Evaluation of microvascular anastomosis using real-time, ultra-high-resolution, Fourier domain Doppler optical coherence tomography.
Evaluation of microvascular anastomosis using real-time, ultra-high-resolution, Fourier domain Doppler optical coherence tomography.
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DOI：
10.1097/prs.0000000000001124
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发表时间：
2015-04
影响因子：
3.6
通讯作者：
Kang JU
中科院分区：
文献类型：
--
作者：
Huang Y;Tong D;Zhu S;Wu L;Mao Q;Ibrahim Z;Lee WPA;Brandacher G;Kang JU
显微外科技术和工具的发展和改进为临床领域中血管直径通常接近0.8 mm以下，在小鼠模型中甚至更小（0.2-0.3 mm）的超显微外科血管病变铺平了道路。已经引入了几种成像和监测设备用于术后监测，但是术中指导、评估和可预测性仍然限于双目光学显微镜和外科医生的经验。我们提出了一种高分辨率的真实的时间三维成像模式，用于术中评估管腔狭窄，血栓形成和血流改变。相位分辨多普勒光学相干断层扫描（PRDOCT）是一种能够提供即时、深入的高分辨率三维结构视图和血流信息的成像模式。用PRDOCT对22例小鼠股动脉栓塞和17例小鼠静脉栓塞进行了评价。根据PRDOCT成像结果分析血流状态、血管内腔3D结构和早期血栓检测。基于PRDOCT的初始预测与实际长期手术结果相关。最后进行了4例小鼠原位肢体移植，PRDOCT预测的远期通畅率得到了实际结果的证实。PRDOCT能够提供血管流动状态和血管内腔的高分辨率3D可视化。基于PRDOCT可视化的评估显示，动脉栓塞的敏感性和特异性分别为92%和90%，静脉栓塞的敏感性和特异性分别为90%和86%。PRDOCT是评价微血管吻合的有效工具。它能以较高的敏感性和特异性预测血管的长期通畅。
Evolution and improvements in microsurgical techniques and tools have paved the way for super-microsurgical anastomoses with vessel diameters often approaching below 0.8 mm in the clinical realm and even smaller (0.2–0.3 mm) in murine models. Several imaging and monitoring devices have been introduced for post-operative monitoring but intra-operative guidance, assessment and predictability have remained limited to binocular optical microscope and surgeon’s experience. We present a high-resolution real time 3D imaging modality for intra-operative evaluation of luminal narrowing, thrombus formation and flow alterations. An imaging modality that provides immediate, in-depth high resolution 3D structure view and flow information of the anastomosed site called phase resolved Doppler optical coherence tomography (PRDOCT) was developed. 22 mouse femoral artery anastomoses and 17 mouse venous anastomoses were performed and evaluated with PRDOCT. Flow status, vessel inner lumen 3D structure, and early thrombus detection were analyzed based on PRDOCT imaging results. Initial PRDOCT based predictions were correlated with actual long term surgical outcomes. Eventually four cases of mouse orthotopic limb transplantation were carried out and PRDOCT predicted long term patency were confirmed by actual results. PRDOCT was able to provide high-resolution 3D visualization of the vessel flow status and vessel inner lumen. The assessments based on PRDOCT visualization shows a 92% sensitivity and 90% specificity for arterial anastomoses and 90% sensitivity and 86% specificity for venous anastomoses. PRDOCT is an effective evaluation tool for microvascular anastomosis. It can predict the long term vessel patency with high sensitivity and specificity.