The authors are solely responsible for the design and conduct of the presented study. Dr. Marbacher was supported by a grant from the Swiss National Science Foundation (PBSKP3-123454). The authors declare no conflict of interests. 
Author contributions to the study and manuscript preparation include the following. Conception and design: SM, JM, JF. Acquisition of data: SM, EA, JF. Analysis and interpretation of data: SM, JF, JM. Drafting the article: SM, JF, JM. Critically revising the article: JH, MN. Statistical analysis: SM, JF. Study supervision: JF, JH, MN.

NOTA: Hombre ratas Wistar (peso corporal medio: 356 ± 44 g; de 10-14 semanas de edad) fueron alojados en la sala de los animales a 22-24 ° C y la luz doce horas / oscuridad ciclo con el libre acceso a la dieta de pellets, el agua del grifo y también recibió atención humanitaria de conformidad con las directrices institucionales. Los experimentos fueron revisados ​​y aprobados por el Comité de Bienestar Animal de la Universidad de Helsinki, Finlandia. NOTA: En la siguiente demostración de este método quirúrgico es como sigue: anestesiar la rata mediante inyección subcutánea adaptado peso de hidrocloruro de medetomidina (0,5 mg / kg) y la inyección intraperitoneal de clorhidrato de ketamina (50 mg / kg). Prueba para la falta de un reflejo dedo del pie-pellizco para confirmar que la rata está totalmente anestesiado. Aplicar pomada para los ojos, una pinza de la zona quirúrgica, y limpiar la piel con un desinfectante adecuado, por ejemplo clorhexidina, ya sea en alcohol o agua. Lávese las manos, póngase ropa protectora, una cubierta de la cabeza y la caramáscara y guantes quirúrgicos estériles. Tener un asistente de ayuda quirúrgica en el mantenimiento de las condiciones de la cirugía aséptica y documentar las características quirúrgicas (como se indica en la Tabla 1). Controle la profundidad de la anestesia cada 15 minutos durante la cirugía siguiendo la frecuencia respiratoria, la frecuencia cardíaca, y la reacción a estímulos nocivos (prueba del pellizco del dedo del pie). La inyección subcutánea de buprenorfina (0,03 mg / kg) fue dado para la analgesia postoperatoria y repetirse si es necesario cada 12 horas. 1. hardware, consumibles, y Posicionamiento <ol><li> Mantenga el animal pequeño quirófano tranquilo, aséptica, y mantener la temperatura ambiente a 23 +/- 3 ° C. Para llevar a cabo la cirugía de aneurisma experimental el siguiente equipo mínimo necesario: <ol><li> Use una tapa microscopio quirúrgico mesa idealmente equipado con un alcance y asistente de cámara microscopio digital. Utilice porosa superficie operativa reutilizable y lavable superficie del instrumento para proteger la mesa de laboratorio. </li><li&gt; Preparar consumibles tales como desinfectantes de la piel, suero fisiológico, gasas pequeñas y más grandes y material de sutura incluyendo 9-0 micro suturas, un no absorbible 5-0 y 3-0 sutura absorbible. </li><li> Utilice los siguientes instrumentos quirúrgicos estándar: Tijeras quirúrgicas, pinzas de tejido, esparcidor de tejidos blandos o retractores de auto-retención, y dos pinzas quirúrgicas de mosquitos. </li><li> Utilice un conjunto básico de microcirugía instrumento que incluye: soporte de microagujas curvo, uno curvo y dos microforceps rectas, y una microscissor recta o curva. </li><li> Mantener los instrumentos de microcirugía en un plato de riñón lleno con solución salina estéril para mantener el instrumento no pegajoso y limpio durante la cirugía. El plato de riñón se rellena con alfombra de goma o un guante quirúrgico para evitar daños en las puntas de los micro-instrumentos. Asegúrese de que todos los suministros son estériles y el procedimiento se realiza con una técnica aséptica de acuerdo con las recomendaciones actuales para la cirugía de la supervivencia en animales de laboratorio <sup&gt; 8-10. </li><li> Además, use un aplicador de clip vascular y tres pinzas vasculares temporales no traumáticas. Es importante que las abrazaderas utilizadas tienen un bajo poder de cierre para prevenir la lesión a la pared muy delgada de la aorta de rata. También hay que preparar un gobernante con barras de medio milímetro escala, una pequeña almohadilla de goma de color, y una aguja roma corto. </li><li> Colocar las ratas en una posición supina, inmovilizar la parte delantera y traseras patas con cinta quirúrgica sin aplicar estiramiento o compresión a la piel, y doblar su espalda con un marcador grueso o un bolígrafo cauterio colocándolo bajo la región lumbar de la espalda. Es importante obtener la mayor lordosis de la columna lumbar como sea posible con el fin de mejorar la exposición retroperitoneal y el acceso a la aorta infrarrenal que facilita la anastomosis microquirúrgica. Se recomienda esta posición para la creación de un aneurisma de aorta abdominal pero no es necesario para la cosecha torácica injerto. </li></ol></li></ol> 2. injerto cosecha <ol><li> Uanestesia general nder, abrir la cavidad torácica (iniciar el tiempo de isquemia del injerto). Aplicar una pizca dedo nociva para confirmar que la rata no responde antes de continuar con los siguientes pasos. Corte a través de la pared abdominal medioventral, identificar el diafragma justo por encima del hígado, y cortar el tejido conectivo en la parte inferior del diafragma para permitir el acceso a la caja torácica. Con grandes tijeras, parte roma abajo, cortados a través de las costillas apenas un centímetro a la izquierda y derecha de la línea media de la caja torácica y abrir la cavidad torácica. Los pulmones se movilizan hacia el lado derecho del corazón. Sacrificar las ratas con una sobredosis con inyección intracardiaca de ketamina hydrochloride.Pulmonary tronco, la vena subclavia izquierda, izquierda vena cava craneal, y la vena ácigos interfiere con la cosecha de la aorta torácica proximal. </li><li> Caudal a las venas prominentes hay un buen punto de entrada para comenzar la disección de la aorta torácica descendente utilizando micro-tijeras y microforceps. </li><li> Trace la aorta torácica back de la pared dorsal del tórax hacia arriba para el arco aórtico por la retracción y disección roma suave con la abrazadera quirúrgica Mosquito. </li><li> Clamp y luego cortar las venas con unas tijeras. Mantener las pinzas en las venas y utilizar como un retractor para exponer el arco aórtico subyacente. </li><li> Colocar un no absorbible ligadura de seda 6-0 justo encima de la primera arteria intercostal dejando la aorta. </li><li> Cortar la aorta descendente justo debajo de la arteria subclavia izquierda y luego por debajo de la ligadura. Recorte se puede hacer con el fin de obtener una geometría estandarizada aneurisma perpendicular, o si es necesario, para conseguir un ángulo específico entre el eje del aneurisma y la aorta. Mida el injerto en su anchura y longitud. NOTA: Cosechado injertos o bien pueden ser trasplantados inmediatamente en ratas receptoras o se procesen para lograr descelularización de la pared del injerto. Injertos descelularizado se pueden almacenar a -4 grados Celsius hasta el re-implantación en una fecha posterior (Figura 1). The descelularización de la