Name: Une technique modifiée pour la construction de la fistule artérioveineuse chez le lapin (Vidéo) | JoVE Journal
Uploaded: 2023-02-10T13:33:00.000+00:00
Description: Apprenez la création d'une fistule artérioveineuse chez le lapin par une technique sans contact modifiée. Cette méthode préserve les tissus péri-veineux pour améliorer la perméabilité primaire et réduire la sténose juxta-anastomotique.

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This study was supported by grants from the Suzhou Science and Technology Plan Project (SYS2020077), Suzhou High-tech Zone Medical and Health Science and Technology Plan Project (2020z001), Suzhou Science and Technology Development Plan Project-Medical and Health Science and Technology Innovation (SYK2021030), Nanjing Medical University Science and Technology Development Fund-General Project (NMUB20210253), Suzhou Science and Technology Bureau of the application of the basic research project (No.SYSD2019205, No.SYS2020119), Jiangsu Province Traditional Chinese Medicine Science and Technology Development Plan Project (No.MS2021098), the Ministry of Education Industry-University Cooperation Collaborative Education Project (No. 202102242003),&#160;the Sixth &#34;333 High-level Talent Cultivation&#34; Project in Jiangsu Province, Suzhou Science and Technology City Hospital 2022 Hospital-level Pre-research Fund Project (SZKJCYY2022014), and Suzhou &#34;KeJiaoXingWei&#34; Youth Science and Technology Project (KJXW2022086).

The experimental procedures using laboratory animals were approved by the Experimental Animal Welfare Ethics Committee of Nanjing Medical University. New Zealand rabbits aged 10 months (of both sexes; body weight, 3.18 &#177; 0.24 kg) were used for this study. The animals were obtained from a commercial source (see Table of Materials).
1. Animal preparation
<ol>
	<li>Anesthetize the rabbits using a mixed intravenous injection of tiletamine hydrochloride and zolazepam hydrochloride (3 mg/kg) into the marginal ear vein and an intramuscular injection of sumianxin II (0.02 mL/kg) (see Table of Materials) into the hindlimb muscle. 
	NOTE: After about 1-3 min, the anesthetic effect stabilizes. Before proceeding, the level of anesthesia should be checked by pinching the skin behind the neck and observing the corneal reflex. Tiletamine hydrochloride, zolazepam hydrochloride (0.5 mg/kg), and sumianxin II (0.01 mL/kg) could be added during the operation if needed.</li>
	<li>Lay the rabbit on a fixed table (see Table of Materials) in a supine position, and tie the limbs and incisors with binds.</li>
	<li>Shave the neck and upper chest using an electric razor, and remove the hair by animal depilatory cream (see Table of Materials).</li>
	<li>Maintain sterile conditions during the surgery by autoclaving the surgical equipment and cleaning the surgery area with povidone-iodine solution.</li>
</ol>
2. Skin incision
<ol>
	<li>Position the rabbit with its head toward the surgeon.</li>
	<li>Make a longitudinal incision of ~3 cm between the mandible and the sternoclavicular joint using surgical scissors or a&#160;scalpel blade.</li>
</ol>
3. Preparation of the external jugular vein (EJV)
<ol>
	<li>Expose the incision, and identify the right EJV. Ensure that the EJV and its perivascular tissues are clearly visible and not dissected. 
	NOTE: The EJV shows an inverted &#34;Y&#34; pattern, and the branch close to the medial neck needs to be anastomosed.</li>
	<li>Make a tunnel that a vascular clamp can be passed through (see Table of Materials) along the direction perpendicular to the EJV. Ensure that the distances between the openings on both sides of the tunnel and the EJV are &#62;1 cm.</li>
	<li>Place a vascular clamp along the tunnel.</li>
	<li>Make another tunnel (same as in step 3.2) at the distal EJV using the same method. 
	NOTE: Ensure the distance between the two tunnels is &#8805;2 cm.</li>
	<li>Apply a&#160;4-0 suture (see Table of Materials) and a vascular clamp along the tunnel to control the blood flow (Figure 1A).</li>
</ol>
4. Dissecting and preparing the common carotid artery (CCA)
<ol>
	<li>Use forceps (see Table of Materials) to explore the CCA lateral to the trachea and medial to the sternocleidomastoid muscle. 
	NOTE: The CCA has a pulsatile sensation and runs parallel to the cervical nerve.</li>
	<li>Bluntly dissect the CCA to a length of about 2 cm. 
	NOTE: Avoid injury to the vagus nerve and its branches with a deep arterial course.</li>
	<li>Place a 4-0 suture thread around the CCA to control the blood flow when needed.</li>
	<li>Apply vascular clamps (see Table of Materials) as distally and proximally as possible (Figure 1B).</li>
</ol>
5. Preparing the anastomosis
<ol>
	<li>For phlebotomy and anastomosis, use microscissors (see Table of Materials) to dissect the internal part of the EJV (4 mm long) free from the surrounding tissues.</li>
	<li>Make a 4 mm long longitudinal incision with microscissors in the middle of the vein. Rinse the vein with heparin solution (100 IU/mL) to prevent thrombosis.</li>
	<li>Make a longitudinal incision measuring approximately 4 mm in the anterior wall of the artery using a sharp blade and microscissors. Rinse the artery with 100 IU/mL heparin solution until the vessel is clear of blood.</li>
</ol>
6. Side-to-side anastomosis
<ol>
	<li>Pull the EJV and CCA closely together, as close as possible.</li>
	<li>Apply Kunlin&#39;s technique12 for the side-to-side anastomosis of the CCA and EJV using 8-0 nonabsorbable sutures (see Table of Materials). Suture the posterior wall of the vessel first (Figure 1C), followed by the anterior wall of the vessel. 
	NOTE: Since the EJV wall in a rabbit is thin, care should be taken during the surgery to prevent damage to the vessels that could later compromise the patency of the anastomosis. During the process of vascular anastomosis, heparin solution (100 IU/mL) must be used repeatedly to rinse the lumen to prevent thrombosis.</li>
</ol>
7. Vascular clamp removal and ligation of the vein
<ol>
	<li>Remove the distal vascular clamp of the CCA, the proximal vascular clamp of the EJV, and the proximal vascular clamp of the CCA in turn. Observe active blood flow through the anastomosis.</li>
	<li>Ligate the distal end of the EJV using the 4-0 suture that was placed earlier. Remove the distal vascular clamp of the EJV.</li>
	<li>Remove the suture thread that was placed around the CCA (Figure 1D).</li>
</ol>
8. Skin closure and postoperative care
<ol>
	<li>After ensuring no significant bleeding in the surgical field, close the skin of the neck using interrupted sutures (4-0).</li>
	<li>Place the rabbit in a cage until it completely recovers. Typically, this takes 30-45 min. 
	NOTE: In case of incomplete or delayed recovery, care should be taken to ensure that the rabbit does not experience hemodynamic shock due to bleeding in the surgical area. If required, administer Sumianxin II (0.01 mL/kg) post-surgery.</li>
</ol>

