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Thrombolysis in microvascular surgery using tissue-type plasminogen activator.

J E Romano1, M A Biel

  • 1Department of Otolaryngology, University of Minnesota, Minneapolis.

Archives of Otolaryngology--Head & Neck Surgery
|November 1, 1989
PubMed
Summary

Local infusion of tissue-type plasminogen activator effectively resolves microvascular thrombosis in a rabbit model. This thrombolytic therapy reestablished blood flow without causing significant systemic fibrinolysis, offering a promising solution for free flap survival.

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Area of Science:

  • Vascular Surgery
  • Thrombosis Research
  • Pharmacology

Background:

  • Microanastomotic thrombosis is a leading cause of free flap failure.
  • Tissue-type plasminogen activator (tPA) is a potent thrombolytic agent.
  • Effective strategies are needed to prevent flap loss due to thrombosis.

Purpose of the Study:

  • To evaluate the efficacy of local tissue-type plasminogen activator infusion in a rabbit microvascular thrombosis model.
  • To assess the impact of local tPA on systemic fibrinolysis.

Main Methods:

  • A modified vascular inversion graft model was used in 17 rabbits.
  • Thrombosis was induced at the microanastomotic site.
  • Ten rabbits received local tPA infusion (1 mg over 4 hours); 6 controls received saline.

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Main Results:

  • Blood flow was restored in all 10 rabbits treated with local tPA.
  • No blood flow restoration occurred in the 6 control rabbits.
  • Systemic fibrinolysis markers were not significantly altered by local tPA infusion.

Conclusions:

  • Local infusion of tissue-type plasminogen activator is effective in lysing microvascular thromboses at the anastomotic site.
  • This localized approach reestablishes blood flow without significant systemic fibrinolytic activation.
  • Local tPA presents a viable option for preventing free flap failure due to venous thrombosis.