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A Modified Surgical Model of Hind Limb Ischemia in ApoE-/- Mice using a Miniature Incision

Published: May 13th, 2021



1Department of Surgery, Medical Faculty Manheim, Heidelberg University, 2European Center of Angioscience ECAS, Medical Faculty Manheim, Heidelberg University, 3Computer-Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, 4Cooperative Core Facility Animal Scanner ZI, Medical Faculty Mannheim, Heidelberg University

This article demonstrates an efficient surgical approach to establish acute ischemia in mice with a small incision. This approach can be applied by most research groups without any laboratory upgrades.

The purpose of this study is to introduce and evaluate a modified surgical approach to induce acute ischemia in mice that can be implemented in most animal laboratories. Contrary to the conventional approach for double ligation of the femoral artery (DLFA), a smaller incision on the right inguinal region was made to expose the proximal femoral artery (FA) to perform DLFA. Then, using a 7-0 suture, the incision was dragged to the knee region to expose the distal FA. Magnetic resonance imaging (MRI) on bilateral hind limbs was used to detect FA occlusion after the surgery. At 0, 1, 3, 5, and 7 days after the surgery, functional recovery of the hind limbs was visually assessed and graded using the Tarlov scale. Histologic evaluation was performed after euthanizing the animals 7 days after DLFA. The procedures were successfully performed on the right leg in ten ApoE-/- mice, and no mice died during subsequent observation. The incision sizes in all 10 mice were less than 5 mm (4.2 ± 0.63 mm). MRI results showed that FA blood flow in the ischemic side was clearly blocked. The Tarlov scale results demonstrated that hind limb function significantly decreased after the procedure and slowly recovered over the following 7 days. Histologic evaluation showed a significant inflammatory response on the ischemic side and reduced microvascular density in the ischemic hind limb. In conclusion, this study introduces a modified technique using a miniature incision to perform hind limb ischemia (HLI) using DLFA.

There is an unmet need for preclinical animal models for research in vascular diseases such as peripheral artery disease (PAD). Despite the advanced developments in diagnosis and treatment, there were more than 200 million patients with PAD in 20181, and their number is constantly increasing. Although several novel therapeutic approaches2,3,4,5,6,7 have been described, successful translation of these therapeutic modalities into clinical application ....

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NOTE: All experimental procedures were performed according to the EC guideline EC 2010/63/EU and have been approved by the local German legislation (35-9185.81/G[1]239/18). Ten male ApoE-/- mice with the C57BL/6J background, weighing 29.6-38.0 g, were housed on a 12 h light/dark cycle and fed a western diet (1.25% cholesterol and 21% fat) and water ad libitum for 12 weeks from the age of 8 weeks. HLI was performed on 20-week-old mice as described below.

1. Induction of HLI in.......

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Characteristics of ApoE-/- mice
DLFA surgeries were successfully performed on 10 mice to establish the HLI model, and none of the mice died after the procedure. To follow changes in body weight, mice were weighed before the DLFA procedure (Pre-DLFA) and 7 days after the DLFA surgery (Post-DLFA). Pre-DLFA weights ranged from 29.6 to 38.0 g (mean 34.74 ± 2.47 g), and post-DLFA weights ranged from 26.5 to 34.1 g (mean 30.77 ± 2.15 g), which were s.......

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This study reports a modified, simplified, and surgically efficient approach to establish an HLI model in ApoE-/- mice using double ligation in the proximal and distal regions of the FA through a 3-4 mm incision without any required laboratory upgrades. The main characteristic of this method is the smaller size of the incision compared to previously reported studies describing mouse HLI models8,9,10,

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Authors thank Viktoria Skude, Alexander Schlund, and Felix Hörner for the excellent technical support.