<ol>
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E., et al. <a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=KDOQI+Clinical+Practice+Guideline+for+Vascular+Access:+2019+update.">KDOQI Clinical Practice Guideline for Vascular Access: 2019 update.</a> American Journal of Kidney Diseases. 75, 1 (2020).</li><li>Schmidli, J., et al. <a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Editor's+choice+-+Vascular+access:+2018+Clinical+Practice+Guidelines+of+the+European+Society+for+Vascular+Surgery+(ESVS).">Editor's choice - Vascular access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS).</a> European Journal of Vascular and Endovascular Surgery. 55 (6), 757-818 (2018).</li><li>Grogan, J., et al. <a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frequency+of+critical+stenosis+in+primary+arteriovenous+fistulae+before+hemodialysis+access:+Should+duplex+ultrasound+surveillance+be+the+standard+of+care.">Frequency of critical stenosis in primary arteriovenous fistulae before hemodialysis access: Should duplex ultrasound surveillance be the standard of care.</a> Journal of Vascular Surgery. 41 (6), 1000-1006 (2005).</li><li>Swinnen, J., Lean, T. 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The authors have no potential conflicts of interest related to the drugs and materials used in this procedure.

Currently, several animal models are available for AVF. Among them, pigs, sheep, and dogs are mostly used as large animal models13,14,15. The small animal models used include rabbits, rats, and mice16,17,18. New Zealand rabbits were used in this study. New Zealand rabbits have abundant perivenous tissues around the EJV, which makes them...

