Experimental model for sutureless proximal anastomosis by the viabahn open revascularization technique (VORTEC)

Abstract Introduction: In the treatment of complex aneurysms, debranching is an extra-anatomical revascularization of visceral arteries followed by endograft coverage of the thoracoabdominal aorta. It eliminates the need for a thoracotomy and aortic clamping, but requires the performance of several technically demanding visceral anastomosis. In 2008, Lachat described visceral revascularization with the use of a sutureless distal anastomosis, performed by the telescoping of an endograft in the visceral branch, named VORTEC (Viabahn Open Revascularization TEChnique). Objective: An experimental model was created to test the feasibility and short term results of performing a telescoped proximal anastomosis to the abdominal aorta. Methods: Swine model. The abdominal aorta was dissected and ligated between the renal arteries and the iliac vessels. Three centimeters bellow the renal arteries a Viabahn endograft was telescoped for 2 cm into the proximal aorta. The other extremity was conventionally anastomosed to the distal aorta. Patency, sealing and tensile strength of the anastomosis were tested. Results: Time for performing the telescoped anastomosis was shorter (5.4±2.8 min versus 10.3±3.4 min, P<0.05). All grafts were patent and both types of anastomosis presented no bleeding. Immediate tensile strength showed a higher strength of the conventional suture (22.7 x 14.3 N, P<0.09). After 30 days there was no pseudo-aneurysms and the strength of the conventional and VORTEC anastomosis were similar (37.3 x 40.8 N, respectively, P=0.17). Conclusion: Telescoped proximal anastomosis by the technique of VORTEC is feasible. After 30 days the tensile strength of the both anastomosis were similar.

How does static stretching influence the tendons mechanical response?

OBJECTIVE: Analyze in vitro the mechanical response of bovine calcaneus tendons subjected to static stretching in three different intervals (15, 30, 45 s). METHODS: Six groups of bovine calcaneus tendons (n=10) were formed according to the static stretching protocol: three different intervals (15, 30, 45 s) and initial stretching percentage (2.5% and 3.5%). The control group (n=10) did not perform prior stretching. At the end of the stretching tests, the specimens were subjected to stress rupture tests. RESULTS: The values for force relaxation presented stability after the 30(th) second (p<0.0001) at both levels of deformation. Greater force relaxation (p<0.0026) and the least tensile strength (p=0.0123) was observed in the group that was subjected to the highest stretch percentage (3.5%). No difference was observed between the rupture parameters of the stretch and control groups. The variables, stretch duration and percentage did not demonstrate interaction. CONCLUSION: In relation to force relaxation, the 30 second interval seems to be the most effective when stretching tendons. This fact should be considered when establishing new clinical stretching protocols. Laboratory investigation.

Tempo e o percentual de alongamento estático influenciam a resposta mecânica do tendão? / How does static stretching influence the tendons mechanical response?

OBJETIVO: Analisar in vitro, a resposta mecânica de tendões calcâneo bovino, submetidos ao alongamento estático e avaliar a influência do alongamento no evento lesivo.MÉTODOS: Seis grupos de espécimes de tendões calcâneos bovinos (n=10) foram submetidos a alongamento estático: três intervalos (15, 30, 45 segundos) e percentuais de alongamento inicial (2,5 e 3,5%). O grupo controle (n=10) não realizou alongamento prévio. Ao termino do ensaio de alongamento, os espécimes foram submetidos ao ensaio de ruptura.RESULTADOS: Os valores de relaxamento de força apresentaram estabilização a partir do trigésimo segundo (p<0.0001) nos dois níveis de deformação estudados. Foi observado maior relaxamento de força (p<0.0026) e menor tensão de ruptura (p = 0.0123) para o grupo submetido a maior taxa de alongamento percentual (3,5%). Não houve diferença nos parâmetros de ruptura entre os grupos alongamento e controle. As variáveis tempo e percentual de alongamento não apresentaram interação.CONCLUSÃO: Considerando-se o relaxamento de estresse, o intervalo de 30 segundos parece ser o mais efetivo no alongamento de tendões, fato a ser considerado no estabelecimento de novos protocolos clínicos de alongamento. Trabalho experimental.

OBJECTIVE: Analyze in vitro the mechanical response of bovine calcaneus tendons subjected to static stretching in three different intervals (15, 30, 45 s).METHODS: Six groups of bovine calcaneus tendons (n=10) were formed according to the static stretching protocol: three different intervals (15, 30, 45 s) and initial stretching percentage (2.5% and 3.5%). The control group (n=10) did not perform prior stretching. At the end of the stretching tests, the specimens were subjected to stress rupture tests.RESULTS: The values for force relaxation presented stability after the 30th second (p<0.0001) at both levels of deformation. Greater force relaxation (p<0.0026) and the least tensile strength (p=0.0123) was observed in the group that was subjected to the highest stretch percentage (3.5%). No difference was observed between the rupture parameters of the stretch and control groups. The variables, stretch duration and percentage did not demonstrate interaction.CONCLUSION: In relation to force relaxation, the 30 second interval seems to be the most effective when stretching tendons. This fact should be considered when establishing new clinical stretching protocols. Laboratory investigation.

The optical analysis of the abdominal wall using the biospeckle after implants of polypropylene mesh in rats.

