The End-to-Side Anastomosis: A Comparative Analysis of Arterial Models in the Rat.

BACKGROUND: The end-to-side anastomosis is 1 of the most common anastomosis configurations used in cerebrovascular surgery. Although several living practice models have been proposed for this technique, few involve purely arterial vessels. The purpose of the present study was to compare 2 arterial models using common carotid arteries (CCAs) and common iliac arteries (CIAs) in rats.

METHODS: The CIAs and CCAs were exposed in 10 anesthetized rats, and their lengths and diameters were measured. Also, the mobilization extent of each vessel along its contralateral counterpart was measured after each artery had been transected at its proximal exposure point. We also studied the technical advantages and disadvantages of each model for practicing end-to-side anastomosis.

RESULTS: The average diameters of the CCA and CIA were 1.1 and 1.3 mm, respectively. The average extent of mobilization along the contralateral vessel was 13.9 mm and 10.3 mm for CCA and CIA, respectively. The CCA model had the advantages of greater arterial redundancy (allowing completion of both suture lines extraluminally) and a minimal risk of venous injury. The main disadvantage of the CCA model was the risk of cerebral ischemia. The CIA model was not limited by the ischemic time and provided the technical challenge of microsurgical dissection of the common iliac vein from the CIA, although it had limited CIA redundancy.

CONCLUSIONS: Both CCA and CIA models could be efficiently used for practicing the end-to-side anastomosis technique. Each model provides the trainee with a specific set of advantages and disadvantages that could help with the optimal selection of the practice model according to trainee's skill level.