TY - JOUR
T1 - A swine model of reproducible timed induction of peripheral arterial shunt failure
T2 - Developing warning signs of imminent shunt failure
AU - Stonko, David P.
AU - Patel, Neerav
AU - Edwards, Joseph
AU - Abdou, Hossam
AU - Lang, Eric
AU - Elansary, Noha N.
AU - Treffalls, Rebecca
AU - White, Joseph
AU - Morrison, Jonathan J.
N1 - Publisher Copyright:
© 2022 Society for Vascular Surgery
PY - 2022/1
Y1 - 2022/1
N2 - Temporary intravascular shunts are used to maintain perfusion in injured vessels, although failure can be unpredictable and lead to significant morbidity. The aim of the present study was to develop a dose- and timing-controlled swine model of intrinsic shunt failure to facilitate the development of a warning system for impending failure. Ten Yorkshire swine (weight, 56.6 ± 4.2 kg) underwent bilateral Argyle shunt (Cardinal Health, Dublin, OH) placement in the external iliac arteries, with proximal cannulation of the circumflex iliac arteries for infusion of thrombin. The thrombin infusion was randomized to the left or right side for 5000 vs 10,000 U/h. The 5000-U/h group required 2.1 times as long as the 10,000-U/h group to reach failure (mean, 21.8 minutes vs 46.4 minutes; P < .0001), as shown by a Kaplan-Meier survival analysis (log-rank P < .0001). However, the 5000-U/h group required the same total amount of thrombin (mean, 3752 ± 856 U; P = .57). Thus, time- and/or thrombin dose-controlled induction of shunt failure is technically feasible. Furthermore, in the final 15 minutes before failure, the flow was similar between the two groups (P >. 05), and the slope of the flow curve became more negative the closer the model was to failure. Overall, this model could be used to develop an alert system to predict for impending shunt failure or the need for intervention.
AB - Temporary intravascular shunts are used to maintain perfusion in injured vessels, although failure can be unpredictable and lead to significant morbidity. The aim of the present study was to develop a dose- and timing-controlled swine model of intrinsic shunt failure to facilitate the development of a warning system for impending failure. Ten Yorkshire swine (weight, 56.6 ± 4.2 kg) underwent bilateral Argyle shunt (Cardinal Health, Dublin, OH) placement in the external iliac arteries, with proximal cannulation of the circumflex iliac arteries for infusion of thrombin. The thrombin infusion was randomized to the left or right side for 5000 vs 10,000 U/h. The 5000-U/h group required 2.1 times as long as the 10,000-U/h group to reach failure (mean, 21.8 minutes vs 46.4 minutes; P < .0001), as shown by a Kaplan-Meier survival analysis (log-rank P < .0001). However, the 5000-U/h group required the same total amount of thrombin (mean, 3752 ± 856 U; P = .57). Thus, time- and/or thrombin dose-controlled induction of shunt failure is technically feasible. Furthermore, in the final 15 minutes before failure, the flow was similar between the two groups (P >. 05), and the slope of the flow curve became more negative the closer the model was to failure. Overall, this model could be used to develop an alert system to predict for impending shunt failure or the need for intervention.
KW - Argyle shunt
KW - Arterial shunt
KW - Combat vascular injury
KW - Peripheral shunt
KW - Swine model of vascular injury
KW - Vascular trauma
UR - http://www.scopus.com/inward/record.url?scp=85140017180&partnerID=8YFLogxK
U2 - 10.1016/j.jvssci.2022.07.001
DO - 10.1016/j.jvssci.2022.07.001
M3 - Article
AN - SCOPUS:85140017180
SN - 2666-3503
VL - 3
SP - 285
EP - 291
JO - JVS-Vascular Science
JF - JVS-Vascular Science
ER -