The comparative effects of total hepatic vascular isolation techniques performed at different durations in rat.
BACKGROUND
Total hepatic vascular exclusion (THVE) leads to massive venous congestion below the level of diaphragm and may promote undesirable hemodynamic disturbances in some patients. Supraceliac aortic clamping during THVE may achieve hemodynamic stability at the price of arterial ischemia. However, the parenchymal injury of venous congestion has been a greater concern than of arterial ischemia in various settings. We hypothesized that supraceliac aortic occlusion during THVE may attenuate the reperfusion injury and improve the outcome that would be acquired after THVE alone.


METHODS
Rats were randomly assigned to (1) THVE alone, (2) THVE plus aortic occlusion, (3) THVE plus celio-mesenteric arterial occlusion or (4) sham during 30, 45, or 60 min followed by 180 min reperfusion period. Serum enzymes (alanine aminotransferase, lactate dehydrogenase) and creatinine as well as tissue "thiobarbituric acid reactive substances" (TBARS) and histopathology were evaluated. Seven animals per group were followed for survival up to 7 d.


RESULTS
After 30 min, no difference was found in serum enzyme, creatinine and tissue TBARS measures among the isolation methods used. In these, all rats survived to 7 d. However, after 45 and 60 min isolation, aortic occlusion resulted in significant rise in serum enzyme and tissue TBARS measures as well as poor survival (14% and 0%, respectively). In contrast, all rats survived even after 60 min of THVE.


CONCLUSIONS
THVE was tolerated up to 60 min with less reperfusion injury and better survival than celio-mesenteric arterial occlusion and supraceliac aortic occlusion in the rat, if needed, aortic clamping should not exceed 30 min. Beyond that, selective celio-mesenteric arterial occlusion may be considered.
Kaya
Hamza
H
Department of General Surgery, Dokuz Eylül University School of Medicine, Balçova, Izmir, Turkey.
Karademir
Sedat
S
Tuncel
Pinar
P
Astarcioglu
Huseyin
H
Sagol
Ozgul
O
Astarcioglu
Ibrahim
I
D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D001012:Aorta, Abdominal / Q000601:surgery; D002445:Celiac Artery / Q000601:surgery; D003404:Creatinine / Q000097:blood; D006503:Hepatic Veins / Q000601:surgery; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000473:pathology; D007668:Kidney / Q000378:metabolism / Q000473:pathology; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008099:Liver / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D008102:Liver Circulation; D008297:Male; D008638:Mesenteric Arteries / Q000601:surgery; D011183:Postoperative Complications / Q000473:pathology / Q000517:prevention & control*; D051381:Rats; D017208:Rats, Wistar; D015427:Reperfusion Injury / Q000473:pathology / Q000517:prevention & control*; D013525:Surgical Instruments; D015996:Survival Rate; D017392:Thiobarbituric Acid Reactive Substances / Q000378:metabolism
D017392:Thiobarbituric Acid Reactive Substances; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D000410:Alanine Transaminase