Carotid Artery and Jugular Vein Interposition: A Technique to Induce Venous Intimal Hyperplasia in Rabbit Model

All procedures involving animal models have been reviewed by the local institutional animal care committee and the JoVE veterinary review board.

1. Interposing the carotid artery by the harvested jugular vein

1. Begin with an anesthetized rabbit. Incise 50–60 mm of the cervical region with surgical scalpel longitudinally. Bluntly dissect the subcutaneous tissues and fascia. Expose a 20–30 mm segment of the ipsilateral carotid artery. Separate the artery carefully from the vein and nerve nearby. Ligate all the branches of the exposed vein with 4-0 silk suture.
2. Administer heparin sodium intravenously (200 IU/kg). Wait for 3–4 min.
3. Clamp the proximal and distal ends of the artery with surgical clamps. Cut the artery in the middle, between the clamps. Inject normal saline into the incised carotid artery proximally and distally to distend the artery.
   NOTE: A rabbit carotid artery tends to shrink. Choose a well-distended site as an anastomosis site.
4. Anastomose the harvested vein to the artery in a reversed end-to-end fashion.
   1. Insert a 20 G intravenous catheter into the harvested vein from the distal to the proximal direction to keep the venous lumen open during the distal anastomosis.
   2. Anastomose the proximal end of the vein to the distal end of the artery using 8-0 polypropylene interrupted sutures. Place two anchor stiches at the site and the opposite site. Add stiches at the upper side of the anastomosis line between the anchor stiches.
   3. Flip the artery and the vein graft upside down. Add stiches on the remaining part of the anastomosis line.
   4. Remove the intravenous catheter from the vein. Clamp the vein graft proximally and declamp the carotid artery distally. Ascertain that the vein graft is expanding gradually.
   5. Anastomose the distal end of the vein to the proximal end of artery using 8-0 polypropylene interrupted sutures. Declamp the artery to check the bleeding from the anastomosis sites. Add sutures for hemostasis, if required.
      NOTE: A gentle compression of the bleeding site with gauze and waiting may be enough for hemostasis. Check the immediate expansion and strong pulsation of the vein graft after the proximal declamping. If that is not observed, consider repeating steps 1.4.2 –1.4.3
5. Ligate the internal carotid artery with a 4-0 silk suture to simulate a poor runoff condition and to facilitate intimal hyperplasia.
6. Clean the wound with saline. Close the wound using 3-0 polyglactin 910, layer by layer.