The construction of an arteriovenous fistula (AVF) is widely used in clinical practice for patients undergoing maintenance hemodialysis (MHD), and it has higher patency and fewer complications than an arteriovenous graft (AVG) or tunneled cuffed catheter (TCC)1,2. Although AVF is the preferred mode of vascular access, it is not perfect and has inherent limitations. The 1 year primary AVF patency rates are only 60%-65%, with many failures occurring in the near anastomotic region3,4,5.
Vessels undergo different degrees of damage during the traditional surgical approach, which ultimately affects the maturation of the AVF. New surgical modalities, such as the no-touch technique (NTT)&#160;(Supplementary Figure 1) proposed by H&#246;rer et al.6 and radial artery excursion and reimplantation (RADAR) proposed by Sadaghianloo et al.7,8 and Bai et al.9, were designed to decrease the rate of juxta-anastomotic stenosis and to improve the fistula patency by modifying the surgical technique. Although the effect of RADAR was better than that of NTT, inflow arterial stenosis was observed to be more prominent with RADAR. To further reduce injury to the veins and arteries during the operation, in 2021, a new modified no-touch technique (MNTT) was proposed to create a radio-cephalic AVF by preserving the perivenous tissue around the cephalic vein without cutting the radial artery (Supplementary Figure 1 and Supplementary Figure 2). The preliminary results showed increased primary patency, decreased juxta-anastomotic stenosis, and no arterial stenosis10,11.
Considering the current lack of animal models of AVF using MNTT, and to further explore the mechanism of MNTT in AVF surgery, this study introduces a common carotid artery (CCA)-external jugular vein (EJV) AVF procedure using MNTT.

<table><tbody><tr><td>Animal Depilatory</td><td>Fuzhou Feijing Biotechnology Co., Ltd.</td><td>PH1877</td><td></td></tr><tr><td>Curved hemostatic forceps</td><td>Xinhua Surgical Instrument Co., Ltd.</td><td>ZH131R/RN</td><td></td></tr><tr><td>Dissecting forceps</td><td>Xinhua Surgical Instrument Co., Ltd.</td><td>ZDO25R/RN</td><td></td></tr><tr><td>electrical razor</td><td>Shenbao Technology Co., Ltd</td><td>PGC-660</td><td></td></tr><tr><td>Fixed Table</td><td>Zhenhua Biomedical Instrument Co., Ltd</td><td>ZH-DSB019</td><td></td></tr><tr><td>Halsey needleholder</td><td>Xinhua Surgical Instrument Co., Ltd.</td><td>ZM208R/RN</td><td></td></tr><tr><td>Heparin Dodium Injection</td><td>Jiangsu Wanbang Biochemical Pharmaceutical Group Co., Ltd.</td><td>H32020612</td><td></td></tr><tr><td>Medical gauze dressing</td><td>Nanchang Kangjie medical hygiene products Co., Ltd</td><td>20172640135</td><td></td></tr><tr><td>Micro forceops</td><td>Xinhua Surgical Instrument Co., Ltd.</td><td>ZD275RN/T</td><td></td></tr><tr><td>Micro needle holder forceps</td><td>Xinhua Surgical Instrument Co., Ltd.</td><td>ZF2618RB/T</td><td></td></tr><tr><td>Micro scissors</td><td>Xinhua Surgical Instrument Co., Ltd.</td><td>ZF022T</td><td></td></tr><tr><td>Non-silk sutures 4-0</td><td>Kollsut Medical Instrument Co., Ltd.</td><td>NMB020RRCN26C075-1</td><td></td></tr><tr><td>Non-absorbable sutures 8-0 (double needle)</td><td>Yangzhou Yuankang Medical Instrument Co., Ltd.</td><td>10299023602</td><td></td></tr><tr><td>Povidone iodine solution</td><td>Shanghai Likang Disinfection High-tech Co., Ltd.</td><td>310512</td><td></td></tr><tr><td>Rinse needle</td><td>Jiangsu Tonghui Medical Instrument Co., Ltd</td><td>20180039</td><td></td></tr><tr><td>scalpel handle</td><td>Shanghai Medical Instrument (Group) Co., Ltd. Surgical Instruments Factory</td><td>J11030</td><td></td></tr><tr><td>Sharp blade</td><td>Suzhou Medical Products Factory Co., Ltd.</td><td>TY21232001</td><td></td></tr><tr><td>Sodium Chloride Injection&amp;nbsp; (100 mL)</td><td>Guangdong Otsuka Pharmaceutical Co., Ltd.</td><td>B21K0904</td><td></td></tr><tr><td>Sugical Scissors</td><td>Xinhua Surgical Instrument Co., Ltd.</td><td>ZC120R/RN</td><td></td></tr><tr><td>Sumianxin II</td><td>Jilin Dunhua Shengda Animal Pharmaceutical Co., Ltd.</td><td>20180801</td><td></td></tr><tr><td>Syringe with needle?5 mL)</td><td>BD medical devices (Shanghai) Co., Ltd</td><td>2006116</td><td></td></tr><tr><td>Tiletamine Hydrochloride and Zolazepam Hydrochloride for Injection</td><td>Virbac Pet Health, France</td><td>83888204</td><td></td></tr><tr><td>Triangle needle</td><td>Hangzhou Huawei medical supplies Co., Ltd</td><td>7X17</td><td></td></tr><tr><td>Vascular clamp</td><td>Xinhua Surgical Instrument Co., Ltd.</td><td>ZF220RN</td><td></td></tr><tr><td>New Zealand rabbits</td><td>Suzhou Huqiao Biological Co., Ltd.</td><td>SCXK2020-0001</td><td></td></tr></tbody></table>

