Carotid Artery and Jugular Vein Interposition: A Technique to Induce Venous Intimal Hyperplasia in Rabbit Model

Overview

This video demonstrates the interposition of the rabbit carotid artery with the jugular vein to induce venous intimal hyperplasia by subjecting the veins to arterial pressure. This model will help investigate molecular and genetic interventions to attenuate the progression of intimal hyperplasia after revascularization surgeries.

Protocol

All procedures involving animal models have been reviewed by the local institutional animal care committee and the JoVE veterinary review board.

1. Interposing the carotid artery by the harvested jugular vein

1. Begin with an anesthetized rabbit. Incise 50–60 mm of the cervical region with surgical scalpel longitudinally. Bluntly dissect the subcutaneous tissues and fascia. Expose a 20–30 mm segment of the ipsilateral carotid artery. Separate the artery carefully from the vein and nerve nearby. Ligate all the branches of the exposed vein with 4-0 silk suture.
2. Administer heparin sodium intravenously (200 IU/kg). Wait for 3–4 min.
3. Clamp the proximal and distal ends of the artery with surgical clamps. Cut the artery in the middle, between the clamps. Inject normal saline into the incised carotid artery proximally and distally to distend the artery.
   NOTE: A rabbit carotid artery tends to shrink. Choose a well-distended site as an anastomosis site.
4. Anastomose the harvested vein to the artery in a reversed end-to-end fashion.
   1. Insert a 20 G intravenous catheter into the harvested vein from the distal to the proximal direction to keep the venous lumen open during the distal anastomosis.
   2. Anastomose the proximal end of the vein to the distal end of the artery using 8-0 polypropylene interrupted sutures. Place two anchor stiches at the site and the opposite site. Add stiches at the upper side of the anastomosis line between the anchor stiches.
   3. Flip the artery and the vein graft upside down. Add stiches on the remaining part of the anastomosis line.
   4. Remove the intravenous catheter from the vein. Clamp the vein graft proximally and declamp the carotid artery distally. Ascertain that the vein graft is expanding gradually.
   5. Anastomose the distal end of the vein to the proximal end of artery using 8-0 polypropylene interrupted sutures. Declamp the artery to check the bleeding from the anastomosis sites. Add sutures for hemostasis, if required.
      NOTE: A gentle compression of the bleeding site with gauze and waiting may be enough for hemostasis. Check the immediate expansion and strong pulsation of the vein graft after the proximal declamping. If that is not observed, consider repeating steps 1.4.2 –1.4.3
5. Ligate the internal carotid artery with a 4-0 silk suture to simulate a poor runoff condition and to facilitate intimal hyperplasia.
6. Clean the wound with saline. Close the wound using 3-0 polyglactin 910, layer by layer.

Materials

Name	Company	Catalog Number	Comments
10% Povidone-iodine solution	Nakakita	872612	Surgical expendables
2-0 VICRYL Plus	Johnson and Johnson	VCP316H	Surgical expendables
4-0 Silk suture	Alfresa pharma	GA04SB	Surgical expendables
8-0 polypropylene suture	Ethicon	8741H	Surgical expendables
Fogarty Catheter (2Fr)	Edwards Lifesciences LLC	E-060-2F	Surgical expendables
Heparin	Nipro	873334	Anticoagulant
Intravenous catheter (20G)	Terumo	SR-OT2051C	Surgical expendables