Radiological Assessment of Abdominal Aortic and Junctional Tourniquet-Induced Ischemia and Organ Displacement in a...

Lower abdominal and junctional hemorrhages are major causes of trauma-related mortality in both military and civilian settings. The Abdominal Aortic and Junctional Tourniquet (AAJT) is designed to occlude the infrarenal aorta through external compression, providing a potential prehospital hemorrhage control strategy. However, concerns remain regarding time-dependent adverse effects, particularly ischemic injury to abdominal organs. This study aimed to evaluate the anatomical and physiological consequences of AAJT application over different durations using computed tomography angiography in a porcine model.

Six male crossbred swine (mean 62.4 kg) underwent controlled class II hemorrhage, followed by AAJT application for either 60 or 240 min. computed tomography angiographies were performed at baseline, immediately after application, and at the designated time points. Three-dimensional vascular reconstructions were analyzed to assess blood flow and ischemic changes in major abdominal organs.

AAJT successfully occluded the infrarenal aorta in all cases, preventing blood flow to the distal aorta and inferior vena cava. Abdominal organs were displaced cranially, but contrast enhancement remained intact in the intestines and liver. Significant hydronephrosis was observed at 240 min (P = 0.022), suggesting time-dependent renal impairment. No pleural effusion or pulmonary embolism was detected.

AAJT caused time-dependent adverse effects. Radiological imaging may underestimate ischemic damage, highlighting the need for multimodal assessment when evaluating AAJT, especially with prolonged use. Limiting application duration to 60 min minimizes ischemic risks while maintaining effective hemorrhage control. Future research should focus on device modifications and alternative protocols to mitigate these complications.