pared del aneurisma se ha demostrado que predisponer el aneurisma para agrandar 11. </li></ol> 3. Graft Descelularización <ol style="margin-left: 40px;"><li> Injertos de donantes Freeze en PBS a -4 ° C. </li><li> Al día siguiente, descongele los injertos, enjuague con agua purificada y desionizada a temperatura ambiente, y se incuba durante 10 horas a 37 ° C en el 0,1% de dodecil sulfato de sodio. </li><li> Finalmente, lavar los injertos tratados con sulfato de dodecil de sodio tres veces con agitación suave, vuelva a congelar en tampón fosfato salino, y mantener a -4 ° C hasta su uso. </li></ol> 4. Aneurisma Creación <ol style="margin-left: 40px;"><li> La disección de la aorta abdominal <ol><li> Después de que el animal ha sido anestesiado, cortar la piel de la zona quirúrgica y limpiar la piel con un desinfectante adecuado. Prueba para la falta de una respuesta dedo del pie-pellizco antes de la incisión de la piel. Inicie el 1cm proximal de la incisión en los genitales in posición medioventral (hora de inicio de operación). Separar cuidadosamente la piel de los músculos subyacentes. Fin disección uno a dos centímetros por debajo del esternón. </li><li> Con cuidado pero con firmeza, tire hacia arriba los músculos abdominales subyacentes para evitar daños a los órganos subyacentes. Extender el corte longitudinal a lo largo de la línea alba hacia arriba para el proceso xifoides y terminan en dirección caudal a nivel de la vejiga. </li><li> Aplique suavemente la presión a la vejiga para vaciarla a fin de facilitar el acceso al espacio retroperitoneal. </li><li> Mueva el intestino delgado y el ciego prominente a la derecha oa la izquierda. Identificar el intestino grueso a saber, el colon descendente en la parte inferior izquierda de la cavidad abdominal. </li><li> Cortar el ligamento entre el intestino delgado y el colon descendente en dirección craneal para permitir más amplia exposición de la pared dorsal del cuerpo. Coloque un retractor de auto-retención para mantener los intestinos aparte. </li><li> La ubicación ideal de extremo a lado anastomosis aneurisma is encuentra en el nivel entre el renal y iliolumbar venas. La aorta abdominal se encuentra retroperitoneal incrustado en el tejido graso. Durante la disección de prestar especial atención a los pares casi transparentes uréteres y los vasos testiculares. </li><li> Si se necesita mayor retracción de los intestinos, utilizar swaps de gasa grandes. La lordosis lumbar inducida durante el posicionamiento mediante la colocación de un lápiz cauterizador u objeto similar en la parte posterior inferior de la rata, reduce significativamente la necesidad de retracción del intestino. </li><li> La superficie ventral de la pared dorsal del cuerpo está cubierta con una delgada peritoneo parietal. Una vez que se abrió, visualizar la aorta justo debajo. Durante la disección cuidadosa, precisa y roma de la aorta abdominal de las grandes venas adyacentes comprender sólo la adventicia para evitar daños a la pared del vaso. </li><li> Con poca frecuencia, las pequeñas arterias lumbares surgen como recipiente segmentaria de la superficie dorsal de la aorta abdominal e interfieren con la preparación. La ligadura y corte de la vasija es neeDED para evitar exudación retrógrada durante la sutura aneurisma. El uso de curvas micro-fórceps puede facilitar la colocación de ligadura en la profundidad. </li></ol></li><li> De extremo a lado anastomosis <ol><li> Ponga una almohadilla de goma de color debajo de la aorta abdominal y tapizar con un pequeño hisopo de gasa. Quitar el tejido conectivo laxo y adventicia en el nivel del sitio de la anastomosis planificada. </li><li> Sujete la aorta abdominal distal a la anastomosis, luego proximal (hora de inicio pinzamiento aórtico). Esto asegura un llenado firme de la embarcación y facilita la posterior arteriotomía. </li><li> Realice la arteriotomía usando ya sea micro-tijeras rectas o curvas. Un micro-forceps sostiene un pedazo muy pequeño de la pared del vaso para cortar una forma elíptica. </li><li> Enjuague la arteria a fondo con solución salina en ambas direcciones utilizando una aguja de punta roma. </li><li> Coloque los dos primeros puntos de sutura de esta anastomosis de extremo a lado en el extremo proximal y distal de la arteriotomía (hora de inicio anastomosis). Evite agarrar de la pared del vaso con las micro-fórceps siempre que sea posible. Asegúrese de que cada sutura se coloca a través de todas las capas de la pared del vaso. </li><li> Realizar sutura ya sea como suturas continuas o interrumpidas. Si se elige la sutura interrumpida luego colocar la parte de atrás nueve en punto de sutura en primer lugar. Suturas posteriores pueden estar separadas de partida adyacente a la primera sutura. Sujete la adventicia cuidadosamente. Evitar cualquier compresión / aferramiento de la íntima. </li><li> Una vez finalizada la pared trasera, compruebe la parte endoluminal de la anastomosis para suturas fuera de lugar. Realice los mismos procedimientos en el mismo orden en el lado frontal. Asegúrese de que el primero de un total de tres nudos por sutura es firme, pero no demasiado ajustado. </li></ol></li><li> Hemostasia y Clausura <ol><li> Tras el fin de la anastomosis lateral se completa (fin de los tiempos anastomosis), enjuagar la zona con solución salina y retire la pinza distal primero para permitir el flujo de retorno (aórtica extremo de sujeción del tiempo y del injerto final ti isquemiame). </li><li> Si el sangrado evidente se produce por reflujo puede ser necesaria una puntada adicional (hora de inicio de la hemostasia). En caso de menor exudación, lograr la hemostasia con una presión suave sobre la zona de sangrado utilizando una pequeña pieza de un hisopo de gasa. </li><li> Retire la pinza vascular proximal, enjuagar el sitio de la anastomosis, una vez más, y cortar los extremos restantes de la ligadura en la cúpula del aneurisma. </li><li> Confirmar la permeabilidad del aneurisma mediante la observación de aumento de volumen del aneurisma durante la onda de pulso arterial alta. Evaluar la permeabilidad de la arteria abdominal distal a través de la &quot;prueba de ordeño&quot; directa. </li><li> Retire la lámina de plástico y el pequeño hisopo de gasa debajo. El torbellino de sangre palpitante dentro del aneurisma creado es claramente visible. </li><li> Cubra líneas de sutura alrededor de la anastomosis con pequeños trozos de tejido adiposo o Spongostan para hemostasis adicional si pequeña exudación está todavía presente (hora de finalización de la hemostasia). </li><li> Retire las separadoras y gasa hisopos de los tejidos blandos.Coloque el intestino delgado, el ciego y la masa grasa en su posición correcta. </li><li> Cierre los músculos abdominales en la línea media utilizando 5-0, 4-0, o 3-0 suturas reabsorbibles o no reabsorbibles, seguido de cierre de la herida de la piel utilizando la técnica de sutura continua con 3-0 sutura multifilamento reabsorbible (tiempo de funcionamiento de extremo). Nota: En nuestra experiencia ratas toleraron suturas reabsorbibles piel mejor que las suturas de monofilamento no absorbibles. </li></ol></li></ol>

