Bu çalışma, Ulusal Sağlık hibe R01-HL095498 Enstitüsü, hem de kaynakları ve VA Connecticut Sağlık Sistemi, West Haven, CT tesislerinin kullanımı ile kısmen desteklenmiştir.

1. Anestezi ve Ameliyat öncesi Prosedürleri <ol><li> Genel anestezi Uygun Kurumsal Hayvan Bakım ve Kullanım Kurulu tarafından onay elde edilir. 10 haftalık yaşlı erkek farenin C57/black, anestezi altına alınır. Bir izofluran buharlaştırıcı ile 0,8 L / a pleksiglas kutusuna dk oksijen ile izofluran% 4 sunun ve içinde fare yerleştirin. Cerrah tarafından tercih Alternatif olarak, eğer, intraperitonal anestezi kullanılabilir. </li><li> Anestezi korunması Ayak tutam tepki eksikliğinden anestezi onay alındıktan sonra, fareyi bir silikon maske ile bir yatar pozisyonda operasyon masasına oturtulmuştur. Izofluran uygun anestezi düzeyde tutmak için% 2 azalır. </li><li> Epilasyon Ventral saç saç çıkarıcı kullanarak alt karın için boyun kaldırılır. Bir tıraş makinesi kullanarak kalan saç Doppler ultrason ile etkileyebilir çünkü saç çıkarıcı tercih edilir. </li></ol> 2. Ameliyat öncesi ultrasond <ol><li> Ultrason Amaçları Doppler ultrasonografi anatomik ve fizyolojik değişiklikleri görmek için ameliyat sonrası bulgular ile karşılaştırılabilir temel düzeyde bulgular kaydetmek amacıyla önce AVF cerrahi yapılır. </li><li> Gözlem noktaları Şahdamarından, üstü ve alt-böbrek inferior vena kava (IVC) ve abdominal aorta darbe Doppler ve B-mod her ikisini de kullanarak incelenmiştir. </li><li> Ölçümler Her damar B-mod kullanarak, çapı ölçülür. Buna ek olarak, maksimum hız (damar doruk sistolik hızı) ve dalga yukarıda açıklanan ölçüm noktalarının her kaydedilir. </li></ol> 3. Operatif Prosedürleri <ol><li> Fare Hazırlık Topikal bir antiseptik ile kesi bölgesini hazırlayıp, steril eldiven ve aletleri bir cerrahi örtü kullanarak da dahil olmak üzere ameliyat sırasında uygun aseptik teknik, vb devam </li><li> Laparotomi Orta hat abdominal kesi f yapılırsadece inden yukarıda karaciğer ROM alt kenarı olabilir. </li><li> Aorta ve IVC maruz kalması. Bir retraktör eklenir ve bağırsakları tüm karın boşluğunun çıkardı olan sağ tarafına ve serum fizyolojik ile ıslatılmış gazlı bez sarılı tuttu. Aorta ve IVC tam ekran için retroperitoneal ve alt kolon bağlayan zar parçalara ayır. Bu şekilde dilate ve alır ise mesane üzerinde baskı uygulayın. </li><li> Ponksiyon maruz kalması Delinme sitesi aort bifürkasyon sol renal ven mesafe üç yarısına arasında dörtte olacaktır. (Şekil 1) bu delinmiş olabilir ki aortun sol kenar ayır. Aort IVC arkasında 45 derece hakkında konumlandırılmış ve sol ek olarak posterior disseke gerektiğini unutmayın. (Şekil 2) Bu cerrahisinin en önemli nokta aorta ve IVC arasında incelemek değildir. Uzak onlardan tutun. </li><li> AOR ve kelepçe site Çekimta Çevre dokulardan infrarenal aort parçalara ayır. Sağdaki kolları ile sol ve sol renal damarlar üzerinde IVC kesmemeye dikkat edin. </li><li> Aort sıkma Mikrocerrahi klipleri uygulayarak proksimal aort Kelepçe. </li><li> Aort Dönme Lastik aort biraz dorsal tarafında (Şekil 2) yapılmış olabilir, böylece, aort çevreleyen bağ dokusu tutarak, aort döndürün. </li><li> IVC kadar aort Delinme 25 G iğne ile IVC kadar bir döndürülmüş konumda, delinme aort aort tutulması. Eğer başarılı olursa (Şekil 2), iğne ince IVC duvarından görülebilir. </li><li> Hemostaz Kasları dahil olmak üzere retroperitoneal dokular, çekerek, aort ponksiyon sarın. IVC karşı aort sıkıştırmak, bu pıhtı AVF (Şekil 3) olabilir gibi. Etmeyin </li><li> Aorta De-sıkma Onay alındıktan sonrabirincil hemostaz, aort de-kelepçe. Ek bir kanama ortaya çıkabilir ancak yukarıda açıklanan daha fazla sıkıştırma ile durdurulabilir. De-sıkıştırma üzerine, arter kan yerine koyu venöz kan akımının IVC akan görülebilir. </li><li> Karın kapatılması Doğal pozisyona bağırsakları dönün ve karın kapatın. </li></ol> 4. Ameliyat sonrası Prosedürleri <ol><li> Post-operatif bakım Karın kapatılması sonra, izofluran durdurulur. Analjezi ve yara bakımı da dahil olmak üzere post-operatif bakım Kurumsal Hayvan Bakım ve Kullanım Kurulu tarafından önerilen talimatlara uygun olarak uygulanır. Analjezi için biz cerrahi prosedürleri takip 24 saat intrasmuscularly 0.1 mg / kg her 12 saatte buprenorfin kullanın. </li><li> Ameliyat sonrası ultrason Ameliyat sonrası ilk gün, Doppler ultrason AVF onaylamak için yapılır. Buna ek olarak, diğer değişkenler ameliyat öncesi gelen değişiklikleri kontrol etmek için ölçülürdeğerleri. </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>

