The pathogenesis of vascular thrombosis and its impact in microvascular surgery

Esclamado, Ramon M.; Carroll, William R.

doi:10.1002/(sici)1097-0347(199907)21:4<355::aid-hed10>3.0.co;2-y

Cited by 58 publications

(28 citation statements)

References 26 publications

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“…1 All the thrombolytic agents act either directly or indirectly by stimulation of plasminogen. Thrombolytic agents were reviewed in detail in an earlier publication.…”

Section: Pharmacotherapeutics: An Effort To Improve Free Flap Survivalmentioning

confidence: 99%

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Ischemia/reperfusion injury in microvascular surgery

2000

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“…1 All the thrombolytic agents act either directly or indirectly by stimulation of plasminogen. Thrombolytic agents were reviewed in detail in an earlier publication.…”

Section: Pharmacotherapeutics: An Effort To Improve Free Flap Survivalmentioning

confidence: 99%

“…1 In part one, the pathogenesis of suture line thrombosis was discussed. 1 In part one, the pathogenesis of suture line thrombosis was discussed.…”

mentioning

confidence: 99%

Ischemia/reperfusion injury in microvascular surgery

2000

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“…Limitations of this study include the contrived model of injury, a chemical induction of ferric chloride to the surface of an artery [34]. This contrasts with the mechanical injury associated with both balloon-and stent-associated injuries and with the microvascular anastomoses of coronary artery bypass grafting, wherein the balloon, stent, suture injury and vessel edge exposure present collagen and tissue factor to the reflowing blood, creating the thrombogenic stimulus [10,35]. Despite this difference in thrombotic mechanism, once thrombogenesis begins, the propagation of thrombosis is mediated by the accruing clotting elements-activated platelets and coagulation complex assemblies-which lead to the rapid onset of vessel occlusion through platelet aggregation supported by fibrin matrix assembly.…”

Section: Discussionmentioning

confidence: 99%

Timing of Heparin Administration Modulates Arterial Occlusive Thrombotic Response in Rats

Matrai

Kastetter

Cooley

2020

JCDD

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Background: The timing for initiation of effective antithrombotic therapy relative to the onset of arterial thrombosis may influence outcomes. This report investigates the hypothesis that early administration of heparin anticoagulation relative to the onset of thrombotic occlusion will effect a reduction in occlusion. Methods: A standard rat model of experimental thrombosis induction was used, injuring the carotid artery exposure with FeCl 3 -saturated filter paper, followed by flow monitoring for onset of occlusion and subsequent embolization events. Intravenous heparin administration (200 units/mL) was timed relative to the initiation of injury or onset of near occlusion, compared with controls (no heparin administration). Results: No occlusion was found for delivery of heparin 5 min prior to thrombus induction, whereas all vessels occluded without heparin. Unstable (embolic) thrombi were seen with heparin given at or shortly after initial occlusion. Only 9% (1/11) of the vessels had permanent occlusion when heparin was given at the time of thrombotic onset (p < 0.0001 vs. unheparinized), while 50% occluded when heparin was delayed by 5 min (p > 0.05). Conclusions: These findings provide evidence that antithrombotic therapy may need to be administered prior to the onset of anticipated loss of patency, with less effectiveness when given after occlusion has occurred.

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“…If the veins of a free flap are released and the fibrinolytics are injected directly into the flap's circulation, these contraindications do not exist [10]. Furthermore, urokinase is inactivated after 15 minutes.…”

Section: Discussionmentioning

confidence: 99%

Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap

et al. 2013

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We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.

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The pathogenesis of vascular thrombosis and its impact in microvascular surgery

Cited by 58 publications

References 26 publications

Ischemia/reperfusion injury in microvascular surgery

Ischemia/reperfusion injury in microvascular surgery

Timing of Heparin Administration Modulates Arterial Occlusive Thrombotic Response in Rats

Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap

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