<ol>
	<li>Bouzeghrane, F., 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=In+vivo+experimental+intracranial+aneurysm+models:+a+systematic+review.">In vivo experimental intracranial aneurysm models: a systematic review.</a> AJNR Am J Neuroradiol. 31, 418-423 (2010).</li><li>Marbacher, 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=Complex+bilobular,+bisaccular,+and+broad-neck+microsurgical+aneurysm+formation+in+the+rabbit+bifurcation+model+for+the+study+of+upcoming+endovascular+techniques.+AJNR.">Complex bilobular, bisaccular, and broad-neck microsurgical aneurysm formation in the rabbit bifurcation model for the study of upcoming endovascular techniques. AJNR.</a> American journal of neuroradiology. 32, 772-777 (2011).</li><li>Frosen, J., 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=Contribution+of+mural+and+bone+marrow-derived+neointimal+cells+to+thrombus+organization+and+wall+remodeling+in+a+microsurgical+murine+saccular+aneurysm+model.">Contribution of mural and bone marrow-derived neointimal cells to thrombus organization and wall remodeling in a microsurgical murine saccular aneurysm model.</a> Neurosurgery. 58, 936-944 (2006).</li><li>Marjamaa, J., 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=Mice+with+a+deletion+in+the+first+intron+of+the+Col1a1+gene+develop+dissection+and+rupture+of+aorta+in+the+absence+of+aneurysms:+high-resolution+magnetic+resonance+imaging.">Mice with a deletion in the first intron of the Col1a1 gene develop dissection and rupture of aorta in the absence of aneurysms: high-resolution magnetic resonance imaging.</a> at 4.7 T, of the aorta and cerebral arteries. Magn Reson Med. 55, 592-597 (2006).</li><li>Oyamada, 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=Trans-iliac+rat+aorta+stenting:+a+novel+high+throughput+preclinical+stent+model+for+restenosis+and+thrombosis.">Trans-iliac rat aorta stenting: a novel high throughput preclinical stent model for restenosis and thrombosis.</a> The Journal of surgical research. , 166-191 (2011).</li><li>Lowe, H. C., James, B., Khachigian, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+model+of+in-stent+restenosis:+rat+aortic+stenting.">A novel model of in-stent restenosis: rat aortic stenting.</a> Heart. 91, 393-395 (2005).</li><li>Marjamaa, J., 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=Occlusion+of+neck+remnant+in+experimental+rat+aneurysms+after+treatment+with+platinum-+or+polyglycolic-polylactic+acid-coated+coils.">Occlusion of neck remnant in experimental rat aneurysms after treatment with platinum- or polyglycolic-polylactic acid-coated coils.</a> Surg Neurol. 71, 458-465 (2009).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=with+the+support+of+the+NC3Rs.">with the support of the NC3Rs.</a> Aseptic Technique in Rodent Surgery. , (2014).</li><li>Bernal, J., 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=Guidelines+for+rodent+survival+surgery.">Guidelines for rodent survival surgery.</a> Journal of investigative surgery : the official journal of the Academy of Surgical Research. 22, 445-451 (2009).</li><li>Pritchett-Corning, K. R., Luo, Y., Mulder, G. B., White, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Principles+of+rodent+surgery+for+the+new.">Principles of rodent surgery for the new.</a> , (2011).</li><li>Marbacher, 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=Loss+of+mural+cells+leads+to+wall+degeneration,+aneurysm+growth,+and+eventual+rupture+in+a+rat+aneurysm+model.">Loss of mural cells leads to wall degeneration, aneurysm growth, and eventual rupture in a rat aneurysm model.</a> Stroke. 45, 248-254 (2014).</li><li>Frosen, J., 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=Remodeling+of+saccular+cerebral+artery+aneurysm+wall+is+associated+with+rupture:+histological+analysis+of+24+unruptured+and+42+ruptured+cases.">Remodeling of saccular cerebral artery aneurysm wall is associated with rupture: histological analysis of 24 unruptured and 42 ruptured cases.</a> Stroke. 35, 2287-2293 (2004).</li><li>Frosen, J., 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=Saccular+intracranial+aneurysm:+pathology+and+mechanisms.">Saccular intracranial aneurysm: pathology and mechanisms.</a> Acta neuropathologica. , 123-773 (2012).</li><li>Ysuda, R., Strother, C. M., Aagaard-Kienitz, B., Pulfer, K., Consigny, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+large+and+giant+bifurcation+aneurysm+model+in+canines:+proof+of+feasibility.">A large and giant bifurcation aneurysm model in canines: proof of feasibility.</a> AJNR Am J Neuroradiol. 33, 507-512 (2012).</li><li>Sherif, C., 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=Microsurgical+venous+pouch+arterial-bifurcation+aneurysms+in+the+rabbit+model:+technical+aspects.">Microsurgical venous pouch arterial-bifurcation aneurysms in the rabbit model: technical aspects.</a> Journal of visualized experiments : JoVE. , (2011).</li><li>Marjamaa, J., 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=High-resolution+TOF+MR+angiography+at+4.7+Tesla+for+volumetric+and+morphologic+evaluation+of+coiled+aneurysm+neck+remnants+in+a+rat+model.">High-resolution TOF MR angiography at 4.7 Tesla for volumetric and morphologic evaluation of coiled aneurysm neck remnants in a rat model.</a> Acta Radiol. 52, 340-348 (2011).</li></ol>