Femoral AVF, 6, AVF 8 ve aorto-kaval AVF juguler için 7 karotis dahil olmak üzere sıçanlarda AVF tarif ettiğim çeşitli raporlar vardır. 9, 10 sıçan göre sıçan daha kolay cerrahi sağlayan, fareyi daha birkaç kat daha büyüktür fare. Bununla birlikte, fare genetik suşları ve türevleri yararlanmak için prosedür fare modelleri kapsayacak şekilde genişletilmelidir. Çeşitli önce yayınlanan raporlar farelerde AVF modelini tanıttı, ancak bu raporlar genel...

Son dönem böbrek hastalığı olan hastalarda renal replasman tedavisi için seçilen en yaygın seçenek hemodiyaliz olduğunu. Hemodiyaliz için Erişim arteriyovenöz fistül (AVF), AV greft, ya da geçici kateter yerleştirme yapılır. AVF erişim tercih edilen modu olmasına rağmen, AVF mükemmel olmaktan uzak hala. Bir yıllık temel AVF açık kalma oranları neointimal hiperplazi nedeniyle birçok hataları ile, sadece% 60-65 bulunmaktadır. Normal AVF oluşumu ve uyumsuz oluşumu moleküler biyoloji ve fizyoloji kötü karakterize kalır. Bu nedenle, çok fistül oluşumu yönetmeliğin anlayış eşlik eden kazanç ile AVF sonuçların iyileştirilmesi elde olmaktır. 1-3 Ven greft ve AVF benzer bir arter ortama bir damar açığa rağmen arter akışına bir ven maruz sık cerrahi bypass doğrudan modellerdir ven greft. 4, 5 bağlamında incelenmiştir, pek çok kritik di vardıraralarında fferences. Ven grefti AVF artmış kan akımı ve kayma gerilmesi ile sonuçlanan, genellikle hastalıklı distal küçük arterlere drene ise AVF sağ atriyuma drene ilk olarak, distal akış yatağın direnci, AVF çok daha düşüktür. İkinci olarak, AVF venöz ekstremite kan venöz ve damar greft tamamen arteriyel içeriğe göre daha düşük oksijen yol açan arteriyel kan bir karışımı olabilir. Üçüncü olarak, AVF de ven arter yatağa ven grefti tam hukuka göre, kendi vazo venorum ve sinir inervasyonları korunması yol açan, kendi yatak kaldırılmaz. AVF genellikle sadece birine sahip ise Son olarak, anastomoz sayısı genellikle ven greft iki olduğunu. Bu çalışmada, AVF çalışma için kullanılabilir aortocaval fistül bir fare modeli tanıtmak.