a modified technique for arteriovenous fistula construction in rabbits

A Modified Technique for Arteriovenous Fistula Construction in Rabbits

Juxta-anastomotic stenosis is a challenging problem that often causes non-maturation and decreases the patency of an arteriovenous fistula (AVF). Injury to the veins and arteries during the operation and hemodynamic changes can lead to intimal hyperplasia, leading to juxta-anastomotic stenosis. To reduce injury to the veins and arteries during the operation, this study proposes a new modified no-touch technique (MNTT) for AVF construction that can decrease the rate of juxta-anastomotic stenosis and improve the AVF patency. To unravel the hemodynamic changes and mechanisms of the MNTT, this study presented an AVF procedure using this technique. Although this procedure is technically challenging, 94.4% procedural success was achieved after adequate training. Ultimately, 13 out of 34 rabbits had a functional AVF 4 weeks after the surgery, leading to a 38.2% AVF patency rate. However, at 4 weeks, the survival rate was 86.1%. Ultrasonography showed active blood flow through AVF anastomosis. Furthermore, the spiral laminar flow was observed in the vein and artery near the anastomosis, suggesting that this technique may improve the hemodynamics of the AVF. On histological observation, significant venous intimal hyperplasia was observed at the AVF anastomosis, whereas no significant intimal hyperplasia was observed at the proximal external jugular vein (EJV) of the anastomosis. This technique will improve the understanding of the mechanisms underlying the use of MNTT for AVF construction and provide technical support for the further optimization of the surgical approach in AVF construction.

The outcome of the successful application of this technique is a patent AVF in the rabbit neck. This study used the following criteria to evaluate the success: (1) when the vascular anastomosis is completed, the venous tremor of the AVF can be touched, and the vascular murmur can be heard; (2) 4 weeks after the AVF is established, the active blood flow through the internal fistula anastomosis can be measured by color Doppler ultrasound; (3) 4 weeks after the AVF is established, hematoxylin-eosin (H&amp;E) staining shows ...

Watch this Scientific Journal Video about A Modified Technique for Arteriovenous Fistula Construction in Rabbits at JoVE.com

The present protocol proposes the creation of an arteriovenous fistula in rabbits using a modified no-touch technique. The technique involves the side-to-side anastomosis of the common carotid artery and external jugular vein without the dissection of the perivenous tissues or cutting off the artery.

Juxta-anastomotic stenosis is a challenging problem that often causes non-maturation and decreases the patency of an arteriovenous fistula (AVF). Injury ...

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Microchirurgie veineuse Pouch artériel Bifurcation anévrismes dans le modèle du lapin: Aspects techniques

Cette vidéo démontre l’interposition de l’artère carotide du lapin avec la veine jugulaire pour induire une hyperplasie intimale veineuse en soumettant les veines à une pression artérielle. Ce modèle aidera à étudier les interventions moléculaires et génétiques visant à atténuer la progression de l’hyperplasie intimale après des chirurgies de revascularisation.