Los autores no tienen ningún interés financiero o comercial en cualquiera de los medicamentos, materiales o equipos utilizados.

Los avances en nuestra comprensión de la compleja biología de aneurisma de la arteria cerebral sacular depende del análisis de los datos epidemiológicos y clínicos, complementados por estudios de laboratorio sobre muestras de los pacientes y el trabajo experimental en modelos animales 3,12,13. Animales pequeños, tales como la rata están intrínsecamente asociados con menores costos de experimentos y la vivienda, y la necesidad de equipo especializado reducidos. Un tiempo de...

La rotura de un aneurisma de la arteria cerebral sacular provoca hemorragia que amenaza la vida que conduce a un accidente cerebrovascular, daño neurológico permanente o la muerte. La ruptura puede ser prevenida por cualquiera de clipaje o la oclusión del aneurisma endovascular. Un tratamiento médico para prevenir el crecimiento del aneurisma y la ruptura aún no ha sido establecida. Se necesitan modelos experimentales para aneurismas saculares para estudiar la biología de los aneurismas arteriales y para el ensayo de dispositivos y nuevas estrategias terapéuticas. A estos efectos, varios modelos diferentes en diferentes especies se han desarrollado y publicado 1. Grandes modelos de aneurismas en cerdos, perros y conejos se utilizan preferentemente para probar innovaciones endovasculares en la arquitectura aneurisma complejo 1,2. Modelos murinos aneurisma, por otro lado, permiten probar preguntas de investigación en especies modificadas genéticamente 3,4 y facilitar la aclaración de aneurisma en la biología celular y molecularnivel mucho mejor que las especies más grandes 1. Aunque endovascular trans-carótida y despliegue del dispositivo de trans-ilíaca se limita a las ratas más grandes (&gt; 400-500 g) y los stents más pequeño que 2,0 mm y 1,5 mm de diámetro 5,6, stents también se pueden colocar a través de la inserción directa en la aorta abdominal segmento de albergar los aneurismas experimentales. El trabajo previo utilizando el modelo de rata abdominal microquirúrgico aneurisma aórtico pared lateral demostró su viabilidad en las pruebas de nuevos dispositivos embólicos y su uso en el estudio de las bases moleculares de la biología aneurisma 3,7. Muchos de los modelos de aneurismas saculares experimentales publicados actualmente requieren un equipo costoso, ambientes especiales (por ejemplo, quirófanos estériles con capacidades de fluoroscopia), la competencia de radiología intervencionista, o el uso de especies caros. Estos requisitos limitan el uso generalizado de estos modelos, y conducen a la utilización de diferentes modelos en diferentes laboratorios, que mcopos comparación de datos y meta-análisis difícil, si no imposible. Se necesita un modelo experimental simple, robusto y de bajo costo como una herramienta estandarizada que se puede utilizar de una manera estandarizada en diversos laboratorios con el fin de obtener resultados comparables de diferentes instituciones. Para ello, hemos creado la pared lateral de la aorta modelo aneurisma arterial sacular rata. El objetivo de este informe es presentar instrucciones de procedimiento paso a paso, información sobre el equipo necesario, y para discutir importantes características anatómicas y quirúrgicas para la creación de microcirugía con éxito de los aneurismas abdominales de pared lateral de la aorta en la rata.

