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December 1990

The Natural History of Intimal Flaps in a Canine Model

Author Affiliations

From the Department of Surgery, Division of Vascular Surgery, University of Illinois College of Medicine, Chicago (Drs Sawchuk, Eldrup-Jorgensen, Tober, McCoy, Durham, Schuler, and Flanigan), and the Department of Pathology, Indiana University Medical Center, Indianapolis (Dr Waller). Dr Sawchuk is now with the Division of Vascular Surgery, Indiana University Medical Center, Indianapolis.

Arch Surg. 1990;125(12):1614-1616. doi:10.1001/archsurg.1990.01410240096019

• The natural history of arterial intimal flaps has not been well defined. This study characterizes the natural history of unrepaired intimal flaps. Thirty-nine 1-, 2-, and 3-mm hemispheric, distally based intimal flaps were made in 4- to 5-mm diameter canine femoral and carotid arteries. Twenty arteries had 2- and 3-mm intimal flaps and were monitored for short-term arterial thrombosis and flap extension. Nineteen had 1- and 2-mm intimal flaps and were monitored for thrombosis, long-term development of neointimal hyperplasia, arterial stenosis, and persistence of the flap. While 40% of the arteries with 3-mm intimal flaps developed thrombosis in 3 to 5 days, only 3% of the arteries with 1- or 2-mm intimal flaps developed thrombosis. Most 1- or 2-mm intimal flaps resolved and the subsequent development of neointimal hyperplasia or arterial stenosis was minimal. Arteries with hemodynamically significant stenoses intimal flaps warrant repair, while arteries with smaller intimal flaps may not require repair.

(Arch Surg. 1990;125:1614-1616)