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Optimisation of Volume Flow Rates When Using Endovascular Shunting Techniques: An Experimental Study in Different Bench Flow Circuits

  • Johan Millinger
    Correspondence
    Corresponding author. Department of Hybrid and Interventional Surgery, Vascular Surgery Unit, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Affiliations
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

    Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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  • Daniel Bengtsson
    Affiliations
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
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  • Marcus Langenskiöld
    Affiliations
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

    Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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  • Andreas Nygren
    Affiliations
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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  • Klas Österberg
    Affiliations
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

    Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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  • Joakim Nordanstig
    Affiliations
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

    Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Open AccessPublished:November 19, 2022DOI:https://doi.org/10.1016/j.ejvsvf.2022.11.002
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      Highlights

      • Endovascular shunting techniques have emerged as versatile approaches to manage ischaemia during vascular emergencies and procedures but remain poorly studied.
      • In this experimental study the flow rates in different practically useful endovascular shunt systems were investigated. Marked flow capacity differences were noted both between individual devices and different interconnected endoshunt systems.
      • Only optimised endoshunt circuits matched or outperformed the corresponding flow capacity of a commercially available conventional vascular shunt.
      • the observations for different devices and interconnected shunt system flow capacities may guide vascular surgeons to select more optimised endoshunting approaches, that ultimately may limit end organ damage in many clinical scenarios.

      Abstract

      Objective

      Acute tissue ischaemia may arise due to arterial emergencies or during more complex vascular procedures and may be mitigated by temporary shunting techniques. Endovascular shunting (ES) techniques enable percutaneous access and shunting from the donor artery without the need to completely interrupt the arterial flow in the donor artery. An endoshunt system may also cover longer distances than most conventional shunts. The aim was to investigate and optimise the flow rates in different endovascular shunt systems.

      Methods

      Step 1: The flow capacity of different ES configurations was compared with the flow capacity in a 9 Fr Pruitt–Inahara shunt (PIS). An intravenous bag with 0.9% NaCl, pressurised to 90 mmHg, was connected simultaneously to a PIS and to one of the tested ES configurations. The two shunt systems were thereafter opened at the same time. The delivered fluid volumes from the shunt systems were collected and measured. The volume flow rate was subsequently calculated. Steps 2 and 3: Within a heart–lung machine circuit, pressure–flow charts were constructed for the individual ES components and for the fully connected optimised endoshunt systems. The flow rate was increased in steps of 40 – 50 mL/min while monitoring the driving pressure, enabling the creation and comparison of the pressure–flow charts for the individually tested components. In total, seven individual inflow and outflow potential ES components were investigated with inflow and outflow diameters ranging from 6 to 15 Fr.

      Results

      ES systems based on standard donor introducers lead to substantially lower volume flow than the corresponding PIS volume flow, whereas ES systems based on dedicated 6 or 8 Fr dialysis access introducers (Prelude Short Sheet, Merit Medical) matched PIS flow rates. The introduction of 30 cm long ¼′′ perfusion tubing within the ES system did not affect volume flow for any of the tested ES configurations.

      Conclusion

      Endoshunting techniques can match PIS volume flow rates over short and long distances. The achieved ES flow rates is highly dependent on the components used within the ES system.

      Keywords

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