The impact of selective visceral perfusion on intestinal macrohemodynamics and microhemodynamics in a porcine model of thoracic aortic cross-clamping

Slides:

Advertisements

Similar presentations

Lucy Wales, FRCS, MD, Martin Gosling, PhD, Graham W

Advertisements

Department of human anatomy

Loss of renal function and microvascular blood flow after suprarenal aortic clamping and reperfusion (SPACR) above the superior mesenteric artery is greatly.

Regarding “A 10-year institutional experience with open branched graft reconstruction of aortic aneurysms in connective tissue disorders versus degenerative.

Bedside vena cava filter placement with intravascular ultrasound: A simple, accurate, single venous access method Donald L. Jacobs, MD, Raghunandan L.

Therapeutic distant organ effects of regional hypothermia during mesenteric ischemia- reperfusion injury Rachel J. Santora, MD, Mihaela L. Lie, MD, Dmitry.

Direct thrombolytic therapy in portal and mesenteric vein thrombosis

Central venous catheter failure is induced by injury and can be prevented by stabilizing the catheter tip Ted R. Kohler, MD, Thomas R. Kirkman, BS Journal.

Michael Zhen-Yu Tong, MBA, MD, Pavan Koka, MD, Thomas L. Forbes, MD

Totally videoendoscopic descending thoracic aorta-to-femoral artery bypass Sumio Fukui, MD, Nikolaos Paraskevas, MD, Patrick Soury, MD, Frédéric Gigou,

Celiac dissection after blunt abdominal trauma complicated by acute hepatic failure: Case report and review of literature Chlodwig Kirchhoff, MD, Julia.

Selective renal blood perfusion induces renal tubules injury in a porcine model Johannes Kalder, MD, Maria Kokozidou, DVM, MSc, PhD, Paula Keschenau,

Extracorporeal circulation increases proliferation in the intestinal mucosa in a large animal model Paula Rosalie Keschenau, MD, Stefanie Ribbe, Miriam.

Fundus microvascular flow monitoring during retrograde cerebral perfusion: an experimental study Peiqing Dong, MD, Yulong Guan, MD, Jing Yang, MD, Meiling.

Volume 77, Issue 10, Pages (May 2010)

Endovascular treatment of contained rupture of a superior mesenteric artery aneurysm resulting from neurofibromatosis type I Célio Teixeira Mendonça,

Walter J. Scott, M.D., Bruce L. Gewertz, M.D.

Reconstructive surgery for segmental arterial mediolysis involving both the internal carotid artery and visceral arteries Hideaki Obara, MD, PhD, Kenji.

Johannes Kalder, MD, Dieudonne Ajah, Paula Keschenau, MD, Lieven N

Prevention of paraplegia in pigs by selective segmental artery perfusion during aortic cross-clamping Sven A. Meylaerts, MDa, Peter de Haan, MD, PhDb,

The revolutionary studies by Leonardo on blood circulation were too advanced for his times to be published Antonio V. Sterpetti, MD, FACS, FRCS (Engl)

Christian A. P. Schmidt, MD, PhD, Markus J. Wilhelm, MD, Dieter O

Melanie K. Rose, MD, Benjamin J. Pearce, MD, Thomas C

Endovascular stent graft for symptomatic mobile thrombus of the thoracic aorta Philipp Fueglistaler, MD, Thomas Wolff, MD, Lorenz Guerke, MD, Peter Stierli,

Beware of interrupting aortic-to-visceral collaterals!

Descending thoracic aortic aneurysm: surgical approach and treatment using the adjuncts cerebrospinal fluid drainage and distal aortic perfusion Anthony.

Stuart I. Myers, MD, Li Wang, BS, Fang Liu, BS, Lori L. Bartula, BS

Gary R. Seabrook, MD Journal of Vascular Surgery

Middle mesenteric artery arising from an inflammatory infrarenal aortic aneurysm Andrea M. Dirrigl, MD, Alexander Zimmermann, MD, Stefan Ockert, MD, Hans-Henning.

Effects of thoracic aortic occlusion and cerebrospinal fluid drainage on regional spinal cord blood flow in dogs: Correlation with neurologic outcome

Dose-dependent neuroprotection of delta-opioid peptide [D-Ala2, D-Leu5] enkephalin on spinal cord ischemia-reperfusion injury by regional perfusion into.

Murine ultrasound imaging for circumferential strain analyses in the angiotensin II abdominal aortic aneurysm model John T. Favreau, BS, Binh T. Nguyen,

Identification of unique characteristics and the management of blunt traumatic aortic injuries occurring at unusual locations in the descending thoracic.

Human ex-vivo model of Stanford type B aortic dissection

Leiomyosarcoma of the splenic vein

Heitham T. Hassoun, MD, R. Scott Mitchell, MD, Michel S

Spinal cord injury in experimental thoracic aortic occlusion: investigation of combined methods of protection James R. Elmore, MD, Peter Gloviczki, MD,

Giant cell arteritis manifesting as mesenteric ischemia

Paraplegia prevention branches: A new adjunct for preventing or treating spinal cord injury after endovascular repair of thoracoabdominal aneurysms Christos.

