Systemic and regional effects of supraceliac aortic occlusion during experimental hepatic vascular exclusion

Background: Supraceliac aortic occlusion (AO) has been recommended to avoid hypotension during hepatic vascular exclusion (HVE). We hypothesized that AO may negatively affect splanchnic perfusion during HVE. Methods: Twenty-six dogs (16 +/- 0.3 kg) were randomly assigned to HVE (n = 13) or HVE + AO (n = 13), during 30 minutes followed by a 60-minute reperfusion period. Cardiac output (CO), mean arterial pressure (MAP), superior mesenteric artery blood flow (SMABF, ultrasonic flowprobe), gastric mucosal PCO2 (gas tonometry) and PCO2 gap were evaluated. Results: HVE alone induced decreases in MAP from 115 +/- 5.1 to 26 +/- 1 mm Hg, in CO from 2.0 +/- 0.1 to 0.4 +/- 0.1 L/min and SMABF from 398 +/- 42 to 16 +/- 7.6 mL/min, while PCO2 gap increased from 4 +/- 3.7 to 52 +/- 5.4 mm Hg. Supraceliac aortic occlusion only avoided severe hypotension. During reperfusion MAP, CO, and SMABF were partially restored, while PCO2 gap showed no improvements in either group. Conclusions: HVE promotes major systemic and splanchnic perfusional derangement. Concomitant AO may avoid HVE-induced hypotension without producing further deleterious effects. (C) 2003 Excerpta Medica, Inc. All rights reserved.