Microsurgical Venous Pouch Arterial-Bifurcation Aneurysms in the Rabbit Model: Technical Aspects

This demonstration details, an effective and facilitated microsurgical technique for the creation of venous pouch, arterial bifurcation aneurysms in rabbits begin with isolation of the external jugular vein and preparation of the venous pouch. Then prepare both common carotid arteries. For later anastomosis proceed to create an artificial bifurcation of both common carotid arteries using facilitated techniques.

Finally, suture the venous pouch into this artificially created bifurcation through facilitated microsurgical techniques, prolonged postoperative analgesia and prolonged aggressive anticoagulation. The resulting bifurcation aneurysms in rabbits present low mortality and morbidity rates together with high aneurysm patency rates. The main advantage of this technique over existing methods are the facilitated microsurgical techniques and prolonged postoperative anal gaia and aggressive anticoagulation resulting in high aneurysm patency rates and low morbidity mortality rates.

Using these aneurysms for the evaluation of new endovascular devices of cerebral aneurysm treatment, this method can help answer key questions concerning histologic response of the respective device or resulting long-term stability of the embolized aneurysms. Now I will demonstrate the procedure Under general anesthesia. Fix a 2.5 to 3.5 kilogram female New Zealand white rabbit in a supine position on a body warming plate.

Perform a midline incision from the angle of the jaw down to the manubrium stern eye during the whole operation. Frequently apply 4%Papine hydrochloride solution and antibiotic solution topically on the vessels and anastomosis to prevent vasospasm and local infections. Using the operation microscope, select a one centimeter long segment of the left external jugular vein without venous branches and isolate it micro surgically, ligate the vein proximally and distally with four zero polyfilament sutures.

Then resect it and keep it in heparinized saline. First, prepare a segment of the left common carotid artery reach from the carotid bifurcation down to the aortic arch as far as possible. Preserve arterial branches running medially and supplying laryngeal and tracheal structures, as well as all neural structures.

Continue to prepare the right common carotid artery, mobilize it up to the carotid bifurcation and down to the brachiocephalic trunk. Next, administer 1000 international units of heparin intravenously. Then clip the right common carotid artery temporarily just below the carotid bifurcation, ligate the right common carotid artery proximally directly above the brachiocephalic trunk.

Cut the right common carotid artery above the ligature and irrigate the stump with heparinized saline at the free end of the right common carotid artery. Cut and carefully resect the advent tissue meticulously clip the left common carotid artery both distally and proximally and free. The segment planned for the anastomosis of the advent perform an elliptical arteriopathy of the left common carotid artery between the clips according to the size of the plant anastomosis with the right common carotid artery and the venous pouch irrigate the left common carotid artery with heparinized saline.

Now suture the posterior circumference of the right common carotid artery stump into the arter otomy of the left common carotid artery using four to five non-resorbable 10 zero monofilament sutures. Make a longitudinal cut in the stump of the right common carotid artery to adapt to half the circumference of the venous pouch. Anas tomos the backside of the venous pouch wall with the arter otomy in the left common carotid artery, again using four to 5 10 0 sutures.

Then anes tomos the backside of the venous pouch with the backside of the right common carotid artery with three to four sutures at the anterior side. Repeat the anastomosis in the same order. Now, remove the distal clip on the right common carotid artery.

Note that since the aneurysm is usually not completely sealed, trapped air and debris are washed out. Finally, seal the suture lines around the anastomosis and the aneurysm neck with a fat pad and ever cell fibrin glue. Finally, remove the remaining clips and use four zero resorbable sutures for deep and superficial wound closure.

First, administer 10 milligrams per kilogram of acetyl salicylic acid intravenously and 60 milliliters of 5%glucose subcutaneously. Then apply transdermal fentanyl matrix patches releasing 12.5 micrograms per hour in the shaved neck region of the animals for effective analgesia during 72 hours. Also subcutaneously administer 250 international units per kilogram of low molecular heparin daily for two weeks.

This procedure first isolates the external jugular vein. Then to define the length of the elliptical arter ostomy. The left common carotid artery in the venous pouch are placed beside the right common carotid artery that has been temporarily clipped both proximally and distally.

The anastomosis is performed at the backside. This image exhibits a successfully completed anastomosis. This video demonstrates the key steps leading to high aneurysm patency and low mortality in the creation of venous pouch, arterial bifurcation aneurysms in rabbits with aim of mimicking cerebral aneurysms for the evaluation of new endovascular embolization devices.

Don't forget that working with living animals can be extremely hazardous. Pre precautions such as protection wear should always be taken while performing this procedure. Finally, it is highly important for me to emphasize the ethical value of the living animals resulting in respectful treatment.