PURPOSE: To evaluate an experimental animal model to study the abdominal tissue activity considering its interaction with a polypropylene mesh, through the use of one of the optical phenomena of light Laser, the biospeckle. METHODS: Fifty Wistar male rats were divided into four groups: Group 1: ten animals not submitted to surgery; Group 2: ten animals submitted to surgery without polypropylene mesh; Group 3: 20 animals submitted to surgery followed by the mesh placement; Group 4: (sham) with ten animals. None of the animals presented post surgical complications being submitted to the optical tests at the 20th postoperative day. RESULTS: The analysis from the biospeckle tests, comparing the medians and standard deviations with T Student test, indicated that no significative difference was observed on the abdominal wall tissue activity in the four groups considered, with and without polypropylene mesh prosthesis implantation. CONCLUSION: The animal model is viable and the biospeckle open ways for a great number of experiments to be developed in evaluating tissue activity.

The optical analysis of the abdominal wall using the biospeckle after implants of polypropylene mesh in rats / Análise ótica da parede abdominal pelo biospeckle após implante de prótese de polipropileno em ratos

PURPOSE: To evaluate an experimental animal model to study the abdominal tissue activity considering its interaction with a polypropylene mesh, through the use of one of the optical phenomena of light Laser, the biospeckle. METHODS: Fifty Wistar male rats were divided into four groups: Group 1: ten animals not submitted to surgery; Group 2: ten animals submitted to surgery without polypropylene mesh; Group 3: 20 animals submitted to surgery followed by the mesh placement; Group 4: (sham) with ten animals. None of the animals presented post surgical complications being submitted to the optical tests at the 20th postoperative day. RESULTS: The analysis from the biospeckle tests, comparing the medians and standard deviations with T Student test, indicated that no significative difference was observed on the abdominal wall tissue activity in the four groups considered, with and without polypropylene mesh prosthesis implantation. CONCLUSION: The animal model is viable and the biospeckle open ways for a great number of experiments to be developed in evaluating tissue activity.

OBJETIVO: Avaliar o modelo experimental animal para o estudo da atividade tecidual da parede abdominal em sua interação com a prótese de polipropileno, através da utilização de um dos fenômenos ópticos da luz Laser, o biospeckle. MÉTODOS: Foram utilizados 50 ratos Wistar machos, divididos em quatro grupos: Grupo 1 com 10 animais não operados e controles; Grupo 2 com 10 animais submetidos a cirurgia sem a colocação de prótese; Grupo 3 com 20 animais submetidos a cirurgia com colocação de prótese de polipropileno pré-peritonial; Grupo 4 (Sham) com 10 animais. Nenhum animal apresentou complicações pós-operatórias, sendo que no 20º PO foram submetidos ao ensaio óptico. RESULTADOS: A comparação das médias e o desvio padrão das medidas da atividade tecidual da parede abdominal, com e sem implantação da prótese de polipropileno obtidas dos grupos de animais, pelo teste T de Student, não evidenciou diferença estatística significativa (p>0.05). CONCLUSÃO: A análise dos dados obtidos permitiu concluir que o modelo animal é viável e que o biospeckle abre caminhos para toda uma linha de experimentos a ser desenvolvida em avaliar atividade tecidual.

Estudo da perda da tensão do enxerto de tendão calcâneo bovino / Tension loss of a bovine calcaneus tendons

A lesão do ligamento cruzado anterior do joelho (LCA) é um problema que afeta tanto os animais como os seres humanos, e pode evoluir com instabilidade articular, muitas vezes, sintomática e incapacitante para o paciente. Os enxertos de tendões autólogos são a principal opção como substitutos ligamentares. Durante a reconstrução cirúrgica do LCA, o enxerto é submetido a tensionamento com o objetivo de restabelecer a lassidão normal do joelho LCA-deficiente. Embora o tensionamento do enxerto exerça papel fundamental na evolução clínica pós-operatória, a literatura ainda não estabeleceu os níveis ideais de tensionamento a serem aplicados. Assim, o estiramento ou elongamento do enxerto que pode ocorrer com o passar do tempo permanece como uma das principais causas da falha da reconstrução ligamentar.Neste trabalho, dez tendões de calcâneo bovino foram submetidos a dois ensaios sucessivos de tensionamento fisiológico a deformação relativa máxima de 2.5% do comprimento inicial do tendão ensaiado, mantida durante 600s, sendo registrados os valores de força (N) no tempo zero (inicial), 300s e 600s. Ao término do primeiro ensaio, o tendão retornava ao seu comprimento inicial, sendo mantido em repouso durante 300s, seguido de novo ensaio de tensionamento repetindo-se os mesmos procedimentos anteriores. A análise estatística permitiu concluir que o elongamento do tendão é mais pronunciado nos 300s iniciais, refletindo uma queda mais acentuada nos valores da tensão do enxerto. Portanto, 300s após o tensionamento e fixação do enxerto, o cirurgião pode avaliar mais adequadamente se o nível de tensionamento foi suficiente

Lesion of the anterior cruciate ligament (ACL) in the knee is a problem that affects animals as well as humans and may evolve with joint instability that is often symptomatic and incapacitating. The main option for ligament substitution is the autologous tendon graft. The graft undergoes tensioning during ACL reconstructive surgery to reestablish the normal laxity of the ACL- deficient knee. Although graft tensioning plays a fundamental role in postoperative clinical evolution, ideal tensioning levels have not been established in the literature. Therefore, graft elongation that may occur over time is still one of the main reasons for ligament reconstruction failure. In this study, ten bovine calcaneus tendons underwent two successive assays of physiological tensioning for a maximum deformation of 2.5% of the initial tendon length, maintained for 600s with force (N) values recorded at zero time (initial), 300s and 600s. At the end of the first assay, the tendon returned to its initial length and was maintained at rest for 300s and then the next tensioning assay was initiated, repeating the previous procedure. Statistical analysis revealed that tendon elongation is more pronounced during the initial 300s, reflecting a more accentuated decline in the tension values of the graft. Therefore, 300s after tensioning and fixing the graft, the surgeon can assess with more precision if the tensioning level was adequate