Periadventitial delivery of heparin in the prevention of microvenous thrombosis

Purpose: In spite of advances in technique and instrumentation, microvascular free tissue transfer remains associated with a persistent risk of flap failure. The use of systemic anticoagulants to overcome the formation of vasoocclusive thrombi at reactive anastomotic sites is associated with a high rate of flap hematoma and is ill advised in the operative setting. The purpose of this study was to investigate the use of a biodegradable, nontoxic polymer gel (polyvinyl alcohol, PVA) to effect a sustained localized release of perivascular heparin around thrombogenic venous anastomoses. Materials and Methods: A modified adventitial inclusion model was created in the femoral vein of 64 adult female Sprague-Dawley rats. Animals were divided into four experimental groups: 1) no treatment (controls), 2) periadventitial PVA gel contained in a vicryl chamber, 3) periadventitial PVA gel mixed with heparin, and 4) systemic heparin (intravenous pump). Patency rates in the femoral vein were checked at 10 minutes, 1 hour, 1 day, and 4 days after surgery. Systemic coagulation parameters and histology (scanning electron microscopy, SEM) were assessed in representative animals from all groups. Results: Patency rates for experimental groups showed a significant improvement in animals treated with PVA/heparin and systemic heparin over controls. Wound hematomas occurred in 7 of 16 animals in group 3, and in 4 of 16 animals in group 4. Activated partial thromboplastin times were elevated in group 4 only (>150 seconds). Conclusions: Continuous release of periadventitial heparin using a polymeric delivery system may represent an efficient means of attenuating the reactivity of microvenous anastomoses without affecting systemic coagulation parameters. In this model, however, its use was associated with a high rate of local wound hematoma.