Nonoperative management of grade III blunt thoracic aortic injuries

Impact of distal aortic and visceral perfusion on liver function during thoracoabdominal and descending thoracic aortic repair Hazim J. Safi, MD, Charles.

Comparison of the vascular responses to balloon-expandable stenting in the coronary and peripheral circulations: Long-term results in an animal model.

Combined endovascular and surgical approach (CESA) to thoracoabdominal aortic pathology: A 10-year experience William Quinones-Baldrich, MD, Juan Carlos.

New method for absolute spinal cord ischemia protection in rabbits

Hidetoshi Inokawa, MD, PhD, Mayura Sevala, PhD, William K

Depressed cardiovascular function and altered platelet kinetics following protamine sulfate reversal of heparin activity Thomas W. Wakefield, M.D., Walter.

The use of an aortoiliac side-arm conduit to maintain distal perfusion during thoracoabdominal aortic aneurysm repair Kenneth Ouriel, MD Journal of.

Axillomesenteric bypass: An unusual solution to a difficult problem

Todd R. Vogel, MD, MPH, Robin L. Kruse, PhD

Mycotic aneurysm of the superior and inferior mesenteric artery

New temporary internal introducer shunt for brain perfusion during total endovascular arch replacement with in situ fenestration technique Björn Sonesson,

Severe visceral ischemia and death after multilayer stent deployment for the treatment of a thoracoabdominal aortic aneurysm Rafael Noronha Cavalcante,

Abe DeAnda, MD, Vigneshwar Kasirajan, MD, Daniel Henry, MD, Stuart I

Glucagon potentiates intestinal reperfusion injury

Loss of renal function and microvascular blood flow after suprarenal aortic clamping and reperfusion (SPACR) above the superior mesenteric artery is greatly.

Suprarenal aortic clamping and reperfusion decreases medullary and cortical blood flow by decreased endogenous renal nitric oxide and PGE2 synthesis

Outcome after celiac artery coverage during endovascular thoracic aortic aneurysm repair: Preliminary results Sarat K. Vaddineni, MD, Steve M. Taylor,

R. Jason VonDerHaar, MD, Aamir Shah, MD, Nicholas N

Extrahepatic portal vein aneurysm

R. Jason VonDerHaar, MD, Aamir Shah, MD, Nicholas N

Sukgu M. Han, MD, Warren J. Gasper, MD, Timothy A.M. Chuter, MD

The double two-chimney technique for complete renovisceral revascularization in a suprarenal aneurysm Jip L. Tolenaar, MD, Herman J.A. Zandvoort, MD,

Postoperative outcomes in intimal aortic angiosarcoma: A case report and review of the literature Saila P. Nicotera, MD, MPH, Hector F. Simosa, MD, David.

Bhagwan Satiani, MD, MBA, Thomas E. Williams, MD, PhD, Michael R

Failure of motor evoked potentials to predict neurologic outcome in experimental thoracic aortic occlusion James R. Elmore, MD, Peter Gloviczki, MD,

Retrograde visceral vessel revascularization followed by endovascular aneurysm exclusion as an alternative to open surgical repair of thoracoabdominal.

Nutcracker syndrome due to left-sided inferior vena cava compression and treated with superior mesenteric artery transposition Bao-Zhong Yang, MD, Zhen.

Endovascular longitudinal fenestration and stent graft placement for treatment of aneurysms developing after chronic type B aortic dissection Neal R.

A staged replacement of the entire aorta from the ascending arch to the hypogastric arteries using a hybrid approach Juan Carlos Jimenez, MD, Wesley.

Twelve-year experience with intraluminal sutureless ringed graft replacement of the descending thoracic and thoracoabdominal aorta Mehmet C. Oz, MD *,

Presentation transcript:

