Acute aortic wall injury caused by aortic cross-clamping: morphological and biomechanical study of the aorta in a swine model of three aortic surgery approaches

Aortic ischemia-reperfusion injury and potency of fluoxetine

Objectives

Due to cross-clamping of the aorta during aortic aneurysm surgeries, ischemia-reperfusion (IR) develops, and it may cause damage to the aorta itself or even to remote organs by oxidative stress or inflammation. Fluoxetine (FLX) which might be used in the preoperative period for its tranquilizing effect also has antioxidant effects in short-term use. The purpose of our study is to examine whether FLX protects aorta tissue, against the damage caused by IR.

Materials and Methods

Three groups of Wistar rats were formed randomly. 1) Control group (sham-operated), 2) IR group (60 min ischemia+120 min perfusion), and 3) FLX+IR group (FLX dose was 20 mg/kg for 3 days IP before IR). At the end of each procedure, aorta samples were collected, and oxidant-antioxidant, anti-inflammatory, and anti-apoptotic status of the aorta were evaluated. Histological examinations of the samples were provided.

Results

Levels of LOOH, MDA, ROS, TOS, MPO, TNFα, IL-1β, IL-6, NF-kB, MMP-9, caspase-9, 8-OHdG, NO, and HA were found to be significantly increased in the IR group compared with control (P<0.05) and SOD, GSH, TAS, and IL-10 levels were significantly lower (P<0.05). FLX significantly decreased LOOH, MDA, ROS, TOS, MPO, TNFα, IL-1β, IL-6, NF-kB, MMP-9, caspase-9, 8-OHdG, NO, and HA levels in the FLX+IR group compared with IR group (P<0.05) and increased IL-10, SOD, GSH, and TAS (P<0.05). FLX administration prevented the deterioration of aortic tissue damage.

Conclusion

Our study is the first study that demonstrates FLX-mediated suppression of IR injury in the infrarenal abdominal aorta by antioxidant, anti-inflammatory, and anti-apoptotic properties.

Aortic clamping for limiting blood loss at cesarean hysterectomy for placenta percreta: A case series

OBJECTIVE

In women with placenta percreta, cesarean hysterectomy is associated with massive blood loss during dissection of bladder from lower uterine segment. We studied the safety and effectiveness of temporary aortic clamping as a method of limiting blood loss at cesarean hysterectomy in women with placenta percreta.

METHODS

This was a retrospective case series of 15 women with placenta percreta who underwent cesarean section with total hysterectomy at KEM Hospital, Pune, India, with a technique of temporary clamping of the infra-renal aorta for reducing blood loss during hysterectomy.

RESULTS

Fifteen women with placenta percreta underwent classical cesarean section followed by total hysterectomy with temporary clamping of the aorta. The procedure was associated with median estimated intra-operative blood loss of 650 ml. No woman had ureteric injury or needed post-operative intensive care. Aortic clamping for 28-70 min was not associated with any intra-operative vascular complications or post-operative ischemic lesions in the lower limbs, kidneys, or bowel.

CONCLUSION

Aortic clamping safely and effectively limited blood loss during cesarean hysterectomy for placenta percreta and thereby reduced transfusion requirements. It compares favorably with reported outcomes of other strategies of managing placenta percreta.

Comparative angiotomographic study of swine vascular anatomy: contributions to research and training models in vascular and endovascular surgery

Background

Medium and large animal models allow researchers to evaluate the efficacy and safety of cardiovascular procedures in systems that resemble human anatomy and can be used to simulate scenarios for training purposes. Although porcine models have been used extensively, many physiological and anatomical features remain unknown or only superficially described.

Objectives

To describe the normal porcine vascular anatomy on computed tomography scans, compare it to human vascular anatomy, and discuss the application of porcine models for open and endovascular procedures.

Methods

Three male Landrace pigs underwent computed tomography. The vascular anatomy of the neck, thorax, abdomen, and limbs was analyzed and described; relevant similarities and differences between porcine and human vascular anatomies and the implications for vascular procedures in pigs are highlighted.

Results

The carotid territory, aortic arch, and terminal aorta branches all show marked differences in pigs compared to their human counterparts. Compressions of both left renal and common iliac veins were detected, analogous to those seen in human Nutcracker and May-Thurner syndromes. Vascular measurements (diameters, lengths, and angles) of several different porcine territories are presented.

Conclusions

The data presented should be useful for planning preclinical trials and basic research and for refining surgical training using porcine models in vascular fields.