Interposition de l’artère carotide et de la veine jugulaire : une technique pour induire l’hyperplasie intimale veineuse dans un modèle de lapin

Source : Wanderer, S., et al. Poche artérielle Modèle d’anévrisme de bifurcation microchirurgicale chez le lapin. J. Vis. Exp. (2020)Cette vidéo montre la création d’un modèle expérimental d’anévrisme chez un lapin à l’aide d’une poche vasculaire traitée à l’élastase. Après l’excision d’un segment de l’ACC droit, le sac est traité avec de l’élastase, puis suturé à l’ACC gauche pour rétablir la circulation sanguine. Le stress qui en résulte sur les parois affaiblies de la poche induit la...

Développement d’un modèle expérimental d’anévrisme chez un lapin à l’aide d’une poche vasculaire traitée à l’élastase

L'objectif est de produire une fistule artério-veineuse qui est simple et reproductible. Cette méthode n'utilise pas de sutures adhésives ou de la colle. Par conséquent, les échantillons peuvent être utilisés avec la moindre quantité de matériaux étrangers à l'analyse.

Aspects techniques de la fistule aorto-cave de la souris

Ici, nous présentons un modèle murin d’insuffisance de la fistule artérioveineuse (FAV) dans lequel une configuration anastomotique cliniquement pertinente est incorporée. Ce modèle peut être utilisé pour étudier la physiopathologie et pour tester d’éventuelles interventions thérapeutiques.

A Novel modèle murin de la fistule artério-veineuse échec: la procédure chirurgicale en détail

Nous décrivons une méthode microchirurgie pour la génération d'une boucle artérioveineuse (AV) en tant que modèle pour l' analyse de la vascularisation in vivo dans un environnement isolé et bien caractérisés. Ce modèle est non seulement utile pour l'étude de l'angiogenèse, mais est également parfaitement adaptée pour l'ingénierie axialement vascularisé et les tissus transplantables.

La boucle artério (AV) dans un modèle Small Animal pour étudier l&#39;angiogenèse et du génie tissulaire vascularisé

Le protocole actuel vise à créer expérimentalement l’hyperplasie intimale veineuse en soumettant les veines à la tension artérielle pour développer des stratégies pour atténuer l’hyperplasie intimale veineuse après la chirurgie de revascularisation utilisant des greffes de veine.

Un modèle d’interposition veineuse de lapin imitant la chirurgie de revascularisation utilisant des greffes de veine pour évaluer l’hyperplasie intimale sous la tension artérielle

Le développement et le test de dispositifs endovasculaires pour le traitement de l’anévrisme intracrânien sont toujours d’une grande importance. La plupart des modèles d’anévrisme utilisés aujourd’hui manquent soit les caractéristiques importantes d’une paroi artérielle dégénérée, soit l’hémodynamique d’une véritable bifurcation. Par conséquent, nous avons cherché à concevoir un nouveau modèle de bifurcation de poche artérielle chez le lapin.

Modèle d’anévrisme de bifurcation microchirurgicale de la poche artérielle chez le lapin

Nous présentons une technique modifiée sans contact (MNTT) pour créer une fistule artérioveineuse radio-céphalique (RC-AVF) dans laquelle la paroi veineuse et artérielle évite la dévascularisation et l’artère radiale ne se sépare pas.

Création d’une fistule artérioveineuse radio-céphalique dans l’avant-bras avec une technique modifiée sans contact

Nous décrivons ici la technique de création microchirurgicale d’anévrismes de bifurcation géants chez le lapin pour l’évaluation des dispositifs endovasculaires.

Création microchirurgicale d’anévrismes de bifurcation géants chez le lapin pour l’évaluation de dispositifs endovasculaires

Ce protocole présente l’établissement et la confirmation d’un modèle de surcharge du volume ventriculaire droit postnatal chez la souris atteinte de fistule artérioveineuse abdominale (FAV), qui peut être appliqué pour étudier comment la VO contribue au développement cardiaque postnatal.

Etablissement et confirmation d’un modèle murin de surcharge du volume ventriculaire droit postnatal

Apprenez la création d'une fistule artérioveineuse chez le lapin par une technique sans contact modifiée. Cette méthode préserve les tissus péri-veineux pour améliorer la perméabilité primaire et réduire la sténose juxta-anastomotique.

A Modified Technique for Arteriovenous Fistula Construction in Rabbits

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