The effects of intra-arterially injected adriamycin on microvascular anastomosis

Although free tissue transfer following limb-saving wide resection has become increasingly necessary in the treatment of sarcomas of the extremities, the side effects of adjuvant chemotherapy on the microvascular structure are not yet known. There may be significant effects, especially with intra-arterial administration. In order to study the time-dependent manifestations of possible effects, experimental microvascular anastomoses in the rat femoral artery were performed at various intervals, after intra-arterial injection of Adriamycin. This drug was used because of its popularity as an adjuvant chemotherapeutic agent. Vessels were examined at varying intervals for macroscopic changes affecting patency and for histologic changes. Anastomoses done at three weeks after Adriamycin injection resulted in the worst patency rate. Histologically, thrombotic occlusion was associated with widespread and profound disruption of the internal elastic lamina, thought to be thrombogenic trauma: the vessel was presumed to have been made fragile by preoperative Adriamycin treatment. Five weeks or longer after injection, this effect was reduced, according to patency rates and histologic findings. Endothelial damage was minimal and appeared insignificant.