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			<td>Any genericon</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">Phosphate buffered saline</td>
			<td style="width:236px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">Sodium dodecyl sulfate (0.1%)</td>
			<td style="width:236px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">3-0 resorbable suture</td>
			<td style="width:236px;">Ethicon Inc., USA</td>
			<td><a name="RANGE!C7">VCP824G</a></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">5-0 non absorbable suture</td>
			<td style="width:236px;">Ethicon Inc., USA</td>
			<td>8618G</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">6-0 non absorbable silk suture</td>
			<td style="width:236px;">B. Braun, Germany</td>
			<td style="width:119px;">C0761060</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">9-0 nylon micro suture</td>
			<td style="width:236px;">B. Braun, Germany</td>
			<td style="width:119px;">G1118471</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">Spongostan</td>
			<td style="width:236px;">Ethicon Inc., USA</td>
			<td style="width:119px;">MS0002</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">Operation microscope</td>
			<td style="width:236px;">Leica , Germany</td>
			<td style="width:119px;">M651</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">Digital microscope camera</td>
			<td style="width:236px;">Sony, Japan</td>
			<td style="width:119px;">SSC-DC58AP</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">Standard surgical instruments</td>
			<td style="width:236px;">B. Braun, Germany</td>
			<td style="width:119px;">Multiple</td>
			<td>See protocol 1.4</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">Microsurgical instruments</td>
			<td style="width:236px;">B. Braun, Germany</td>
			<td style="width:119px;">Multiple</td>
			<td>See protocol 1.5</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">Vascular clip applicator</td>
			<td style="width:236px;">B. Braun, Germany</td>
			<td style="width:119px;">FT495T</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:231px;">Temporary vascular clamps</td>
			<td style="width:236px;">B. Braun, Germany</td>
			<td style="width:119px;">FT250T</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;">Graph Pad Prism statistical software&#160;</td>
			<td style="width:236px;">GraphPad Software, San Diego, California, USA</td>
			<td style="width:119px;"></td>
			<td>V 6.02 for Windows</td>
		</tr>
	</tbody>
</table>

the helsinki rat microsurgical sidewall aneurysm model

Modelos aneurisma sacular experimentales son necesarios para probar opciones y dispositivos de tratamiento quirúrgico y endovascular nuevos antes de su introducción en la práctica clínica. Además, se necesitan modelos experimentales para dilucidar la compleja biología aneurisma conduce a la ruptura de los aneurismas saculares. Varios tipos diferentes de modelos experimentales para aneurismas saculares se han establecido en diferentes especies. Muchos de ellos, sin embargo, requieren habilidades especiales, equipo costoso, o ambientes especiales, lo que limita su uso generalizado. Se necesita un modelo experimental simple, robusto y de bajo costo como una herramienta estandarizada que se puede utilizar de una manera estandarizada en diversas instituciones. El modelo de aneurisma abdominal de la pared lateral de la aorta de rata microquirúrgica combina la posibilidad de estudiar ambos nuevas estrategias de tratamiento endovascular y la base de la biología molecular en un aneurisma estandarizada y baratomanera. Injertos estandarizada por medio de la forma, tamaño, y la geometría se cosechan de la aorta torácica descendente de una rata donante y luego trasplantadas a un receptor singénico de rata. Los aneurismas se suturan de extremo a lado con continua o interrumpida 9-0 suturas de nylon a la aorta abdominal infrarrenal. Presentamos instrucciones de procedimiento paso a paso, información sobre el equipo necesario, y se discute importantes detalles anatómicos y quirúrgicos para la creación de microcirugía con éxito de un aneurisma de la pared lateral de la aorta abdominal en la rata.

Una serie piloto comprendía 14 ratas. Posteriormente un total de 84 animales fueron operados de acuerdo con el protocolo presentado por varios proyectos de investigación, entre marzo y septiembre de 2012. adicionales 29 animales sirvieron como donantes de injertos arteriales saculares. Los experimentos restantes se realizaron utilizando injertos pretratadas cosechadas y almacenadas a partir de experimentos previos utilizando ratas del mismo sexo, la tensión, el peso y la edad. El peso cor...

Watch this Scientific Journal Video about The Helsinki Rat Microsurgical Sidewall Aneurysm Model at JoVE.com

The Helsinki Rat Microsurgical Sidewall Aneurysm Model

Microsurgical sidewall aneurysms in rats are created by end-to-side anastomosis of an aortic graft to the abdominal aorta. We present step-by-step instructions and discuss anatomical and surgical details for successful experimental saccular aneurysm creation.

