Plastic Surgery Research Council
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Presenter: Qixu Mao, MD
Co-Authors: Huang Y; Zhu S; Tong D; Ibrahim Z; Christensen J; Pang J; Cooney DS; Li J; Li Y; Lee WP; Kang JU; Brandacher G
Johns Hopkins University School of Medicine

Purpose: Microsurgical vascular anastomotic techniques have greatly expanded the surgeon s armamentarium. With advances in state-of-the-art operating microscopes, surgeons can now perform reconstructive procedures using vessels of an increasingly small calibers (diameter < 0.8 mm). Although currently clinical microsurgery has achieved high success rates, the risk of intra/post-operative anastomotic thrombosis continues to plague patient outcomes. Real-time diagnosis of thrombus formation would facilitate earlier re-operation, anticoagulation treatment and reduce flap failure rates. We sought to apply real-time three-dimensional Fourier-domain optical coherence tomography (3DFD-OCT) as effective method for in vivo monitoring vascular thrombosis and thrombolysis.

Methods: We developed a murine model of femoral arterial thrombosis using 3DFD-OCT for real-time intravital imaging. 10% Ferric chloride (FeCl3) solution was used to induce thrombogenesis. Heparins (200 units/kg) were injected into mice by tail vein after early stage of thrombus formation in the experimental vessel and detection by 3DFD-OCT. 3DFD-OCT running at 70,000 A-scans per second with lateral resolution of 12 m and axial resolution of 3.6 m was used for intravital imaging. Experimental vessels were harvested for hematoxylin and eosin (H&E) staining.

Results: Femoral arterial thrombus commenced to form at 4 min after initiation of FeCl3-induced injury of the femoral artery. and complete vessel occlusion occurred at around 12 min. We were able demonstrate that 3DFD-OCT can be used to monitor the whole pathophysiological cascade of thrombogenesis and the effect of an anticoagulation treatment until complete resolution of the thrombus by 2D tomographic slide, 3D anatomic and Doppler image, and mean velocity of blood flow (Figure 1). Thrombus formation confirmed by H&E histology (Figure 2) correlated with 3DFD-OCT imaging.

Conclusion: 3DFD-OCT enables to assess arterial thrombosis and thrombolysis in real-time, non-invasively and at high-, three-dimensional reduce complications and patient morbidity after microvascular reconstructive procedures.

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