Different Types of Arteriovenous Anastomoses between Femoral Artery and Vein Distal to the Island Groin Flap

Abstract

An experimental study was done in rats in which the animals were randomly divided into four groups. Each group included bilateral standard island groin flaps. The right side flap was used as control. On the left side, after elevation of the flap, different types of arteriovenous connections were constructed distal to the pedicle between the femoral artery and vein. The connection type was a type-C (end-to-end) anastomosis in Group 1; a type-X (side-to-side) anastomosis in Group 2; a type-T a (artery-end-to-vein-side) anastomosis in Group 3; and a type-Tv (vein-end-to-artery-side) anastomosis in Group 4. Flow values in the flaps were measured externally and repeatedly using a laser Doppler flowmeter. Extremity changes, signs of congestive heart failure, flap weights (measured at the end of the study), thrombosis at the anastomosis or distal to it, edema in the flaps, subcutaneous venous stasis, and aneurysm formation in the anastomoses were observed. Histopathologic evaluations were also done. Only the side-to-side anastomosis group showed any aneurysm formation in the distal vein, as well as extremity changes and signs of congestive heart failure in some of the animals. Only the artery-end-to-vein-side group showed distal thromboembolism in some animals. All flaps survived, but there was prominent edema in the flaps of Group 2 and Group 4 animals in decreasing order. All the study flaps demonstrated subcutaneous venous stasis and capsule formation. The authors concluded that although any arteriovenous communication located distal to the pedicle of an island skin flap that connects the arterial to the venous system, bypassing microcirculation, may have some beneficial effects, it is not devoid of some possibly hazardous developments, including edema formation and venous stasis.

Three types of end-to-side microvascular anastomosis training models using rat common iliac arteries

“…There are many types of end-to-side microvascular anastomosis training models, such as those that are ipsilateral to contralateral common carotid arteries ( 9 , 10 ), common carotid artery to external jugular vein ( 11 , 12 ), ipsilateral to contralateral common iliac arteries ( 7 , 9 ), and femoral artery to vein ( 13 – 15 ). Previously, Tayebi Meybodi et al ( 9 ), Hall ( 20 ), and we ( 7 ) have described Prox.…”

“…In this article, three types of end-to-side microvascular anastomosis using the rat common iliac artery were presented to simulate three different anastomotic situations. There are many types of end-to-side microvascular anastomosis training models, such as those that are ipsilateral to contralateral common carotid arteries (9,10), common carotid artery to external jugular vein (11, 12), ipsilateral to contralateral common iliac arteries (7,9), and femoral artery to vein (13)(14)(15). Previously, Tayebi Meybodi et al (9), Hall (20), and we (7) have Schematic illustration shows the measurements in end-to-side anastomosis using rat common iliac arteries.…”

“…Therefore, instead of only practicing these perfectly matched end-to-side anastomoses in microsurgical laboratories, we must learn how to perform these so-called “imperfect” end-to-side anastomoses in the laboratory. Previously, many types of end-to-side microvascular anastomosis training models have been described, such as those that are ipsilateral to contralateral common carotid arteries ( 9 , 10 ), common carotid artery to external jugular vein ( 11 , 12 ), ipsilateral to contralateral common iliac arteries ( 7 , 9 ), and femoral artery to vein ( 13 – 15 ). In this article, three types of end-to-side microvascular anastomotic configurations using the rat common iliac artery (CIA), one with the proximal end of the CIA to the contralateral side of the CIA (Prox.…”