El Helsinki Rata microquirúrgica flanco Aneurisma Modelo

Experimental saccular aneurysm models are necessary for testing novel surgical and endovascular treatment options and devices before they are introduced ...

the-helsinki-rat-microsurgical-sidewall-aneurysm-model

Research

JoVE Journal

Medicine

12.1K vistas.  University of Helsinki, Helsinki, Finland. Microsurgical sidewall aneurysms in rats are created by end-to-side anastomosis of an aortic graft to the abdominal aorta. We present step-by-step instructions and discuss anatomical and surgical details for successful experimental saccular aneurysm creation.

Video: The Helsinki Rat Microsurgical Sidewall Aneurysm Model

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

A New Murine Model of Endovascular Aortic Aneurysm Repair

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of Abdominal aortic aneurysm (AAA) pathophysiology. There is no abdominal aortic aneurysm endograft exclusion model cheap and reproducible, which would allow deep investigations of AAA before and after treatment. We hereby describe how to induce, and then to exclude with a covered coronary stentgraft an abdominal aortic aneurysm in a rat. The well known elastase induced AAA model was first reported in 19901 in a rat, then described in mice2. Elastin degradation leads to dilation of the aorta with inflammatory infiltration of the abdominal wall and intra luminal thrombus, matching with human AAA. Endovascular exclusion with small covered stentgraft is then performed, excluding any interactions between circulating blood and the aneurysm thrombus. Appropriate exclusion and stentgraft patency is confirmed before euthanasia by an angiography thought the left carotid artery. Partial control of elastase diffusion makes aneurysm shape different for each animal. It is difficult to create an aneurysm, which will allow an appropriate length of aorta below the aneurysm for an easy stentgraft introduction, and with adequate proximal and distal neck to prevent endoleaks. Lots of failure can result to stentgraft introduction which sometimes lead to aorta tear with pain and troubles to stitch it, and endothelial damage with post op aorta thrombosis. Giving aspirin to rats before stentgraft implantation decreases failure rate without major hemorrhage. Clamping time activates neutrophils, endothelium and platelets, and may interfere with biological analysis.

Histological and biochemical modifications after aneurysm endograft exclusion are still unclear. We describe a new model of endograft implantation on a murine aneurysm. Through thrombus analysis with and without persistant circulating blood stream interface, and new endovascular biomaterials evaluation, this model will help to better understand endovascular aneurysm exclusion pathobiology.

Un modelo murino Nueva endovascular de aneurismas aórticos

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of ...

Demonstration of the Rat Ischemic Skin Wound Model

The propensity for chronic wounds in humans increases with ageing, disease conditions such as diabetes and impaired cardiovascular function, and unrelieved pressure due to immobility. Animal models have been developed that attempt to mimic these conditions for the purpose of furthering our understanding of the complexity of chronic wounds. The model described herein is a rat ischemic skin flap model that permits a prolonged reduction of blood flow resulting in wounds that become ischemic and resemble a chronic wound phenotype (reduced vascularization, increased inflammation and delayed wound closure). It consists of a bipedicled dorsal flap with 2 ischemic wounds placed centrally and 2 non-ischemic wounds lateral to the flap as controls. A novel addition to this ischemic skin flap model is the placement of a silicone sheet beneath the flap that functions as a barrier and a splint to prevent revascularization and reduce contraction as the wounds heal. Despite the debate of using rats for wound healing studies due to their quite distinct anatomic and physiologic differences compared to humans (i.e., the presence of a panniculus carnosus muscle, short life-span, increased number of hair follicles, and their ability to heal infected wounds) the modifications employed in this model make it a valuable alternative to previously developed ischemic skin flap models.

The rat, due to its size, availability, and rather docile behavior, has been utilized as a research model for many years. The goal of this protocol is to utilize the rat as an ischemic skin wound healing model to provide valuable insight into the pathophysiology of chronic wounds.

Demostración de la rata isquémica de la piel herida Modelo

The propensity for chronic wounds in humans increases with ageing, disease conditions such as diabetes and impaired cardiovascular function, and ...

The Dimethylnitrosamine Induced Liver Fibrosis Model in the Rat

Four to six week old, male Wistar rats were used to produce animal models of liver fibrosis. The process requires four weeks of administration of 10 mg/kg dimethylnitrosamine (DMN), given intraperitoneally for three consecutive days per week. Intraperitoneal injections were performed in the fume hood as DMN is a known hepatoxin and carcinogen. The model has several advantages. Firstly, liver changes can be studied sequentially or at particular stages of interest. Secondly, the stage of liver disease can be monitored by measurement of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) enzymes. Thirdly, the severity of liver damage at different stages can be confirmed by sacrifice of animals at designated time points, followed by histological examination of Masson&#39;s Trichome stained liver tissues. After four weeks of DMN dosing, the typical fibrosis score is 5 to 6 on the Ishak scale. The model can be reproduced consistently and has been widely used to assess the efficacy of potential anti-fibrotic agents.

We describe a method to produce an animal model of liver fibrosis in the rat, and assess the degree of fibrosis by histological examination of the liver. The model can be used to study the development of liver disease as well as to test the efficacy of potential anti-fibrotic agents.

La fibrosis hepática Modelo dimetilnitrosamina inducida en la rata

Four to six week old, male Wistar rats were used to produce animal models of liver fibrosis. The process requires four weeks of administration of 10 mg/kg ...

