TITLE:
How to Deal with an Intraoperative Thrombosis of Microvascular Anastomosis
AUTHORS:
Lawrence Van Look, Tomas Menovsky, Gino Vissers, Thierry Tondu, Filip Thiessen
KEYWORDS:
Microvascular, Intraoperative, Thrombosis, Patency, Salvage, Complication
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.11 No.4,
October
29,
2021
ABSTRACT: Background: Intraoperative thrombosis during microvascular surgery is a nasty
complication. Most intraoperative thromboses occur at the proximity of the
anastomosis and microsurgical salvage techniques are needed to correct the
complication. The aim of this article is to provide an overview of basic clinical
patency testing and microsurgical salvage techniques. Methods: A search of the literature
up to November 2020 was performed, using PubMed and Web of Science databases.
Articles reporting on clinical intraoperative patency testing and/or salvage techniques
in microvascular surgery were included. Results: Comprehensive
illustrations of intraoperative clinical patency testing include: pulsation pattern,
flicker test and milking test. The following surgical salvage techniques for
both end-to-end and end-to-side intraoperative microvascular occlusion
management are described: suture-line thrombectomy, thrombectomy through
arteriotomy, anastomotic resection with complete re-anastomosis and, balloon
extraction. Conclusion: Decision making in surgical salvage techniques
for microvascular thrombosis depends on localization of the thrombus and the
surgeon’s experience and preference. In case of any doubt, it is better to
reopen a few sutures and have a clear inspection of the anastomosis in order to
prevent redo surgeries. This paper serves as a guide for especially the
starting microsurgeon to clinically and surgically identify and handle an
intraoperative microvascular anastomosis thrombosis and occlusion.