Endothelial cell damage by temporary arterial occlusion with surgical clips

Abstract

The effects of temporary vascular occlusion with surgical clips on the underlying endothelial lining were studied with scanning (SEM) and transmission (TEM) electron microscopy. Twenty-five rabbits were anesthetized and both common carotid arteries exposed. A Heifetz clip was used to occlude the right carotid artery for 5, 15, and 30 minutes, and 2 hours in five animals each. The clips were removed and the vessels immediately perfused with glutaraldehyde. In five remaining animals, the right carotid arteries were occluded for 30 minutes followed by removal of the clip and resumption of blood flow for 30 minutes prior to fixation. Combined SEM and TEM examination of the endothelium of compressed segments revealed "craters" and "balloons", blebs and vacuoles, swollen mitochondria, dilated granular endoplasmic reticulum, and subendothelial edema. There were also areas of endothelial cell flattening, discontinuity, and desquamation exposing the subendothelial tissues. Following restoration of flow, platelets and fibrin were found adherent to altered endothelial cells and to exposed subendothelial tissues. Endothelial craters and balloons were also found distal and, significantly less frequently, proximal to the site of occlusion. It is suggested that antiplatelet aggregating agents may prove beneficial for the prevention of thrombus formation at the site of the clip as well as craters and balloons distal to the clip following procedures requiring temporary vascular occlusion.

Effects of temporary vascular occluder poloxamer 407 Gel on the endothelium

“…These methods include intracoronary shunt or occluders and using high flow gas insufflation. Adverse effects of these methods are well reported [1-6]. In an experimental study, Gucu et al [4] have found that filtrated high flow room air insufflation to the coronary anastomotic area may frequently cause type 1 and rarely type 2 endothelial damage.…”

“…Gertz et al [6] studied the endothelial cell damage caused by temporary arterial occlusion with surgical clips using scanning and transmission electron microscopy. They have occluded the right carotid artery for 5, 15 and 30 minutes with a surgical clip.…”

Delayed progressive restenosis of the supraclinoid internal carotid artery treated with percutaneous transluminal angioplasty in a patient with aneurysmal subarachnoid hemorrhage

“…The results ranged from an inability to determine the site of temporary clipping from the uninvolved vessel to completely denuded epithelium, covered with a layer of platelets. In rabbits, Gertz et al 9 conducted a study showing similar range, including endothelial damage and fibrin and platelet aggregation.…”

Histological change in permanently clipped or ligated cerebral arterial wall

“…In this respect reports have been made one after another in recent years by Kawamura et According to Gertz et al 12, who applied the Heifetz clip for temporary clipping of the common carotid artery of rabbits for durations ranging from 5 minutes to 2 hours, and observed the changes which occurred in the tunica interna under a scanning electron microscope, vacuolation, subendothelial oedema, etc. were present in the compressed endothelial cells and, on the peripheral side, there were noted platelets and fibrin that had been adherent on crater, balloon, and injured endothelial cells.…”