To Shunt or Not to Shunt? An Experimental Study Comparing Temporary Vascular Shunts and Venous Ligation as Damage Control Techniques for Vascular Trauma

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• 作者：Adenauer Marinho de Oliveira Gó ; es Junior ; ^{adenauer-junior@ibest.com.br" class="auth_mail} ; Simone de Campos Vieira Abib ; Maria Teresa de Seixas Alves ; Paulo Sé ; rgio Venerando da Silva Ferreira ; Mariseth Carvalho de Andrade
• 刊名：Annals of Vascular Surgery
• 出版年：April, 2014
• 年：2014
• 卷：28
• 期：3
• 页码：710-724
• 全文大小：1918 K

文摘

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Background

To evaluate vascular flow through temporary vascular shunts inserted into peripheral arteries and veins and the repercussion, on the arterial perfusion, of venous ligation and venous shunt insertion in an experimental model for damage control.

Methods

Experimental study in pigs. Animals were distributed in 5 groups: group 1, right external iliac artery (EIA) shunting and right external iliac vein (EIV) ligation; group 2, right EIA shunting and right EIV shunting; group 3, right EIV ligation; group 4, right EIV shunting; group 5, no vascular shunting and no venous ligation. Flowmeters were used to measure vascular flow on right and left external iliac vessels, and blood samples were collected from the EIVs for biochemical analysis. A right anterior limb biopsy was performed before shock. Hemorrhagic shock was induced through the external right jugular vein, until the vascular flow through right iliac external artery shunt or right iliac external vein shunt (group 4) ceased or until the animal's death. After the end of the experiments, biopsies of bilateral hind limb were obtained for histologic analysis. For statistical analysis, Microsoft Office Excel 2007 and BioEstat 5.0 (2007) were used.

Results

In the absence of hemorrhagic shock, venous ligation (group 1) was associated with a 38.8% reduction (P聽<聽0.05) and venous shunting with a 28.4% reduction on the vascular flow through the arterial shunt. When associated with hemorrhagic shock, the mean vascular flow on the right EIA was 13聽mL/min and on the left EIA was 41.2聽mL/min; on group 2, the right EIA flow was 8.5聽mL/min and the left EIA flow was 8.1聽mL/min. When associated with hemorrhagic shock, the pO₂ was 25.8聽mm Hg on right EIV and 33.8聽mm Hg on the left EIV for group 1聽(P聽<聽0.05), whereas for group 2, the pO₂ was 22.6聽mm Hg on right EIV and 22.8聽mm Hg on the left EIV. On group 1, serum potassium was 3.84 mEq/L on the right EIV and 3.96 mEq/L on the left EIV, whereas on group 2, it was 7.1 mEq/L on the right EIV and 5.88 mEq/L on the left EIV (P聽<聽0.05).

Conclusions

In the developed experimental model, venous shunting, when compared with venous ligation, offered less resistance to vascular flow through the arterial shunt and allowed a more efficient limb venous drainage than simple vein ligature.