Temporary incomplete ischemia of the legs induced by aortic clamping in man. Metabolic and hemodynamic effects of temporary extracorporeal by-pass

Temporary extracorporeal brachio-femoral vascular prosthesis shunt for ischemia prevention in an operation for abdominal aortic and iliac aneurysms in a patient with Marfan's syndrome

In open vascular repair, when prolonged infrarenal aortic clamping can be expected, and collateral perfusion is reduced, the use of a temporary shunt may reduce the risk of ischemic complications. In a patient with Marfan's syndrome and aortic dissection who had developed infrarenal aneurysms, segmental arteries had been occluded by prior aortic surgery and collateral arteries in the anterior torso could have been damaged by previous pectus excavatum, muscle flap, sternotomy, and ventral hernia operations. The axillary artery was dilated. For the prevention of ischemia during open repair with a bifurcated graft, a temporary extracorporeal brachio-femoral vascular prosthesis shunt was constructed. Ischemia was not observed. The use of a temporary extracorporeal brachio-femoral shunt with a vascular prosthesis is a feasible method for ischemia prevention.

Preliminary report on the use of the Percluder occluding aortic balloon in human beings

Management of massive exsanguinating hemorrhage is a major challenge in acute trauma care. The value of military antishock trousers (MAST) in this setting is controversial. In selected instances, thoracotomy with aortic cross-clamping may be effective and often is used as the "gold standard" to which new experimental therapy is compared. Previous animal research with an occluding aortic balloon catheter (Percluder) has shown this technique to be physiologically similar to aortic cross clamping. The Percluder was more effective than the MAST plus volume replacement in controlling hemorrhage and prolonging four-hour survival from blunt splenic trauma in an animal model. We have used the Percluder in 23 patients with life-threatening hemorrhage. There were 15 trauma cases, five cases of ruptured abdominal aortic aneurysm, and three others. Only nine of 23 patients (39%) had vital signs when the balloon was inserted; all showed an increase in arterial blood pressure of about 50% to 100% (P less than .0001). Two of 15 trauma victims (13%) and four aneurysm patients in whom the balloon was used were long-term survivors. One trauma victim lived for two weeks before dying of ischemic complications after 90 minutes of balloon aortic occlusion. Overall survival rate was 26%. This study was uncontrolled and occlusion therapy was not randomized. Eleven of 12 attempts to place the catheter by femoral cutdown were successful. Seven of 12 attempts (58%) to place the catheter percutaneously were successful. The six insertion failures were due to an inadequately small introducer, inability to identify arterial pulses in moribund patients, or difficulty in cannulating the femoral artery because of proximal occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Spinal cord infarction in disease and surgery of the aorta

Diseases of the aorta and surgery of the aorta can produce spinal cord damage. There are major variations in blood supply to the spinal cord between individuals. The spinal cord may be tamponaded by increased spinal fluid pressure subsequent to clamping the aorta. Both of these factors may contribute to spinal cord infarction. The available methods and procedures to protect the spinal cord during surgery are discussed.