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Name Company Catalog Number Comments
10x Phosphate buffer saline Roth 9143.1 Used for haematoxylin and eosin stain and immunohistochemistry stain
30% H2O2 Roth 9681.2 Used for immunohistochemistry stain
6-0 absorbable sutures PROLENE 8776H Used for stitching the skin
6-0 absroable suture PROLENE EP8706 Used in Surgery
7-0 absorbable sutures PROLENE EH8021E Used for ligating the artery
7-0 absroable suture PROLENE EP8755 Used in Surgery
Acetic acid Roth 6755.1 Used for haematoxylin and eosin stain
Albumin Fraktion V Roth 8076.2 Used for immunohistochemistry stain
Autoclave Systec GmbH Systec VX-150 Used for the sterilisation of the surgical instruments
Axio vert A1 microscope Carl Zeiss ZEISS Axio Vert.A1 Used for viewing and taking the pictures from haematoxylin and eosin stain and immunohistochemistry stain
Bruker BioSpec 94/20 AVIII Bruker Biospin MRI GmbH N/A Scan the femoral artery blockage
Buprenovet Sine 0,3mg/ml Bayer AG 2542 (WDT) Used in post operative pain-management. Dose - 0.1 mg/kg body weight every 8 hours for 48 h after operation
CD31 antibody Abcam ab28364 Used for immunohistochemistry stain
Eosin Y solution 0.5 % in water Roth X883.1 Used for haematoxylin and eosin stain
Epitope Retrieval Solution pH 6 Leica Biosystems 6046945 Used for immunohistochemistry stain
Ethanol ≥ 99,5 % Roth 5054.1 Used for haematoxylin and eosin stain and immunohistochemistry stain
Fentanyl Cayman Chemical 437-38-7 Used for anesthesia
Fine point forceps Medixplus 93-4505S Used for separating the artery from nerve and vein
Glass bead sterilisator Simon Keller Type 250 Used for sterilisation of the surgical instruments
Graefe iris forceps curved VUBU VUBU-02-72207 Used for blunt separation of skin and subcutaneous tissue
Hair Remover cream, Veet (with aloe vera) Reckitt Benckiser 108972 Remove hair from mice hind limbs
Heating plate STÖRK-TRONIC 7042092 Keep the satble temperature of mice
Hematoxylin Roth T865.2 Used for haematoxylin and eosin stain and immunohistochemistry stain
Leica surgical microscope Leica M651 Enlarge the field of view to facilitate the operation
Liquid DAB+Substrate Chromogen System Dako K3468 Used for immunohistochemistry stain
Male ApoE-/- mice Charles River Laboratories N/A Used for establish the Peripheral artery disease mice model
Medetomidine Cayman Chemical 128366-50-7 Used for anesthesia
Micro Needle Holder Black & Black Surgical B3B-18-8 Holding the needle
Micro suture tying forceps Life Saver Surgical Industries PS-MSF-145 Used to assist in knotting during surgery
Microtome Biobase Bk-Mt268m Used for tissue sectioning
Midazolam Ratiopharm 44856.01.00 Used for anesthesia
MR-compatible Small Animal Monitoring and Gating System Model 1025 SA Instruments N/a monitoring vital signs of animal during MRI scan
Octeniderm farblos Schülke & Mayr GmbH 180212 used for disinfection of the skin
Ointment for the eyes and nose Bayer AG 1578675 Keep the eyes wet under the anesthesia
Paraformaldehyde Roth 0335.1 Used for fixation of the tissue
Pentobarbital Nembutal 76-74-4 Used for anesthesia
Saline DeltaSelect 1299.99.99 Used for anesthesia
Spring handle scissors with fine, sharp tips Black & Black Surgical B66167 Used for cutting the artery
SuperCut Scissors Black & Black Surgical B55992 Used for cutting the skin
Triton X-100 Roth 9002-93-1 Used for immunohistochemistry stain
Western diet, 1.25% Cholesterol ssniff Spezialdiäten GmbH E15723-34 Diet for the mice
Xylene Roth 4436.3 Used for haematoxylin and eosin stain and immunohistochemistry stain

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