Microvascular surgery and diseased vessels

Hardly any data exist concerning the effects of arterial vessel disease on the results of microvascular surgery. As the scope of microvascular surgery expands, diseased vessels will surely be encountered more frequently. Therefore an experiment was performed in rabbits who were fed a cholesterol-enriched diet for 3 months. Then an anastomosis was made in both carotid and femoral arteries (total of 65 arteries) with microsurgical techniques. The diet was continued until the animals were killed at fixed times from 1 day to 4 months. The overall patency rate at the time of death was 91.8%. At the time of the operation two situations were present: hypercholesterolemia without any macroscopic changes and hypercholesterolemia with evident macroscopic atherosclerotic lesions. Atherosclerotic lesions in these small arteries present technical surgical difficulties, and direct results will depend on the skill and experience of the surgeon. Hypercholesterolemia without any macroscopic changes, in combination with the trauma of the operation, will lead to an accelerated formation of atherosclerotic changes. Lesions already present will progress in size. Both events lead to narrowing of the lumen at a later stage.