The effect of anticoagulants in anastomoses of arteries approximately 0.25mm in external diameter

Keimyung Medical Journal 1988;7(2):227-235.

외경 0.25mm 의 동맥문합에 있어서 항혈전제의 효과

전대우; 한기환; 강진성

Abstract

In I960; Jacobson and Suarez reported a 100 per cent patency rate following the anastomoses of vessels which were 1.6 to 3.2mm in diameter. This report speeded modern-day microvascular surgery up for the last 20 years. High patency rate is reported in microvascular anastomosis of the 1.0mm diameter; and microvascular surgery is widely used in clinical practice. Improvement in methods of microanastomoses and development of the microvascular instruments; including the operating microscope along with the microsutures make the microvascular anastomoses of vessels that are less than 0.5mm in diameter possible. The key problem microvascular surgery is the formation of thrombus which is mainly composed of platelets; causing occlusion of the anastomotic site. So much efforts have been made in developing effective anticoagulants. Currently used systemic anticoagulants are heparin; aspirin and persantin. Aspirin inhibits collagen-induced platelet aggregation and the primary action of persantin is to inhibit ADP-induced platelet aggregation. Currently ticlopidine-HCl which is known to inhibit platelet aggregation to ADP; collagen; and epinephrine; is widely used as effective anticoagulant for patients of atherosclerosis; hemodialysis; and subarachnoid hemorrhage. An animal study was carried out to investigate the possibility of ticlopidine-HCl to be used as a choice of anticoagulant in microvascular surgery. One hundred and twenty rats were divided into 3 groups. Group A was the control group. Aspirin and Persantin were given orally in group B. Ticlopidine-HCl was given orally in group C. A superficial epigastric artery as small as 0.25mm in diameter was severed transversely and end-to-end anastomosed with 4 stitches of 11-0 nylon. Author have devised autogenous fascia and silicone rubber tube method to splint the suture line and reduce the bleeding caused by anticoagulants. Fewer sutures were required; saving time and effort in microvascular repair. The results were as follows: 1. At 20 minutes after anastomoses; the patency rates were 100% in all groups. 2. At 3 days afer anastomoses; the patency rates were 75% in the control group(A)’ 75% in the aspirin-persantin group(B); and 80% in the ticlopidine group(C). 3; At 3 weeks after anastomoses; the patency rates were 70% in the group A; 75% in the group B; and 80% in the group C. It is concluded that the ticlopidine-HCl may be used in the microvascular anastomoses of very small arteries as the anticoagulant of choice.