Isometric Contractility Measurement of the Mouse Mesenteric Artery Using Wire Myography

The wire myograph technique is used to assess the contractility of vascular smooth muscles in response to depolarization, GPCR agonists/inhibitors and drugs. It is widely used in many studies on the physiological functions of vascular smooth muscle, the pathogenesis of vascular diseases such as hypertension, and the development of smooth muscle relaxant drugs. The mouse is a widely used model animal with a large pool of disease models and genetically modified strains. We introduced this method to measure the isometric contraction of mouse mesenteric artery in detail. A 1.4-mm segment of mouse mesenteric resistance artery was isolated and mounted on a myograph chamber by passing two steel wires through its lumen. After equilibration and normalization steps, the vessel segment was potentiated by a high-K+ solution twice prior to the contraction assay. As an example of the application of this method in drug development, we measured the relaxant effect of a novel natural substance, neoliensinine, isolated from a Chinese herb, embryos of the lotus seed (Nelumbo nucifera Gaertn.) on mouse mesenteric arteries. The vessel segments mounted on the myograph chamber were stimulated with a high-K+ solution. When the force tension reached a stable sustained phase, cumulative doses of neoliensinine were added to the chamber. We found that neoliensinine had a dose-dependent relaxant effect on smooth muscle contraction, thus suggesting that it bears potential activity against hypertension. In addition, as the vessel segment can survive at least 4 hours after mounting and maintain contractility induced by the high-K+ solution for many times, we suggest that the wire myograph system may be used for the time-consuming process of drug screening.

The wire myograph technique is used to investigate vascular smooth muscle functions and screen new drugs. We report a detailed protocol for measuring the isometric contractility of the mouse mesenteric artery and for screening new relaxants of vascular smooth muscle.

Medición de la contractilidad isométrica de la arteria mesentérica de ratón con cable miografía

The wire myograph technique is used to assess the contractility of vascular smooth muscles in response to depolarization, GPCR agonists/inhibitors and ...

Corneal Epithelial Abrasion with Ocular Burr As a Model for Cornea Wound Healing

The murine cornea provides an excellent model to study wound healing. The cornea is the outermost layer of the eye, and thus is the first defense to injury. In fact, the most common type of eye injury found in clinic is a corneal abrasion. Here, we utilize an ocular burr to induce an abrasion resulting in removal of the corneal epithelium in vivo on anesthetized mice. This method allows for targeted and reproducible epithelial disruption, leaving other areas intact. In addition, we describe the visualization of the abraded epithelium with fluorescein staining and provide concrete advice on how to visualize the abraded cornea. Then, we follow the timeline of wound healing 0, 18, and 72 h after abrasion, until the wound is re-epithelialized. The epithelial abrasion model of corneal injury is ideal for studies on epithelial cell proliferation, migration and re-epithelialization of the corneal layers. However, this method is not optimal to study stromal activation during wound healing, because the ocular burr does not penetrate to the stromal cell layers. This method is also suitable for clinical applications, for example, pre-clinical test of drug effectiveness.

This protocol describes a method to inflict an abrasion to the ocular surface of the mouse, and to follow the wound healing process thereafter. The protocol takes advantage of an ocular burr to partially remove the surface epithelium of the eye in anaesthetized mice.

Cicatrización de heridas de abrasión epitelial corneal con rebabas Ocular como un modelo de córnea

The murine cornea provides an excellent model to study wound healing. The cornea is the outermost layer of the eye, and thus is the first defense to ...

An Ex Vivo Tissue Culture Model for Fibrovascular Complications in Proliferative Diabetic Retinopathy

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and one of the leading causes of blindness in working-age adults. No current animal models of diabetes and oxygen-induced retinopathy develop the full-range progressive changes manifested in human proliferative diabetic retinopathy (PDR). Therefore, understanding of the disease pathogenesis and pathophysiology has relied largely on the use of histological sections and vitreous samples in approaches that only provide steady-state information on the involved pathogenic factors. Increasing evidence indicates that dynamic cell-cell and cell-extracellular matrix (ECM) interactions in the context of three-dimensional (3D) microenvironments are essential for the mechanistic and functional studies towards the development of new treatment strategies. Therefore, we hypothesized that the pathological fibrovascular tissue surgically excised from eyes with PDR could be utilized to reliably unravel the cellular and molecular mechanisms of this devastating disease and to test the potential for novel clinical interventions. Towards this end, we developed a novel method for 3D ex vivo culture of surgically-excised patient-derived fibrovascular tissue (FT), which will serve as a relevant model of human PDR pathophysiology. The FTs are dissected into explants and embedded in fibrin matrix for ex vivo culture and 3D characterization. Whole-mount immunofluorescence of the native FTs and end-point cultures allows thorough investigation of tissue composition and multicellular processes, highlighting the importance of 3D tissue-level characterization for uncovering relevant features of PDR pathophysiology. This model will allow the simultaneous assessment of molecular mechanisms, cellular/tissue processes and treatment responses in the complex context of dynamic biochemical and physical interactions within the PDR tissue architecture and microenvironment. Since this model recapitulates PDR pathophysiology, it will also be amenable for testing or developing new treatments.

Here, we present a protocol to study the pathophysiology of proliferative diabetic retinopathy by using patient-derived, surgically-excised, fibrovascular tissues for three-dimensional native tissue characterization and ex vivo culture. This ex vivo culture model is also amenable for testing or developing new treatments.

Un modelo de cultivo de tejidos Ex Vivo para las complicaciones Fibrovascular en la retinopatía diabética proliferativa

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and one of the leading causes of blindness in working-age adults. No ...

