Decrease of Thrombosis in Microsurgical Anastomoses: The Use of Intraoperative Pure Intraluminal Unfractionated...

Area of Science:

• Vascular surgery
• Surgical innovation
• Anticoagulation therapy

Background:

• Unfractionated heparin (UFH) is an anticoagulant that catalyzes antithrombin III to inactivate coagulation enzymes.
• UFH can prevent thrombosis during microsurgical anastomoses.
• The study aimed to assess UFH's role in preventing vascular thrombosis via intraoperative lumen irrigation.

Purpose of the Study:

• To evaluate the efficacy of intraoperative vascular lumen irrigation with pure sodium heparin in preventing thrombosis.
• To compare heparin irrigation with physiological salt solution irrigation after end-to-end microsurgical anastomoses.

Main Methods:

• End-to-end anastomoses were performed on rats across cervical, femoral, and tail sites.
• Vessels were irrigated with either physiological salt solution or pure unfractionated heparin (5,000 UI/mL).
• The primary endpoint was the occurrence of thrombosis at 60 minutes post-anastomosis.

Main Results:

• A total of 247 anastomoses were performed; 122 with heparin and 125 with saline.
• Thrombosis occurred in 25% of saline-irrigated anastomoses versus 13% in heparin-irrigated ones.
• Heparin irrigation showed a statistically significant 2.6-fold decrease in the thrombosis rate (p=0.01).

Conclusions:

• Intraoperative lumen irrigation with unfractionated heparin effectively reduces 60-minute vascular thrombosis after microsurgical end-to-end anastomoses.
• Heparin irrigation is a viable strategy for preventing thrombosis in microsurgery.
• This technique offers a significant improvement over standard saline irrigation.