LETTER TO THE EDITOR
MICROSURGERY 00:1–2 (2014)
ASSISTING SUSPENSION TRIANGULATED CONTINUOUS SUTURE TECHNIQUE FOR MICROVASCULAR ANASTOMOSIS IN RAT PORTOCAVAL SHUNT Dear Editor,
shunt in rats is widely used for experimental studies of hepatic diseases,1–3 as well as for microsurgical training.4 Suture-based anastomosis is technically challenging due to the small diameter, thinness, and deep location of the portal and renal veins in porto-renal anastomosis for portocaval shunt. “Back wall biting” caused by blood vessel collapse is a common cause of failure in the microvascular anastomosis.5 Here, we report an assisting suspension triangulated continuous suture (ASTCS) technique to prevent back wall biting in end-to-end porto-renal anastomosis for portocaval shunt in rats. Briefly, the major trunk of the portal vein was isolated using an operating microscope under isoflurane anesthesia. The right renal artery was isolated and clamped. The right renal vein was ligated with 0-gauge silk suture adjacent to the infrahepatic caval vein. The right kidney was removed. The blood flow through the portal vein was blocked by ligation at both ends, and the major trunk of the portal vein was dissected. The proximal end of the portal vein was connected with the right renal artery using a stent method, and the distal end of the portal vein was anastomosed with the right renal vein in an end-to-end pattern with 10-0 nylon suture using the ASTCS technique (Fig. 1). The anastomosis was started with 3 whole-layer eversion stitches at 4, 8, and 12 o’clock positions. The suture *Correspondence to: Xing-kai Meng, M.D., No. 1 Tongdao North Street, 010050, Hohhot, China. E-mail: [email protected]
Received 21 March 2014; Revision accepted 23 May 2014; Accepted 13 June 2014 Contract grant sponsor: National Natural Science Foundation of China; Contract grant number: 81260073. Published online 00 Month 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/micr.22289 Ó 2014 Wiley Periodicals, Inc.
Figure 1. Assisting suspension triangulated continuous suture (ASTCS) technique.
at the 8 o’clock position was used to perform subsequent continuous eversion stitching. The guide sutures at 8 and 12 o’clock positions were pulled upward; the guide suture at the 4 o’clock position was pulled downward with the gravity of vascular clip. When stitching reached the 12 o’clock position, continuous stitching was carried out before the guide suture at the 8 o’clock position was managed with a vascular clip. Likewise, continuous stitching at the 4 o’clock position was carried out after clipping the guide suture at the 12 o’clock position. We believe that the ASTCS technique is a convenient method to prevent back wall biting in end-to-end portorenal anastomosis for portocaval shunt in rats. JIAN-LIANG QIAO, M.D., ZHI-YONG WANG, M.D., JUN-JING ZHANG, M.D., JIAN-JUN REN, M.D., AND XING-KAI MENG, M.D.* General Surgery The Affiliated Hospital of Inner Mongolia Medical University Hohhot, China
Letter to the Editor
REFERENCES 1. Llansola M, Cantero JL, Hita-Yanez E, Mirones-Maldonado MJ, Piedrafita B, Ahabrach H, Errami M, Agusti A, Felipo V. Progressive reduction of sleep time and quality in rats with hepatic encephalopathy caused by Portocaval shunts. Neuroscience 2012;201: 199–208. 2. Kamikado C, Shibamoto T, Zhang W, Kuda Y, Ohmukai C, Kurata Y. Portocaval shunting attenuates portal hypertension and systemic
Microsurgery DOI 10.1002/micr
hypotension in rat anaphylactic shock. J Physiol Sci 2011;61: 161–166. 3. Schleimer K, Stippel DL, Kasper HU, Prenzel K, Gaudig C, Tawadros S, Hoelscher AH, Beckurts KT. Portal vein arterialization increases hepatocellular apoptosis and inhibits liver regeneration. J Surg Res 2008;149:250–258. 4. Di Cataldo A, La Greca G, Rodolico M, Candiano C, Li Destri G, Puleo S. Experimental models in microsurgery. Microsurgery 1998; 18;454–459. 5. Ozkan O, Ozgentas HE. Open guide suture technique for safe microvascular anastomosis. Ann Plast Surg 2005;55:289–291.