Till Örebro universitet

Juxtahepatic venous injuries often cause life-threatening hemorrhagic shock, the mortality is high and new management methods are needed. The aims were to explore endovascular methods for retrohepatic vascu-lar isolation, their effects on survival, hemodynamics, metabolism, end-organ damage and bleeding, and if ultrasound and anatomical land-marks could be used to guide placement of resuscitative endovascular balloon occlusion of the inferior vena cava (REBOVC). Study I ex-plored the effects of different combinations of REBOVC +/- endovascu-lar aortic balloon occlusion (REBOA) +/- the Pringle maneuver (PM) for 5 minutes in anesthetized pigs (n=9). REBOVC was found to be tol-erated hemodynamically if combined with REBOA whereas REBOVC alone or combined with PM was not. In study II, REBOA was com-pared to REBOA + REBOVC in normovolemia and in hemorrhagic shock in anesthetized pigs (n=6-7/group). REBOA + REBOVC was tol-erated for 45 minutes, but negative hemodynamic and metabolic ef-fects in hemorrhagic shock must be considered. In Study III, the effects in anesthetized pigs of different combinations of balloon occlusion (REBOA vs REBOA + REBOVC vs REBOA + infra- and suprahepatic REBOVC + portal vein occlusion) on survival, hemodynamics, retrohe-patic bleeding, metabolism, and collateral flow were compared to no occlusion. REBOA was found to most efficiently stabilize hemodynam-ics and prolong survival despite larger collateral flow and retrohepatic bleeding. The inability of venous occlusion to stabilize hemodynamics as efficiently as REBOA was probably due to a combination of arterial collateral flow combined with reduced venous return. Studies IV + V examined if ultrasound (in anesthetized pigs, n=9) and anatomical landmarks (computerized tomography images from 50 humans) could be used to position REBOVC and found that subxiphoidal ultrasound and external landmarks can be useful tools to adequately position RE-BOVC in the inferior vena cava.