이 작품은 국민 건강 보조금 R01-HL095498 연구소뿐만 아니라 자원과 VA 코네티컷 헬스 케어 시스템, 웨스트 헤이븐, 코네티컷의 시설의 사용에 의해 부분적으로 지원되었다.

1. 마취 및 수술 전 절차 <ol><li> 전신 마취의 유도 해당 기관 애니멀 케어 및 사용위원회의 승인을 얻을 수 있습니다. 십주 세 남성 C57/black 마우스는 마취입니다. isoflurane을 기화기를 통해 0.8 L / 플렉시 유리 상자 분 산소 isoflurane을 4 %를 제공하고 내부에 마우스를 놓습니다. 외과 의사에 의해 선호하는 경우 또는, 복강 내 마취를 사용할 수 있습니다. </li><li> 마취 유지 발가락 핀치에 반응의 부족에 의한 마취 확인 후, 마우스 실리콘 마스크와 앙와위에서 작업 테이블에 배치됩니다. isoflurane을가 적절한 마취 수준을 유지하기 위해 2 %로 감소됩니다. </li><li> 머리 제거 복부 머리는 머리 제거제를 사용하여 낮은 복부에 목에서 제거됩니다. 면도기를 사용하여 남아있는 머리 도플러 초음파 검사를 방해 할 수 있기 때문에 머리 제거하는 것이 좋습니다. </li></ol> 2. 수술 Ultrasoun디 <ol><li> 초음파의 목적 도플러 초음파 검사는 해부학 적 및 생리적 변화를 확인하기 위해 수술 후 결과와 비교 될 수있는 기본 수준의 결과를 기록하는만큼 사전 AVF 수술로 수행됩니다. </li><li> 관찰 점 정맥, 위에 및 인프라 신장 대정맥 (IVC) 및 복부 대동맥 펄스 도플러와 B-모드를 모두 사용하여 검사합니다. </li><li> 측정 각 혈관의 B-모드를 사용하여 직경을 측정합니다. 또한, 최대 속도 (동맥의 최대 수축기 속도) 및 파형은 위에서 설명한 측정 각 점에 ​​기록됩니다. </li></ol> 3. 수술 절차 <ol><li> 마우스 준비 국소 소독제와 절개 사이트를 준비하고, 멸균 장갑과 악기 외과 드레이프를 사용하는 등 수술 중 적절한 무균 기술 등을 지속적으로 </li><li> 개복술 정중선 복부 절개 F 이루어집니다바로 치골 위 간 ROM 하단. </li><li> 대동맥과 IVC의 노출. 견인기가 삽입되어 창자의 모든 복강 밖으로 끌려 오른쪽과 생리 식염수로 적신 거즈에 싸서 보관. 대동맥과 IVC의 전체보기를 얻을 수있는 복막과 낮은 결장을 연결하는 막 해부. 이 방법으로 열렸하고 얻는 경우 방광에 압력을 적용합니다. </li><li> 천자 사이트 노출 빵꾸 사이트 대동맥 분기에 왼쪽 신장 정맥에서의 거리 세 반 사이에 분기 될 것입니다. (그림 1)은 구멍이 될 수 있도록 대동맥의 왼쪽 여백을 해부하다. 대동맥은 IVC 뒤에 45도 정도 위치 그리고 그것은 왼쪽에 추가 후방 절개해야한다는 점에 유의하십시오. (그림 2)이 수술의 가장 중요한 점은 대동맥과 IVC 사이 해부하지 않습니다. 멀리 그들로부터 보관하십시오. </li><li> AOR의 클램프 사이트 노출고마워 주변 조직에서 infrarenal 대동맥 해부. 오른쪽에 그 지류 함께 왼쪽과 왼쪽 신장 정맥 IVC를 손상하지 않도록주의하십시오. </li><li> 대동맥의 클램핑 미세 클립을 적용하여 근위 대동맥 클램프. </li><li> 대동맥의 회전 구멍이 대동맥 약간 윗면 (그림 2)에서 수행 할 수 있도록 대동맥 주변의 결합 조직을 잡고, 대동맥 회전합니다. </li><li> IVC를 통해 대동맥 구멍 25 G 바늘을 사용하여 IVC에 이르기까지 회전 위치, 구멍 대동맥에 대동맥을 유지. 성공하면 (그림 2), 바늘 얇은 IVC 벽을 통해 볼 수 있습니다. </li><li> 지혈 근육을 포함한 복막 조직을 당겨, 대동맥 구멍 사이트를 래핑합니다. IVC에 대동맥을 압축, 그것은 응고 AVF (그림 3)이 있으므로.하지 마십시오 </li><li> 대동맥 드 클램핑 확인 후차 지혈의, 대동맥 드 클램프. 추가 출혈이 발생할 수 있지만 위에서 설명한 추가적인 압축을 중지 할 수 있습니다. 드 클램핑시 동맥혈 대신 어두운 정맥 혈류의 IVC로 흐르는 볼 수 있습니다. </li><li> 복부의 폐쇄 그것의 자연적인 위치로 장을 반환 복부를 닫습니다. </li></ol> 4. 수술 후 절차 <ol><li> 수술 후 관리 복부의 폐쇄 후 isoflurane을가 중지됩니다. 진통과 상처 치료 등 수술 후 치료는 기관 애니멀 케어 및 사용위원회에서 권장하는 지침에 따라 적용됩니다. 진통을 위해 우리는 수술 후 24 시간 동안 intrasmuscularly 0.1 ㎎ / ㎏ 매 12 시간에서 부 프레 노르 핀을 사용합니다. </li><li> 수술 후 초음파 수술 후 첫날에, 도플러 초음파 AVF를 확인하기 위해 수행됩니다. 또한, 다른 변수는 수술 전의 변경 사항을 확인하는 측정값. </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>

