The optimal selective perfusion flow rate of kidney during thoracoabdominal aortic aneurysm surgery : an experimental analysis in dogs.

点击翻译按钮获取中文摘要

Object : Selective perfusion (SP) of the visceral arteries is a useful adjunctive method for the prevention of organic ischemia during thoracoabdominal aneurysm surgery. However, the appropriate perfusion flow rate is unclear. The present study attempts to characterize the changes seen in the kidney associated with various perfusion flow rates. Method : 28 dogs underwent laparotomy and both kidneys were exposed. A cannula delivering perfusate was introduced in to the left renal artery. The kidney was perfused selectively with normothermic blood for 2 hrs and then returned to normal circulation for 2 hrs. The contralateral kidney served as a control. ATP,inorganic phosphorus (IP) and lactic acid (LA) of the renal cortex were measured. The perfused kidneys were classified into the following 4 groups according to perfusion flow rate.Group 1 (G1) : perfusion flow 10% of native renal blood flow. Group 2 (G2) : 25%. Group 3 (G3) : 50%. Group 4 (G4) : 100%. Results : There was a significant difference in ATP content between G1, G2 and the control group after 2 hrs SP.However, the ATP content was restored in G2 after 2hrs reperfusion. No significant difference was observed in G3 and G4. The level of IP and LA increased significantly in G1 after SP and then decreased after reperfusion. Morphological change was slight in G2, and more pronounced in G1 and G4. During SP,mean renal artery pressure exceed 200 mmHg in G4. Conclusion : The renal function was maintained to almost normal in G3, whereas reversable improvement of renal function was seen in G2.