Mesenteric shunting during thoracoabdominal aortic clamping to prevent disseminated intravascular coagulation in dogs.

The current study was undertaken to determine if cold crystalloid perfusion of the mesenteric circulation or continuous arterial shunting into the superior mesenteric artery would prevent the subsequent development of disseminated intravascular coagulation in a dog model. Twenty-two dogs were divided into four groups: those with distal aortic occlusion; those with isolated washout of the mesenteric circulation via the superior mesenteric artery with cold crystalloid; those with continuous isolated arterial perfusion of the superior mesenteric artery via an open proximal aorta; and those with shunting of blood into the superior mesenteric artery from the proximal aorta with an Inahara-Pruitt shunt. Coagulation parameters were measured for 24 hours and compared to the results with 32 dogs in the following groups: sham operation; supraceliac aortic occlusion for 30 minutes, 60 minutes, 90 minutes; superior mesenteric occlusion for 90 minutes; and celiac axis occlusion for 90 minutes. Shunting or direct arterial perfusion of the superior mesenteric artery prevented disseminated intravascular coagulation from occurring. Infrarenal aortic occlusion resulted in no change in any of the coagulation factors, whereas crystalloid perfusion of the superior mesenteric artery resulted in death in all animals. These results indicate that the disseminated intravascular coagulation that occurs with supraceliac aortic occlusion or superior mesenteric occlusion of greater then one hour can be prevented by continuous arterial perfusion of the superior mesenteric artery during proximal aortic clamping.