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Published on: February 17, 2013
Analysis of collateral blood flow to the lower body during selective cerebral perfusion: is three-vessel perfusion
Yuji Miyamoto1, Shinya Fukui, Tetsuya Kajiyama
1Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
Insights
Selective cerebral perfusion (SCP) protects organs via collateral blood flow (CBF). Three-vessel perfusion, including the left subclavian artery, significantly enhances lower body CBF compared to two-vessel perfusion during SCP.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Selective cerebral perfusion (SCP) is used during aortic arch surgery.
- Collateral blood flow (CBF) is crucial for protecting organs during SCP.
- The left subclavian artery's role in lower body perfusion during SCP is debated.
Purpose of the Study:
- To measure CBF during SCP.
- To compare CBF between three-vessel and two-vessel perfusion techniques.
- To assess the impact of perfusion technique on visceral organ protection during SCP.
Main Methods:
- CBF was measured in 49 patients undergoing aortic arch surgery with SCP.
- Collateral blood flow was assessed using three-vessel (including left subclavian artery) and two-vessel cannulation.
- Hepatic and stomach tissue blood flow were measured using laser-Doppler flowmetry to confirm visceral perfusion.
Main Results:
- Mean CBF was significantly higher with three-vessel perfusion (6.5% of SCP) versus two-vessel perfusion (5.3% of SCP) (p<0.0001).
- Substantial perfusion of visceral organs was confirmed by laser-Doppler measurements.
- Mean perfusion flow rate during SCP was 804±91 ml/min.
Conclusions:
- Visceral organs receive some protection from ischemia during SCP via collateral circulation.
- Three-vessel perfusion, including the left subclavian artery, enhances lower body CBF.
- While three-vessel perfusion is superior, the difference may be less critical under hypothermia.
Objective:
During selective cerebral perfusion (SCP), only the upper body is perfused. However, blood actually returns into the descending aorta through collaterals during SCP. This collateral blood flow (CBF) is thought to be important to protect the visceral organs and spinal cord from ischemia. The left subclavian artery is postulated to be important as a collateral source to the lower body. Therefore, we measured CBF and examined whether a perfusion technique (three- or two-vessel perfusion) affects CBF to the lower body during SCP.
Methods:
CBF was measured in 49 patients who underwent aortic arch surgery with SCP between August 2006 and July 2008. CBF, the amount of blood returning into the descending aorta during SCP, was measured under conditions of constant flow during SCP, with three-vessel cannulation that included the left subclavian artery, or with two-vessel cannulation that excluded the left subclavian artery. To prove visceral perfusion during SCP, hepatic (n=22) and stomach (n=5) tissue blood flows were measured using a laser-Doppler flowmeter.
Results:
The mean perfusion flow rate during SCP was 804+/-91ml/min. The mean CBF under three-vessel perfusion (53+/-34ml/min, 6.5+/-3.8% of SCP) was significantly (p<0.0001) higher compared with that under two-vessel perfusion (43+/-29ml/min, 5.3+/-3.1% of SCP). There was substantial perfusion in the visceral organs during SCP as determined by laser-Doppler flowmeter.
Conclusion:
Visceral organs were perfused to some extent through collaterals and protected from ischemia during SCP. Left subclavian arterial perfusion enabled significant CBF to the lower body. Considering this CBF, three-vessel perfusion appears to be better than two-vessel perfusion during SCP; however, the choice of perfusion technique may not be so important under conditions of hypothermia because the difference in CBF between the two methods was small.