Murine Surgical Model of Topical Elastase Induced Descending Thoracic Aortic Aneurysm

According to the Center for Disease Control, aortic aneurysms (AAs) were considered a leading cause of death in all races and both sexes from 1999-2016. An aneurysm forms as a result of progressive weakening and eventual dilation of the aorta, which can rupture or tear once it reaches a critical diameter. Aneurysms of the descending aorta in the chest, called descending thoracic aortic aneurysms (dTAA), make up a large proportion of aneurysm cases in the United States. Uncontained dTAA rupture is almost universally lethal, and elective repair has a high rate of morbidity and mortality. The purpose of our model is to study dTAA specifically, to elucidate the pathophysiology of dTAA and to search for molecular targets to halt the growth or reduce the size of dTAA. By having a murine model to study thoracic pathology precisely, targeted therapies can be developed to specifically test dTAA. The method is based on the placement of porcine pancreatic elastase (PPE) directly on the outer murine aortic wall after surgical exposure. This creates a destructive and inflammatory reaction, which weakens the aortic wall and allows for aneurysm formation over weeks to months. Though murine models possess limitations, our dTAA model produces robust aneurysms of predictable size. Furthermore, this model can be used to test genetic and pharmaceutical targets which may arrest dTAA growth or prevent rupture. In human patients, interventions such as these could help avoid aneurysm rupture, and difficult surgical intervention.

We describe a surgical protocol to consistently induce robust descending thoracic aortic aneurysms in mice. The procedure involves left thoracotomy, thoracic aorta exposure, and placement of a sponge soaked in porcine pancreatic elastase on the aortic wall.

Modelo Quirúrgico Murino de Aneurisma aórtico torácico descendente fortuito tópico

According to the Center for Disease Control, aortic aneurysms (AAs) were considered a leading cause of death in all races and both sexes from 1999-2016. ...

Porcine Model of Infrarenal Abdominal Aortic Aneurysm

Large animal models to study abdominal aortic aneurysms are sparse. The purpose of this model is to create reproducible, clinically significant infrarenal abdominal aortic aneurysms (AAA) in swine. To achieve this, we use a combination of balloon angioplasty, elastase and collagenase, and a lysyl oxidase inhibitor, called &#946;-aminopropionitrile (BAPN), to create clinically significant infrarenal aortic aneurysms, analogous to human disease.
Noncastrated male swine are fed BAPN for 7 days prior to surgery to achieve a steady state in the blood. A midline laparotomy is performed and the infrarenal aorta is circumferentially dissected. An initial measurement is recorded prior to aneurysm induction with a combination of balloon angioplasty, elastase (500 units)/collagenase (8000 units) perfusion, and topical elastase application. Swine are fed BAPN daily until terminal procedure on either postoperative day 7, 14, or 28, at which time the aneurysm is measured, and tissue procured. BAPN + surgery pigs are compared to pigs that underwent surgery alone.
Swine treated with BAPN and surgery had a mean aortic dilation of 89.9% &#177; 47.4% at day 7, 105.4% &#177; 58.1% at day 14, and 113.5% &#177; 30.2% at day 28. Pigs treated with surgery alone had significantly smaller aneurysms compared to BAPN + surgery animals at day 28 (p &#60; 0.0003). The BAPN + surgery group had macroscopic and immunohistochemical evidence of end stage aneurysmal disease.
Clinically significant infrarenal AAA can be induced using balloon angioplasty, elastase/collagenase perfusion and topical application, supplemented with oral BAPN. This model creates large, clinically significant AAA with hallmarks of human disease. This has important implications for the elucidation of AAA pathogenesis and testing of novel therapies and devices for the treatment of AAA. Limitations of the model include variation in BAPN ingested by swine, quality of elastase perfusion, and cost of BAPN.&#160;

This novel model creates robust infrarenal abdominal aortic aneurysms in swine using a combination of balloon angioplasty, elastase/collagenase perfusion, topical elastase application, and oral compound &#946;-aminopropionitrile administration, which interferes with collagen cross-linking.

Modelo porcino del aneurisma aórtico abdominal infrarrenal

Large animal models to study abdominal aortic aneurysms are sparse. The purpose of this model is to create reproducible, clinically significant infrarenal ...

Vessel-Sparing Microsurgical Longitudinal Intussusception Vasoepididymostomy to Treat Epididymal Obstructive Azoospermia

The epididymis is a common site of obstruction in obstructive azoospermia (OA). Vasoepididymostomy has become an important method for the treatment of epididymal OA since 2000. There are two challenges in classic microscopic vasoepididymostomy. First, anastomosis of the vas deferens and epididymis is performed with double-needle sutures. However, there is a lack of good-quality and cost-effective double-needle sutures in China, which leads to increased difficulty and poor success rates of anastomosis. Second, the separation of the vas deferens does not retain vasculature, although the vas deferens vasculature plays an important role in the blood supply to the vas deferens, epididymis, and testis. This affects the blood supply to the anastomotic area and epididymis.
Therefore, this team has made innovative improvements to address these problems. Good-quality, cost-effective, single-needle sutures, which are easy to purchase in China and other countries, were used in microsurgical longitudinal intussusception vasoepididymostomy. This can optimize the operation procedure and shorten the operation time while ensuring the success rate of the anastomosis. The surgical method of preserving the vas deferens vessels was innovatively proposed because the etiology of epididymal OA is mostly inflammatory in China. The protection of the blood supply to the vas deferens and epididymis is maximized using microsurgical forceps to separate and protect the vasculature. Patency reached 81.7% in the postoperative follow-up, indicating a better surgical treatment effect.

The present protocol describes a vessel-sparing, longitudinal intussusception vasoepididymostomy using readily available single-needle sutures in China, a safe and effective procedure, which may improve patients' patency and natural pregnancy rates.

Vasoepididimostomía por invaginación longitudinal microquirúrgica con preservación de vasos para tratar la azoospermia obstructiva epidídima

The epididymis is a common site of obstruction in obstructive azoospermia (OA). Vasoepididymostomy has become an important method for the treatment of ...