End-to-end arterial anastomosis with fibrin glue in larger arteries: histology, hydroxyproline concentration and tensile strength study in carotids of rabbits
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Data
2002-02-01
Autores
Yoshida, Winston Bonetti [UNESP]
Naresse, Luiz Eduardo [UNESP]
Rodrigues, Antonio C. [UNESP]
Fabris, Viciany Erique [UNESP]
Angeleli, Aparecida Y. [UNESP]
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Editor
Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Resumo
A anastomose arterial término-terminal é demorada, requer tempo prolongado de oclusão vascular e esta associada a necrose focal, infiltração leucocitária e, conseqüentemente, à fibrose e calcificação da parede arterial. A cola de fibrina é uma alternativa para a anastomose microvascular e pode evitar estas alterações com menor aderência aos tecidos vizinhos e melhor coaptação das bordas arteriais. OBJETIVO: Comparar o processo cicatricial de anastomoses convencionais com anastomoses feitas com cola de fibrina em artérias maiores. MÉTODOS: em 22 coelhos, ambas carótidas foram seccionadas transversalmente e reconstruídas por meio de anastomose término-terminal com 4 pontos simples de reparo e cola de fibrina de um lado (G1), e com 8 pontos separados do outro lado (G2). Após 3 e 15 dias, os animais foram destinados aleatoriamente para estudo de força tênsil concentração de hidroxiprolina (8 animais) e avaliação histológica das anastomoses (3 animais). As lâminas histológicas foram coradas pelo HE Masson e Picrossirius polarização (PSP). RESULTADOS: Após 3 e 15 dias a força tênsil aumenta em ambos os grupos, de 280,0± 32,6g para 432,2± 131,2g no Grupo 1 e de 221,4± 72,4g para 452,2± 132,0g no Grupo 2; sem diferença estatística entre os grupos em cada período. A concentração de hidroxiprolina expressa como razão hidroxiprolina/proteína, variou de 0,0816± 0,0651 para 0,0622± 0,0184 no Grupo 1 e de 0,0734± 0,0577 para 0,0460± 0,0271 no Grupo 2; sem diferença estatística entre os períodos e grupos. Os estudos histológicos mostraram discreto aumento das reações de inflamação e reparação no Grupo 2. A técnica PSP mostrou predomínio do colágeno tipo I em relação do colágeno tipo II nas anastomoses de ambos os grupos, sem diferença expressiva entre esses grupos. CONCLUSÃO: A anastomose com a cola de fibrina foi menos lesiva para a parede arterial do que a anastomose convencional. Mesmo usando menos pontos, as características de força tênsil e de cicatrização da anastomose com cola de fibrina foram similares em ambos os grupos. Os tempos de realização das anastomoses foram significativamente maiores do que na anastomose convencional.
End-to-end conventional arterial anastomosis is time consuming, requires prolonged clamping times and is associated with focal necrosis, granulocyte infiltration and subsequently, fibrosis and calcification of the arterial wall. Fibrin glue as an alternative for microarterial anastomosis may obviate these lesions, with less adherence to adjacent tissues and better coaptation of the arterial margins. OBJECTIVE: In this study we compared the healing process of conventional to fibrin glue end-to-end anastomosis in larger arteries. METHODS: In 22 rabbits, both carotid arteries were cross sectioned and repaired by end-to-end anastomosis with 4 interrupted sutures and fibrin glue in one side (GI) and with 8 conventional interrupted sutures in the other side (G2). After 3 and 15 days, the animals were randomly allocated for tensile strength, hydroxyproline determination (8 animals), and histologic analysis of the anastomosis (3 animals). Conventional staining procedures (hematoxylin-eosin and Masson methods) and picrosirius red polarization (PSP) technique for collagen type determination were employed. RESULTS: From 3 to 15 days, the tensile strength increased in both groups, from 280.0± 32.6 g to 432.2± 131.2g in Group I and from 221.4± 72.4g to 452.2± 132.0g in Group 2 (p<0.001), with no statistical difference between the groups in each period of the study. The hydroxyproline content, expressed as hydroxyproline /protein ratio, varied from 0.0816 ± 0.0651 to 0.0622 ± 0.0184 in Group l and from 0.0734 ± 0.0577 to 0.0460 ± 0.0271 in Group 2, with no significant difference between periods and groups (p>0.05). Histology showed slight increase of inflammatory and reparative reactions in Group 2. PSP technique demonstrated predominant type I collagen in relation to type III collagen in the anastomosis of both groups, with no significant difference between them. CONCLUSION: Fibrin glue was less harmful to the arterial wall than conventional suture. Even using less sutures in fibrin glue anastomosis, similar tensile strength and healing characteristics were noted in both groups. Completion times for the fibrin glue group was significantly greater than for the conventional anastomosis.
End-to-end conventional arterial anastomosis is time consuming, requires prolonged clamping times and is associated with focal necrosis, granulocyte infiltration and subsequently, fibrosis and calcification of the arterial wall. Fibrin glue as an alternative for microarterial anastomosis may obviate these lesions, with less adherence to adjacent tissues and better coaptation of the arterial margins. OBJECTIVE: In this study we compared the healing process of conventional to fibrin glue end-to-end anastomosis in larger arteries. METHODS: In 22 rabbits, both carotid arteries were cross sectioned and repaired by end-to-end anastomosis with 4 interrupted sutures and fibrin glue in one side (GI) and with 8 conventional interrupted sutures in the other side (G2). After 3 and 15 days, the animals were randomly allocated for tensile strength, hydroxyproline determination (8 animals), and histologic analysis of the anastomosis (3 animals). Conventional staining procedures (hematoxylin-eosin and Masson methods) and picrosirius red polarization (PSP) technique for collagen type determination were employed. RESULTS: From 3 to 15 days, the tensile strength increased in both groups, from 280.0± 32.6 g to 432.2± 131.2g in Group I and from 221.4± 72.4g to 452.2± 132.0g in Group 2 (p<0.001), with no statistical difference between the groups in each period of the study. The hydroxyproline content, expressed as hydroxyproline /protein ratio, varied from 0.0816 ± 0.0651 to 0.0622 ± 0.0184 in Group l and from 0.0734 ± 0.0577 to 0.0460 ± 0.0271 in Group 2, with no significant difference between periods and groups (p>0.05). Histology showed slight increase of inflammatory and reparative reactions in Group 2. PSP technique demonstrated predominant type I collagen in relation to type III collagen in the anastomosis of both groups, with no significant difference between them. CONCLUSION: Fibrin glue was less harmful to the arterial wall than conventional suture. Even using less sutures in fibrin glue anastomosis, similar tensile strength and healing characteristics were noted in both groups. Completion times for the fibrin glue group was significantly greater than for the conventional anastomosis.
Descrição
Palavras-chave
Cola de fibrina, Artérias, Cicatrização, Colágeno, Anastomoses, Fibrin glue, Arteries, Wound healing, Sutures, Collagen
Como citar
Acta Cirúrgica Brasileira. Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, v. 17, n. 1, p. 4-11, 2002.