대퇴 AVF, 6, AVF 8 대동맥 caval AVF를 경정맥하는 7 경동맥 등의 쥐 AVF를 설명했습니다 몇 가지 보고서가 있습니다. 9, 10 쥐에 비해 쥐 쉽게 수술을 허용, 마우스보다 몇 배 더 크다 마우스입니다. 그럼에도 불구하고, 마우스 유전자 변형과 변형을 활용하기 위해 절차는 마우스 모델을 포함하도록 확장해야합니다. 몇 가지 이전에 게시 된 보고서는 생쥐의 AVF 모델을 도?...

말기 신장 질환 환자에서 신 대체 요법에 대해 선택한 가장 일반적인 옵션은 혈액 투석이다. 혈액 투석에 대한 액세스는 동정맥루 (AVF), 혈관 이식, 또는 일시적으로 카테터에 의해 수행됩니다. AVF 액세스의 기본 모드이지만, AVF 완벽 멀리 아직도이다. 일년 차 AVF의 개통 요금은 내막 증식으로 인해 많은 실패와 만 60~65% 수 있습니다. 일반 AVF 형성과 부적응 형성의 분자 생물학 및 생리학은 저조한 특징 남아있다. 등 많은 누공 형성의 규제의 이해를 첨부 이득 AVF 결과의 개선을 얻을 수있다. 1-3 정맥 이식과 AVF 유사하게 동맥 환경에 정맥을 노출하지만 동맥의 흐름 정맥의 노출은 일반적으로 수술 우회 직접 모델입니다 정맥 이식편. 4, 5의 맥락에서 연구되고, 몇 가지 중요한 디가있다그들 사이 fferences. 정맥 이식편은 AVF 증가 혈액의 흐름과 전단 응력의 결과로 종종 병 말초 작은 동맥에 배수 반면 AVF가 우심방으로 배수로서 첫째, 말초 유출 침대의 저항은 AVF에 훨씬 낮습니다. 둘째, AVF의 정맥 사지에 혈액이 정맥과 정맥 이식편의 순수 동맥 내용에 비해 낮은 산소로 이어지는 동맥 혈액의 혼합이 될 수 있습니다. 셋째, AVF에있는 정맥은 동맥 침대에 정맥 이식편의 전체 전위에 비해 그 혈관 venorum과 신경 신경 분포의 보존에 이르는, 그 침대에서 제거되지 않습니다. AVF는 일반적으로 하나를 가지고 반면 마지막으로, 문합의 수는 일반적으로 정맥 이식편의 두입니다. 본 연구에서는, 우리는 AVF의 연구에 사용될 수 있습니다 aortocaval 루의 마우스 모델을 소개합니다.