<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

Fare bir arteriyovenöz fistül oluşturma teknik yönleri tartışıldı. Genel anestezi altında, bir karın kesi yapılır, ve aort ve inferior vena kava (IVC) maruz kalmaktadır. Proksimal infrarenal aorta ve distal aort sırasıyla, kelepçe yerleştirme ve İğne için disseke edilir. Özel dikkat aorta ve IVC arasında diseksiyonu önlemek için ödenir. Aort sıkıştırdıktan sonra bir 25 G iğne IVC içine lastik aort iki duvarlarını kaplamak için kullanılır. Çevre bağ dokusu hemostatik sıkıştırma için kullanılır. AVF başarılı biçimde oluşturulması IVC içinde pulsatil arteriyel kan akımı gösterecektir. Başarılı AVF teyit etmek post-operatif Doppler ile elde edilebilir.

Antrenmandan sonra, ilk postoperatif gün hayatta kalma% 95 üzerinde tipik olarak, ameliyat sonrası günlük 7, hayatta kalma% 91.3 idi Şekil 1 ve 2 koronal ve kesit görünümlerinde ideal ponksiyon gösterir;. Ponksiyon yerleştirilmesi sitesi aşırı kanama olmadan iyi yaşam elde etmek için çok önemlidir. Intra-operatif ölüm ve erken ameliyat sonrası ölümlerin genellikle kanama nedeniyle. Bu aorta ve IVC, arasında veya yetersiz hemostatik basınç aşırı diseksiyon ile görülme eğil...

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

Technical Aspects of the Mouse Aortocaval Fistula

Amaç basit ve tekrarlanabilir bir arteriyovenöz fistül üretmektir. Bu yöntem, dikiş ya da tutkal yapıştırıcı kullanmaz. Bu nedenle numuneleri analiz için yabancı maddelerin en az miktarı ile de kullanılabilir.

Fare Aortocaval Fistül Teknik Yönleri

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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Research

JoVE Journal

Medicine

16.3K Görüntüleme.  Yale University. Amaç basit ve tekrarlanabilir bir arteriyovenöz fistül üretmektir. Bu yöntem, dikiş ya da tutkal yapıştırıcı kullanmaz. Bu nedenle numuneleri analiz için yabancı maddelerin en az miktarı ile de kullanılabilir.

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.

Tavşan Modelinde Mikrocerrahi Venöz Kılıfı Arter Bifurkasyon Anevrizmalarının: Teknik Yönleri

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

Tıp

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.

Subaraknoid Kanama Akut ve Geç sekeli Çalışmaları Tavşan Kan şant Modeli: Teknik Yönleri

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.

Arter Restenozun bir fare modeli: Femur Tel Yaralanma Teknik Yönleri

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.

Arteriovenöz Fistül Yetersizliğinin A Novel Fare Modeli: Detay Cerrahi Prosedür

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.

Fare Arteriovenöz Fistül Endotelyumunun için intraluminal Drug Delivery

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.

Endotel Fonksiyon Ultrason Değerlendirmesi: Akış aracılı dilatasyon Testinin A Teknik Klavuzu

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.

Bir outflow stenozu ile Aokaval fistül kullanarak Merkezi venöz stenozis murine modeli

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.

Robot Destekli Pankreatikoduodenektomi için Teknik Detay

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.

Üst İdrar Yolu Ürotekeral Karsinomu için Total Transperitoneal Laparoskopik Nefroskopik Nefroureterektomi Sırasında Terminal Üreterinin Teknik Modifikasyonu

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.