Tamer TÜRK, Gündüz YÜMÜN, İlkin ÇAVUŞOĞLU, Derih AY, Önder BOZKURT, Arif GÜCÜ, Faruk KÜÇÜKYILDIZ, Faruk TOKTAŞ

Mikrovasküler klemp ile sıçan aortu oklüzyonunun vasküler endotel hasarı oluşturma etkisinin incelenmesi: Deneysel çalışma

Amaç: Bu çalışmada atravmatik mikrovasküler damar klempi ile sıçan aortu oklüde edilerek, endotel hasarının potansiyel etkisi araştırıldı. Çalışma planı: Çalışmada 15 adet ağırlıkları 300-400 gr olan 3-4 aylık Wistar Albino cinsi dişi sıçan uyutuldu ve abdominal aortu median lapaorotomi ile alındı. Abdominal aort distal segmentine mikrovasküler klemp konuldu. Yaklaşık olarak 10 dakika sonunda oklüde edilen segment mikrovasküler klemp ile birlikte çıkarıldı ve klemp grubu olarak kabul edildi. İnsizyon proksimale doğru uzatılarak torakal aort eksplore edildi. Torasik aort segment örnekleri, kontrol grubu olarak kabul edildi. Bu iki örnekleme grubu taramalı elektron mikroskop incelemesine hazırlandı. İnceleme tek kör yöntemle yapıldı ve sonuçlar istatistiksel değerlendirmeyle yorumlandı. Bulgular: Kontrol grubundaki hiçbir örnekte endotel hasarı saptanmadı. Mikrovasküler klemp grubundaki 10 örnekte tip 1 hasar (%66.7), dört örnekte tip 2 hasar (%26.6), bir örnekte tip 3 hasar (%6.6) saptandı. Mikrovasküler klemp grubuyla kontrol grubu arasında endotel hasarı oluşması açısından istatistiksel anlamlı fark olduğu belirlendi (p< 0.0 01). Sonuç: Mikrovasküler klemp ile vasküler oklüzyon sağlanması, damar endotelinde hasara neden olmaktadır. Tip 2 ve tip 3 endotel hasarı endotel yüzeyi üzerinde kalıcı hasar oluşması nedeniyle erken veya geç dönem tromboz veya restenoza neden olabileceğini düşünüyoruz.

The investigation of the effect of endothelial damage of rat aorta occlusion with microvascular clamp: An experimental study

Background: In this study, we investigated the potential effect of the endothelial damage by occluding the rat aorta through atraumatic microvascular clamp application. Methods: Fifteen 3-4 month old Wistar Albino type female rats weighted 300-400 g were anesthetized and the abdominal aorta was explored with median laparotomy. Distal segment of the abdominal aorta was clamped with a microvascular clamp. After almost 10 minutes, occluded segment with microvascular clamp was excised and defined as the clamp group. The incision lengthened proximally and thoracic aorta was explored. The samples of the thoracic aorta segment were defined as the control group. These two sampling groups were prepared for scanning electron microscopy. The analysis is performed by a single blind method and results were analyzed statistically. Results: No endothelial damage was observed in the samples of the control group. In microvascular clamp group, there was type 1 damage in 10 samples (66.7%), type 2 damage in four samples (26.6%) and type 3 damage in one sample (6.6%). The difference between microvascular clamp and control group was statistically significant in terms of endothelial damage (p

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1.Calafiore AM, Giammarco GD, Teodori G, Bosco G, DAnnunzio E, Barsotti A, et al. Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass. Ann Thorac Surg 1996;61:1658-63.
2.Hangler HB, Pfaller K, Antretter H, Dapunt OE, Bonatti JO. Coronary endothelial injury after local occlusion on the human beating heart. Ann Thorac Surg 2001;71:122-7.
3.Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993;362:801-9.
4.Clarkson TB, Weingand KW, Kaplan JR, Adams MR. Mechanisms of atherogenesis. Circulation 1987;76:I20-8.
5.Furchgott RF, Vanhoutte PM. Endothelium-derived relaxing and contracting factors. FASEB J 1989;3:2007-18.
6.Vanhoutte PM. The endothelium--modulator of vascular smooth-muscle tone. N Engl J Med 1988;319:512-3.
7.Billiar TR. Nitric oxide. Novel biology with clinical relevance. Ann Surg 1995;221:339-49.
8.Lüscher TF, Tanner FC, Tschudi MR, Noll G. Endothelial dysfunction in coronary artery disease. Annu Rev Med 1993;44:395- 418.
9.Wilentz JR, Sanborn TA, Haudenschild CC, Valeri CR, Ryan TJ, Faxon DP. Platelet accumulation in experimental angioplasty: time course and relation to vascular injury. Circulation 1987;75:636-42.
10.Fingerle J, Johnson R, Clowes AW, Majesky MW, Reidy MA. Role of platelets in smooth muscle cell proliferation and migration after vascular injury in rat carotid artery. Proc Natl Acad Sci U S A 1989;86:8412-6.
11.Davies MG, Hagen PO. Pathobiology of intimal hyperplasia. Br J Surg 1994;81:1254-69.
12.Ip JH, Fuster V, Badimon L, Badimon J, Taubman MB, Chesebro JH. Syndromes of accelerated atherosclerosis: role of vascular injury and smooth muscle cell proliferation. J Am Coll Cardiol 1990;15:1667-87.
13.Okazaki Y, Takarabe K, Murayama J, Suenaga E, Furukawa K, Rikitake K, et al. Coronary endothelial damage during off-pump CABG related to coronary-clamping and gas insufflation. Eur J Cardiothorac Surg 2001;19:834-9.
14.Chavanon O, Perrault LP, Menasché P, Carrier M, Vanhoutte PM. As originally published in 1996: Endothelial effects of hemostatic devices for continuous cardioplegia or minimally invasive operations. Updated in 1999. Ann Thorac Surg 1999;68:1118-20.
15.Gertz SD, Rennels ML, Forbes MS, Kawamura J, Sunaga T, Nelson E. Endothelial cell damage by temporary arterial occlusion with surgical clips. Study of the clip site by scanning and transmission electron microscopy. J Neurosurg 1976;45:514-9.
16.Gucu A, Ener S, Cavusoglu I, Kaya FN, Ozcınar E, Atasoy S, et al. Koroner anastomoz alanına hava üflenmesi ve endotel hasarı. Turk Gogus Kalp Dama 2002;10:87-91.
17.Hangler H, Mueller L, Ruttmann E, Antretter H, Pfaller K. Shunt or snare: coronary endothelial damage due to hemostatic devices for beating heart coronary surgery. Ann Thorac Surg 2008;86:1873-7.