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

technical aspects of the mouse aortocaval fistula

마우스 동정맥루를 만드는 기술적 인 측면을 설명합니다. 전신 마취하에, 복부 절개가 이루어지며, 대동맥과 대정맥 (IVC)이 노출됩니다. 근위 infrarenal 대동맥 원위부 대동맥은 각각 클램프 배치 및 바늘 구멍에 대한 해부 있습니다. 특별한주의 대동맥과 IVC 사이의 박리를 방지하기 위해 지급됩니다. 대동맥을 체결 한 후, 25 G 바늘은 IVC에 구멍 대동맥의 양쪽 벽에 사용됩니다. 주변의 결합 조직은 지혈 압축에 사용됩니다. AVF 성공적으로 생성 IVC의 박동 동맥의 혈액 흐름을 보여줍니다. 성공적인 AVF의 추가 확인은 수술 후 도플러 초음파에 의해 달성 될 수있다.

연습 후, 첫 번째 수술 후 하루 생존은 95 % 이상 일반적으로, 수술 후 7 일째에, 생존은 91.3 %였다 그림 1과 2는 관상 단면도에있는 이상적인 천자 사이트를 보여준다;. 구멍의 배치 사이트는 과도한 출혈없이 좋은 생존을 확보하는 것이 중요합니다. 수술 중 사망 및 조기 수술 후 사망은 일반적으로 출혈로 인해 수 있습니다. 이 대동맥과 IVC 사이하거나 불충분 한 지혈 압력의 과도한 박?...

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

Technical Aspects of the Mouse Aortocaval Fistula

목표는 간단하고 재현성 동정맥루를 생산하는 것입니다. 이 방법은 봉합 또는 접착제 접착제를 사용하지 않습니다. 따라서 시료 분석을 위해 이물질 최소한의 함께 사용할 수 있습니다.

마우스 Aortocaval 누관의 기술적 측면

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

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16.3K 조회수.  Yale University. 목표는 간단하고 재현성 동정맥루를 생산하는 것입니다. 이 방법은 봉합 또는 접착제 접착제를 사용하지 않습니다. 따라서 시료 분석을 위해 이물질 최소한의 함께 사용할 수 있습니다.

비디오: 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.

토끼 모델에서 Microsurgical 정맥 주머니 아티 - 분기점의 동맥류 : 기술적인 관점

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

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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.

지주막 하 출혈의 급성과 늦은 후유증의 연구에 대한 토끼 피 션트 모델 : 기술적 측면

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.

동맥 재 협착의 쥐 모델 : 대퇴 와이어 부상의 기술적 측면

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.

동정맥루 실패의 소설 쥐 모델 : 세부 수술

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.

마우스 동정맥루 내피에 관내 약물 전달

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.

내피 기능의 초음파 평가 : 흐름 중재 팽창 시험의 기술 가이드 라인

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.

유출 협착증을 가진 Aortocaval 누공을 사용하여 중앙 정맥 협착증의 뮤린 모형

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.

로봇 보조 췌장췌장 절제술에 대한 기술적 세부 사항

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.

상부 요로 비뇨기과 암에 대한 총 복강경 복강경 신장 절제술 동안 터미널 요관의 기술적 수정

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.