title: Regional blood flow distribution and oxygen metabolism during mesenteric ischemia and congestion.
abstract: BACKGROUND
  Acute mesenteric ischemia is a potentially fatal vascular emergency with mortality rates ranging between 60% and 80%. Several studies have extensively examined the hemodynamic and metabolic effects of superior mesenteric artery occlusion. On the other hand, the cardiocirculatory derangement and the tissue damage induced by intestinal outflow obstruction have not been investigated systematically. For these reasons we decided to assess the initial impact of venous mesenteric occlusion on intestinal blood flow distribution, and correlate these findings with other systemic and regional perfusion markers.
  
  
  METHODS
  Fourteen mongrel dogs were subjected to 45 min of superior mesenteric artery (SMAO) or vein occlusion (SMVO), and observed for 120 min after reperfusion. Systemic hemodynamics were evaluated using Swan-Ganz and arterial catheters. Regional blood flow (ultrasonic flow probes), intestinal O(2)-derived variables, and mesenteric-arterial and tonometric-arterial pCO(2) gradients (D(mv-a)pCO(2) and D(t-a)pCO(2)) were also calculated.
  
  
  RESULTS
  SMVO was associated with hypotension and low cardiac output. A significant increase in the regional pCO(2) gradients was also observed in both groups during the ischemic period. After reperfusion, a progressive reduction in D(mv-a)pCO(2) occurred in the SMVO group; however, no improvement in D(t-a)pCO(2) was observed. The histopathologic injury scores were 2.7 +/- 0.5 and 4.8 +/- 0.2 for SMAO and SMVO, respectively.
  
  
  CONCLUSIONS
  SMV occlusion promoted early and significant hemodynamic and metabolic derangement at systemic and regional levels. Additionally, systemic pCO(2) gradient is not a reliable parameter to evaluate the local intestinal oxygenation. Finally, the D(t-a)pCO(2) correlates with histologic changes during intestinal congestion or ischemia. However, minor histologic changes cannot be detected using this methodology.
authors.affiliation: Research Division, InCor, University of São Paulo Medical School, São Paulo, Brazil. ruycruzjunior@yahoo.com.br
authors.forename: Ruy J
authors.initials: RJ
authors.lastname: Cruz
authors.forename: Alejandra G
authors.initials: AG
authors.lastname: Garrido
authors.forename: Cristiane M F
authors.initials: CM
authors.lastname: Ribeiro
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Harada
authors.forename: Mauricio
authors.initials: M
authors.lastname: Rocha-e-Silva
mesh_terms: D000818:Animals; D004285:Dogs; D006439:Hemodynamics; D006940:Hyperemia / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D007413:Intestinal Mucosa / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology*; D007511:Ischemia / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008643:Mesentery / Q000098:blood supply*; D010100:Oxygen / Q000378:metabolism; D012039:Regional Blood Flow; D013152:Splanchnic Circulation
chemical_list: D010100:Oxygen