Scanning electron microscopic observations on the endothelial healing mechanism of vessels

Systematic scanning electron microscopic observations of the healing mechanism in the endothelium of rat carotid arteries were carried out at the site of anastomosis. The site of needle holes and stitches are the main locations for thrombocyte adhesion and aggregation in normal vascular anastomosis. The repair process in endothelial injury can be divided into three stages. A thrombocyte-adhesion and filling stage is apparent at 1 hr postoperatively; this is also the period when thrombus is most likely to occur. A fibrin-covering stage is apparent at 2 hr after operation and reaches its peak in 24 hr. The formation of fibrin provides a framework for endothelial growth. In this period, there is still the possibility of thrombus formation. At 48 hr postoperatively, endothelial growth can be seen at the site of some needle holes. At 72 hr after operation, 47 percent of needle holes have endothelial growth, and the possibility of thrombus formation at the anastomotic site declines. The data suggest that eversion of the intima in vascular anastomosis and minimization of endothelial injury by considering the size of the needle hole, the duration of ischemia time, and perfection of surgical technique, are keys to the prevention of thrombus formation at the anastomotic site.