title: To shunt or not to shunt? An experimental study comparing temporary vascular shunts and venous ligation as damage control techniques for vascular trauma.
abstract: 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 < 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 mL/min and on the left EIA was 41.2 mL/min; on group 2, the right EIA flow was 8.5 mL/min and the left EIA flow was 8.1 mL/min. When associated with hemorrhagic shock, the pO2 was 25.8 mm Hg on right EIV and 33.8 mm Hg on the left EIV for group 1 (P < 0.05), whereas for group 2, the pO2 was 22.6 mm Hg on right EIV and 22.8 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 < 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.
authors: Department of Surgery, Federal University of São Paulo (UNIFESP-Brazil), São Paulo, Brazil. Electronic address: adenauer-junior@ibest.com.br.
authors: Adenauer
authors: A
authors: Marinho de Oliveira Góes Junior
authors: Department of Surgery, Federal University of São Paulo (UNIFESP-Brazil), São Paulo, Brazil.
authors: Simone
authors: S
authors: de Campos Vieira Abib
authors: Department of Surgery, Federal University of São Paulo (UNIFESP-Brazil), São Paulo, Brazil.
authors: Maria Teresa
authors: MT
authors: de Seixas Alves
authors: Department of Surgery, Federal University of São Paulo (UNIFESP-Brazil), São Paulo, Brazil.
authors: Paulo Sérgio
authors: PS
authors: Venerando da Silva Ferreira
authors: Department of Surgery, Federal University of São Paulo (UNIFESP-Brazil), São Paulo, Brazil.
authors: Mariseth
authors: M
authors: Carvalho de Andrade
mesh_terms: D000818:Animals; D062186:Arterial Pressure; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D004195:Disease Models, Animal; D006614:Hindlimb / Q000098:blood supply*; D007083:Iliac Artery / Q000503:physiopathology / Q000601:surgery*; D007084:Iliac Vein / Q000503:physiopathology / Q000601:surgery*; D008026:Ligation; D008297:Male; D012039:Regional Blood Flow; D012771:Shock, Hemorrhagic / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D034421:Sus scrofa; D013997:Time Factors; D014654:Vascular Patency; D057772:Vascular System Injuries / Q000097:blood / Q000503:physiopathology / Q000601:surgery*
chemical_list: D015415:Biomarkers