Comparative Study Of Cerebrovascular Anastomosis Training On Vessels At Different Sites In Rats

Purpose:We recorded a variety of vascular anastomosis training performed on the femoral artery-femoral vein complex and carotid artery of rats with an electron microscopic device,repeated impressions of procedures required during simulated extracranial-intracranial vascular anastomosis procedures.By comparing the natural anatomical differences between the target vessels of the neck and the target vessels of the thigh and the time required for vascular anastomosis and postoperative related complications between junior and senior physicians,retrospective analysis on the training results of vascular anastomosis at various sites in rats,different vascular anastomosis methods were evaluated for different sites of blood vessels to seek relatively better training results.Methods:The femoral artery-femoral vein complex and carotid artery of rats were freed under inhalation anesthesia,and the objective anatomy of each target vessel(free length,vessel diameter and vessel depth from body surface)was measured.The suturing process of 24 cervical and 36 femoral vascular anastomoses was recorded by two physicians(one junior physician trained in vascular anastomosis only on the tissue,and one senior physician had rich experience in vascular anastomosis)using an electron microrecording system,to compare the natural anatomical differences of vascular models and to assess the blood flow occlusion time during various vascular anastomosis procedures and related complications after anastomosis,retrospectively observe the video of surgical operation,evaluate the training results of vascular anastomosis at each site,and evaluate the training value of vascular anastomosis at different sites.Results:Objective anatomy of each target vessel: free vessel length of cervical vessel11.42 ± 0.64 mm,free vessel length of femoral vessel 12.20 ± 0.85 mm,arterial diameter of cervical vessel 0.35 ± 0.04 mm,arterial diameter of femoral vessel 0.61 ± 0.12 mm,venous diameter of femoral vessel 1.18 ± 0.67 mm,depth of cervical vessel from epidermis 10.47±2.58 mm,depth of femoral vessel from epidermis 3.92±0.53 mm.In the training,the time required for vascular anastomosis of junior doctors: 30.24 ± 3.42 min for end-to-end anastomosis,70.35 ± 4.12 min for side-to-side anastomosis,63.24 ± 6.42 min for end-to-side anastomosis;the time required for vascular anastomosis of senior doctors: 19.32 ± 1.52 min for end-to-end anastomosis,30.24 ± 3.42 min for side-to-side anastomosis,33.26 ± 3.22 min for end-to-side anastomosis.Number of postoperative complications related to junior doctors: end-to-end anastomosis(neck): bleeding in 2cases,thrombosis in 1 case,vascular wall distortion in 1 case;end-to-end anastomosis(femoral): bleeding in 2 cases,thrombosis in 1 case,vascular wall distortion in 1 case;side-to-side anastomosis(femoral): bleeding in 3 cases,thrombosis in 2 cases,vascular wall distortion in 2 cases;end-to-side anastomosis(neck),bleeding in 5 cases,thrombosis in 2 cases,vascular wall distortion in 3 cases;end-to-side anastomosis(femoral),bleeding in 4 cases,thrombosis in 2 cases,vascular wall distortion in 2cases;Number of postoperative complications related to senior doctors: end-to-end anastomosis(neck): 1 case of bleeding,0 case of thrombosis,0 case of vascular wall distortion;end-to-end anastomosis(femoral): 1 case of bleeding,0 case of thrombosis,0case of vascular wall distortion;side-to-side anastomosis(femoral): 1 case of bleeding,0case of thrombosis,1 case of vascular wall distortion;end-to-side anastomosis(neck),2cases of bleeding,1 case of thrombosis,2 cases of vascular wall distortion;end-to-side anastomosis(femoral),1 case of bleeding,1 case of thrombosis,1 case of vascular wall distortion.Conclusions: The research showed that both cervical and femoral vessels of rats have training value for vascular anastomosis technique in primary physicians through the study of vascular anastomosis training at different sites in living animal models:Rat cervical vessels are more suitable for end-to-end vascular anastomosis training,which can better simulate the surgical operation of deep tissues,can be used to simulate the surgical operation of M2-3 complex aneurysm of middle cerebral artery.Rat thigh vessels are more suitable for side-to-side anastomosis as well as end-to-side anastomosis training and are more suitable to simulate surgical procedures in superficial tissues,can be used to simulate the surgical operation of complex anterior communicating artery aneurysm as well as moyamoya disease and middle cerebral artery ischemic cerebrovascular disease.