ARTERIAL INITIAL FLAPS - A COMPARISON OF PRIMARY REPAIR, ASPIRIN, ANDENDOVASCULAR EXCISION IN AN EXPERIMENTAL-MODEL

The optimal management for traumatic arterial intimal injuries is unre solved. Three therapeutic options were compared in an experimental mod el employing a standard intimal flap created in 51 canine superficial femoral arteries. Group 1 (14 arteries) underwent resection with end-t o-end repair. Group 2 (19 arteries) received acetylsalicylic acid (ASA ) and observation only. Group 3 (21 arteries) underwent endovascular e xcision of the flap with angioscopic guidance. Control intimal flaps ( 18 arteries) were created and observed without further intervention. P atency in group 1 (primary repair) and group 2 (ASA) was 100%; the pat ency in both was significantly (p < 0.05) greater than in the controls , which was 67%. Patency in group 3 (endovascular excision) was 79%. R esidual luminal defects were observed in only 8% of the arteries repai red primarily, but in 76% of the aspirin-treated arteries. Residual lu minal defects following endovascular excision were present in 53% of t he arteries remaining patent. Although resection and primary repair (g roup 1) provided better results than observation alone (control), addi tion of ASA (group 2) also sustained patency. However, a high incidenc e of residual intimal defects occurred, the natural history of which i s unknown. While endovascular excision (group 3) may become a feasible alternative, current technology provided inferior patency with freque nt residual intimal defects. These results suggest that observation al one supplemented with antiplatelet medication (ASA) may be adequate tr eatment, but longer follow-up is necessary for confirmation.