Abstract
Testicular artery torsion (twisting) is one such severe vascular condition that leads spermatic cord injury. In this study, we investigate the recovery response of a torsioned ram testicular artery in an isolated organ-culture flow loop with clinically relevant twisting modes (90°, 180°, 270° and 360° angles). Quantitative optical coherence tomography technique was employed to track changes in the lumen diameter, wall thickness and the three-dimensional shape of the vessel in the physiological pressure range (10–50 mmHg). As a control, pressure-flow characteristics of the untwisted arteries were studied when subjected to augmented blood flow conditions with physiological flow rates up to 36 ml/min. Both twist and C-shaped buckling modes were observed. Acute increase in pressure levels opened the narrowed lumen of the twisted arteries noninvasively at all twist angles (at ∼22 mmHg and ∼35 mmHg for 360°-twisted vessels during static and dynamic flow experiments, respectively). The association between the twist-opening flow rate and the vessel diameter was greatly influenced by the initial twist angle. The biomechanical characteristics of the normal (untwisted) and torsioned testicular arteries supported the utilization of blood flow augmentation as an effective therapeutic approach to modulate the vessel lumen and recover organ reperfusion.
Highlights
The degree of the spermatic cord twist and duration of the torsion determine the magnitude of testicular damage
Total decrease in wall thickness (WT) was more than 35% at 50 mmHg pressure
The vessel inner diameter (ID) increased from 1.36 mm under no applied pressure to 2.34 mm with decreasing WT throughout the vessel under 40 mmHg pressure, as seen from the optical coherence tomography (OCT) images (Fig. 1B)
Summary
The degree of the spermatic cord twist and duration of the torsion determine the magnitude of testicular damage. Electro-stimulation at 10 Hz frequency has been shown to have a significant effect on increasing the volume flow rate and diameter of the human internal artery, whereas electro-stimulation at 80 Hz had opposite effects[7]. The C-shaped buckling mode may occur through torsional deformation due to the narrowed vessel cross sectional area[10]. For a twisted TA, it is still unclear which mode of buckling is more prevalent clinically, since in vivo experimental studies focusing on the haemodynamic effects with www.nature.com/scientificreports/. Live vessels of millimetre size are limited in the literature[11,12], despite the existence of several perfusion studies on uniform undeformed large artery systems[13,14]. We hypothesize that the three-dimensional (3D) vessel lumen response of live TAs may be quantitatively predicted from in vitro haemodynamic flow models. To the best of our knowledge, this study is the first to document a detailed analysis of TA buckling covering the multiple physiological twist modes in vitro
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