial se estudia comúnmente en el contexto de los injertos de vena que son modelos directos de derivación quirúrgica. 4, 5 Aunque los injertos de vena y aVF similar exponen una vena para un entorno arterial, hay varios di críticoferencias entre ellos. En primer lugar, la resistencia de la cama escurrimiento distal es mucho más baja en FAV, como la FAV drena a la aurícula derecha, mientras que el injerto de la vena drena a los enfermos a menudo pequeñas arterias distales, lo que resulta en un aumento del flujo sanguíneo y la tensión de cizallamiento en la FAV. En segundo lugar, la sangre venosa en la extremidad de la FAV puede ser una mezcla de sangre venosa y arterial que conduce a una menor oxigenación en comparación con el contenido puramente arterial en el injerto de vena. En tercer lugar, la vena de la FAV no se quita de su cama, lo que lleva a la preservación de su vaso venorum y la inervación nerviosa, en comparación con la transposición completa de la vena del injerto en el lecho arterial. Por último, el número de anastomosis es por lo general dos en injertos de la vena mientras que una FAV típicamente tiene solamente una. En este estudio, se introduce un modelo de ratón de la fístula aorto-cava que se puede utilizar para el estudio de FAV.

<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>
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technical aspects of the mouse aortocaval fistula

Se discuten los aspectos técnicos de la creación de una fístula arteriovenosa en el ratón. Bajo anestesia general, se hizo una incisión abdominal, y la aorta y la vena cava inferior (IVC) están expuestos. La aorta infrarrenal proximal y la aorta distal se diseccionan para la colocación de la abrazadera y la punción de aguja, respectivamente. Se presta especial atención para evitar la disección entre la aorta y la vena cava inferior. Después de sujetar la aorta, se utiliza una aguja de 25 G para la punción ambas paredes de la aorta en la vena cava inferior. El tejido conectivo circundante se utiliza para la compresión hemostático. Creación y el éxito de la FAV se mostrará el flujo de sangre arterial pulsátil en la vena cava inferior. La confirmación adicional de FAV éxito se puede lograr mediante ecografía Doppler post-operatorio.

Después de la práctica, la supervivencia en el primer día post-operatorio es típicamente más del 95%; en el día 7 post-operatorio, la supervivencia fue 91,3% Figuras 1 y 2 muestran el sitio de punción ideales en vistas coronal y transversal;. Colocación de la punción El sitio es fundamental para obtener una buena supervivencia sin hemorragia excesiva. Muertes intraoperatorias y muertes postoperatorias tempranas se deben a hemorragias normalmente. Esto tiende a ocurrir con una disección excesiv...

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

Technical Aspects of the Mouse Aortocaval Fistula

El objetivo es producir una fístula arteriovenosa que es simple y reproducible. Este método no utiliza suturas o adhesivos pegamento. Por lo tanto las muestras se pueden utilizar con la menor cantidad de materiales extraños para el análisis.

Aspectos técnicos de la aortocava Fístula Ratón

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 vistas.  Yale University. El objetivo es producir una fístula arteriovenosa que es simple y reproducible. Este método no utiliza suturas o adhesivos pegamento. Por lo tanto las muestras se pueden utilizar con la menor cantidad de materiales extraños para el análisis.

Video: 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.

Microcirugía venosa bolsa arterial-Bifurcación Los aneurismas en el modelo de conejo: Aspectos Técnicos

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

Investigación

Medicina

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.

El Conejo Modelo Blood-shunt para el Estudio de la aguda y secuelas tardías de Hemorragia subaracnoidea: Aspectos Técnicos

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.

Un modelo murino de restenosis arterial: Aspectos Técnicos del femoral Lesiones alambre

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.

Un Modelo Murino novela de fístula arteriovenosa Fallo: El procedimiento quirúrgico en Detalle

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.

Intraluminal entrega de la droga a la fístula arteriovenosa ratón endotelio

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.

La evaluación ecográfica de la función endotelial: Una guía técnica de la prueba de dilatación mediada por flujo

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.

Modelo murino de estenosis venosa central usando fístula aortocaval con una estenosis de salida

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.

Detalle técnico de la pancreaticoduodenectomía asistida por robot

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.

Modificación técnica del ureter terminal durante la nefroterectomía laparoscópica transperitoneal total para el carcinoma urotélial del tracto urinario superior

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.