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Experimental study on hepatic vascular exclusion with atrioportacaval shunt in dogs
Insights
A new atrioportacaval shunt (APCS) technique during hepatic vascular exclusion (HVE) in dogs proved safe and simple. This method effectively manages bleeding from hepatic veins and the vena cava while maintaining stable hemodynamics.
Area of Science:
- Surgical Innovation
- Hepatobiliary Surgery
- Cardiovascular Physiology
Background:
- Hepatic vascular exclusion (HVE) can cause significant hemodynamic and metabolic disturbances.
- Controlling bleeding during HVE, especially from major hepatic veins and the retrohepatic vena cava, remains a surgical challenge.
Purpose of the Study:
- To introduce and evaluate a novel atrioportacaval shunt (APCS) technique.
- To assess the efficacy of APCS in mitigating hemodynamic changes and improving safety during HVE in a canine model.
Main Methods:
- Development of the atrioportacaval shunt (APCS) technique for canine subjects.
- Implementation of APCS concurrently with hepatic vascular exclusion (HVE).
- Monitoring of hemodynamic parameters including central venous pressure (CVP), mean arterial pressure (MAP), and cardiac output (CO).
Main Results:
- HVE-APCS demonstrated simplicity and safety in the canine model.
- Hemodynamic parameters (CVP, MAP, MPAP, PCWP, PVR) remained largely stable.
- Cardiac output (CO) decreased by 34.5-45.6%, and systemic vascular resistance (SVR) increased by 46.8-65.7%.
- Recirculation injury to the ischemic liver was mild due to portal system decompression.
Conclusions:
- The HVE-APCS technique is an effective and safe method for controlling bleeding during major hepatic vein and retrohepatic vena cava procedures.
- APCS successfully decompresses the portal system and inferior vena cava during HVE, minimizing liver injury.
Abstract:
The main effects of hepatic vascular exclusion (HVE) on the body are hemodynamic changes and metabolic disorders. We developed a new technique--atrioportacaval shunt (APCS) both to increase the blood--return volume and to decompress the portal system and the inferior vena cava below the occlusion during HVE in canine. Experimental results showed that HVE-APCS is characteristic of simplicity and safety. During HVE-APCS central venous pressure (CVP), mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedged pressure (PCWP) and pulmonary vascular resistance (PVR) remained almost stable while cardiac output (CO) decreased by 34.5-45.6% and systemic vascular resistance (SVR) increased by 46.8-65.7%. The recirculation injury to ischemic liver was mild owing to concomitant decompression of the portal system. It may be concluded that HVE-APCS is an ideal method to control the bleeding from the major hepatic veins and retrohepatic vena cava.