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KMID : 0988420030150030235
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Journal of Dental Science (C.N.U.)
2003 Volume.15 No. 3 p.235 ~ p.245
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Effects of Local Irrigation and Intravenous Administration of Human Tissue-type Plasminogen Activator on Microvascular Thrombosis
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Abstract
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The needs of microvascular anastomosis or vessel graft to reconstruct maxillofacial tissue defect has been increased and a variety of attempts to improve the rate of patency has been achieved. Thrombolytic agents has been advocated in order to decrease the failure rate of microvascular anastomosis and to prevent the need for reoperation. Older thrombolytic agents, such as streptokinase or urokinase, have a significant side effects such as allergy, hyperthermia, systemic bleeding complications.
This study was performed to evaluate the effect of local irrigation and intravenous administration of human tissue-type plasminogen activator (t-PA), which is known as effective thrombolytic agent with less systemic side effects, on patency and thrombus formation of experimental microvascular anastomoses in the traumatized femoral vein of rabbit.
Nine rabbits weighing about 2㎏ were used. After exposure of both femoral veins. the veins were crushed by the jaws of smooth needle holder in order to create a thrombosis model. Transectional incision was made in the vein. The animals were then divided into 3 groups: 1) Experimental Group Ⅰ, topical irrigation of lumen with t-PA saline solution (n=6); 2) Experimental Group 2, Intravenous administration of t-PA (0.75 ㎎/㎏) via the marginal ear vein for 3 days; 3) Control Group, topical irrigation of lumen with saline solution (n=6).
The veins were anastomosed utilizing microvascular technique with 10-0 Ethilon. The patency was evaluated with empty-and-refill test 30 minutes and 3 days after microanastomosis. The thrombus formation was evaluated 3 days after microanastomosis by observing the thrombus with surgical microscope. The histologic findings were also evaluated.
The results were as follows:
1. Thirty minutes after microvascular anastomosis, the patency of all Experimental Groups 1 and 2 was more improved than that of Control Group. However, there was no significant difference among groups.
2. Three days after microvascular anastomosis, the patency of all Experimental Groups was much more improved than that of Control Group (p<0.05). There was no significant difference between Experiment Group 1 and Experiment Group 2.
3. Three days after microvascular anastomosis, the amount of thrombus in all Experimental Groups was much less than that of Control Group (p<0.05).
4. In histologic findings, a lot of luminal thrombus were observed around sutured area in Control Group. Few luminal thrombus was observed in all Experimental Groups. The necrotic changes were was observed in the vessel wall of all specimens.
These results indicate that topical irrigation and intravenous administration of t-PA are effective measures in improving patency and preventing thrombus formation after microvascular anastomosis.
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