Perioperative dilation for vessel-size discrepancy using a percutaneous transluminal angioplasty catheter

The problem of vessel-size discrepancy is still unsolved in microvascular-f ree tissue transfers. In an effort to develop a technique perioperatively t o dilate smaller vessel diameters, the authors utilized a catheter customar ily used in coronary angioplasties, the percutaneous transluminal coronary angioplasty (PTCA) catheter. Twenty New Zealand rabbits were divided into t wo groups: Group 1 consisted of 14 experimental animals; Group 2 of six con trol animals. In both groups, a segmental defect of 2 cm was created in the proximal portion of the femoral artery just below the inguinal ligament, w here the vessel diameter is 2.0 +/- 0.1 mm. In Group 1 animals, an arterial graft was harvested from the superficial femoral artery in the contralater al lower extremity, where the vessel diameter is 1.0 +/- 0.1 mm. The arteri al graft along its entire length was dilated, using a PTCA catheter up to 2 mm in diameter. The duration of dilation was 3 min with pressure applied a t 2.5 atm. Before and following dilation, sections were obtained from both ends of the graft for histologic comparison. The grafts were then interpose d within the defect and microvascular anastomoses were performed, In the co ntrol group, an arterial graft of the same length as in the experimental gr oup was harvested from the contralateral upper femoral region, where the Ve ssel diameter is 2.0 +/- 0.1 mm. These grafts were then interposed within t he defect and microsurgically anastomosed. Seven days later, the patency of the anastomoses was evaluated in both groups. In 13 of 14 rabbits in the e xperimental group, the anastomoses were patent and the arterial grafts main tained their dilated diameters (2 mm). In all six control animals, the anas tomoses were patent. A statistical comparison of vessel patency using Fisch er's exact chi-square test showed no significant differences between the ex perimental and control groups (p = 0.7). Histologically, the dilated arteri es demonstrated intact endothelial layers.