The care of vascular endothelium in pediatric surgery

The influence of manipulating blood vessels by clamping, drying, stretching and surgical anastomotic technique on the subsequent integrity of blood vessel endothelium has been studied in the dog. Thrombogenesis at the vessel surface was found in all specimens where loss of endothelium had exposed subendothelial tissues. Whether thrombotic occlusion of the vessel followed depended upon several local factors including the amount of surface area damaged and volume of blood flow in the vessel. All modes of vessel manipulation studied led to significant endothelial damage. To prevent this damage in the clinical setting all possible methods to avoid the exposure of subendothelial tissues should be used. Endothelial integrity is the cornerstone to success in handling blood vessels and avoiding thrombogenesis. This study suggests that clamping of blood vessels should always be done with a minimum of force, only preventing blood flow, and not crushing the vessel wall. Endothelial surfaces should never be allowed to become dry. Stretching should be avoided as it can lead to thrombosis within intact blood vessels when the endothelium is disrupted. Suture anastomotic techniques should be used which minimize endothelial trauma and thus avoid subendothelial tissue reactions which in turn may jeopardize long-term patency and growth at anastomotic sites. In pediatric cases where growth is anticipated interrupted suture technique should be used. This study suggests that many techniques currently used in vascular surgery may be compromising to short and long-term blood vessel patency.