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[Injury to ascending aorta by cross-clamp--histologic evaluation]
T Takano1, Y Fukaya, H Tsunemoto
1Department of Surgery, Shinshu University, Matsumoto, Japan.
Insights
Vascular clamp trauma to the ascending aorta increases with higher occlusive intensity. Microscopic examination revealed severe damage at the proximal site due to significant clamp pressure.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Histopathology
Context:
- Aortic dissection necessitates surgical intervention, often involving aortic arch and ascending aorta replacement.
- Cross-clamping the ascending aorta is a critical step during these procedures.
- Understanding clamp-induced vessel trauma is crucial for optimizing surgical techniques.
Purpose:
- To microscopically evaluate ascending aorta injury caused by vascular cross-clamping.
- To correlate the degree of vessel wall trauma with the measured occlusive intensity of the clamp.
Summary:
- Six patients undergoing aortic dissection repair had their ascending aorta segments analyzed post-resection.
- Vessel segments were examined microscopically for trauma (Grade 1-3) and clamp intensity was measured.
- Higher clamp pressure correlated with more severe histological changes, including intima disruption and endothelial cell loss.
Impact:
- Findings demonstrate a direct relationship between vascular clamp pressure and ascending aorta injury.
- This highlights the need for careful clamp management to minimize iatrogenic trauma during aortic surgery.
- Results can inform the development of safer clamping strategies and improved patient outcomes.
Abstract:
To evaluate the injury to ascending aorta by cross-clamp, the trauma to the vessel wall was examined microscopically and the occlusive intensity of the vascular clamp was measured. Six patients were underwent total replacement of the ascending aorta and the aortic arch for aortic dissection. The ascending aorta and the aortic arch were resected during operation, the clamped regions of the ascending aorta were cut into the four pieces (the distal site, two part of the medial site, the proximal site applied by the vascular clamp) after operation. The four pieces of the ascending aorta were examined microscopically. The occlusive intensity of the vascular clamp were measured at the distal site, the medial site, and the proximal site by the load-measuring scale. The trauma to the vessel wall were classified to three degrees (grade 1 to grade 3). Grade 1 showed the minimal changes--narrowing of interstices between collagen fibers and muscle fibers in the media. Grade 2 showed the moderate changes--decrease of collagen fibers, atrophy and disruption of smooth muscle and elastic fiber in the media. Grade 3 showed the severe changes--disruption of the intima and defluvium of endothelial cells. The occlusive intensity of the vascular clamp were 1.0 kg at the distal site, 1.9 kg at the medial site and 3.6 kg at the proximal site, respectively. In the microscopic examinations, grade 1 changes were most frequent at the distal site, grade 1 and grade 2 changes were observed equally at the medial site, grade 3 change was observed only at the proximal site. The degree of the trauma to the vessel wall becomes severer in proportion to increase of the occlusive intensity of the vascular clamp.