The impact of selective visceral perfusion on intestinal macrohemodynamics and microhemodynamics in a porcine model of thoracic aortic cross-clamping Johannes Kalder, MD, Paula Keschenau, Sebastiaan J. Hanssen, PhD, Andreas Greiner, MD, Iris C. Vermeulen Windsant, MD, Lieven N. Kennes, Rene Tolba, PhD, Fritz W. Prinzen, PhD, Wim A. Buurman, PhD, Michael J. Jacobs, PhD, Thomas A. Koeppel, MD Journal of Vascular Surgery Volume 56, Issue 1, Pages 149-158 (July 2012) DOI: 10.1016/j.jvs.2011.11.126 Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 1 Experimental setup: A thoracolaparotomy was performed in all animals. A, Cohort I: no procedure (sham-operation); cohort II: 1 hour of thoracic aortic cross-clamping (TAC), followed by 2 hours of reperfusion. B, Cohort III: 1 hour of TAC with selective visceral perfusion (SVP), followed by 2 hours of distal aortic perfusion (DAP). Five pigs in each cohort (n = 15). CT, Celiac trunk; SMA, superior mesenteric artery. Journal of Vascular Surgery 2012 56, 149-158DOI: (10.1016/j.jvs.2011.11.126) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 2 Timeline of experiments. Part 1: Thoracolaparotomy, catheter, and flow probe placement, baseline measurement. Part 2: One hour of specific procedure (cohorts I-III). Part 3: Reperfusion period (2 hours). DAP, Distal aortic perfusion; SVP, selective visceral perfusion. Journal of Vascular Surgery 2012 56, 149-158DOI: (10.1016/j.jvs.2011.11.126) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 3 Periprocedural blood pressure measurement. An intra-arterial line was placed into the right common carotid artery and the pressure was measured at T1, T4, T5 and T6 in all cohorts as well as in cohort I at T2 and T3. In cohort II, the blood pressure was measured through an intra-arterial catheter deployed in the visceral aorta. In cohort III at T2 and T3, the pressure was monitored through lines at the tip of the selective perfusion catheters. Thus, in cohort III at T2 and T3, the celiac trunk (TAC + SVP + DAP-CT) and superior mesenteric artery (TAC + SVP + DAP-SMA) were separately measured and analyzed. DAP, Distal aortic perfusion; SVP, selective visceral perfusion; T1, surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, reperfusion at 15 minutes; T5, reperfusion at 60 minutes; T6, reperfusion at 120 minutes; TAC, thoracic aorta cross-clamp. Journal of Vascular Surgery 2012 56, 149-158DOI: (10.1016/j.jvs.2011.11.126) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 4 Flow rate measurements during the whole experiment were performed at the origin of the (A) celiac trunk (CT) and (B) superior mesenteric artery (SMA) vessels and at T2 and T3 in cohort III at the selective perfusion tubing system. DAP, Distal aortic perfusion; SVP, selective visceral perfusion; T1, surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, reperfusion at 15 minutes; T5, reperfusion at 60 minutes; T6, reperfusion at 120 minutes; TAC, thoracic aorta cross-clamp. Journal of Vascular Surgery 2012 56, 149-158DOI: (10.1016/j.jvs.2011.11.126) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 5 Measurement of microcirculation by 15-μm fluorescent microspheres injected into the descending aorta or at T2 and T3 in cohort III directly into the extracorporeal circulation tubing system. A, Perfusion is calculated for the entire gut wall. B, The ratio between the weight-corrected emanated fluorescence between the mucosal and the muscular layer is calculated. DAP, Distal aortic perfusion; SVP, selective visceral perfusion; T1, surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, reperfusion at 15 minutes; T5, reperfusion at 60 minutes; T6, reperfusion at 120 minutes; TAC, thoracic aorta cross-clamp. Journal of Vascular Surgery 2012 56, 149-158DOI: (10.1016/j.jvs.2011.11.126) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 6 Markers for (A) aerobic oxygen extraction ratio and (B) anaerobic (lactate) metabolism were measured and calculated. The oxygen extraction ratios were calculated from arterial and portal venous blood. DAP, Distal aortic perfusion; SVP, selective visceral perfusion; T1, surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, reperfusion at 15 minutes; T5, reperfusion at 60 minutes; T6, reperfusion at 120 minutes; TAC, thoracic aorta cross-clamp. Journal of Vascular Surgery 2012 56, 149-158DOI: (10.1016/j.jvs.2011.11.126) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 7 A, Repeated pH measurements were conducted in the portal vein. B, Plasma levels (inferior cava vein) of intestinal fatty acid-binding protein (IFABP), which is a sensitive marker for intestinal small-bowel damage. DAP, Distal aortic perfusion; SVP, selective visceral perfusion; T1, surgical preparation; T2, beginning of the main procedure; T3, end of the main procedure; T4, reperfusion at 15 minutes; T5, reperfusion at 60 minutes; T6, reperfusion at 120 minutes; TAC, thoracic aorta cross-clamp. Journal of Vascular Surgery 2012 56, 149-158DOI: (10.1016/j.jvs.2011.11.126) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 8 Hematoxylin and eosin staining of small intestinal biopsy specimens at 15 minutes of reperfusion (original magnification, ×100). Moderate tissue damage (height loss of villi) was seen in (A) sham-operated animals (cohort I) and (C) TAC + SVP + DAP animals (cohort III). B, In cohort II (TAC), extensive mucosal injury (destruction of villi and starting ulcer) was detected. DAP, Distal aortic perfusion; SVP, selective visceral perfusion; TAC, thoracic aorta cross-clamp. Journal of Vascular Surgery 2012 56, 149-158DOI: (10.1016/j.jvs.2011.11.126) Copyright © 2012 Society for Vascular Surgery Terms and Conditions