An experimental study of normothermic abdominal aorta clamping in dogs: I. The safe time limit and syndromes after abdominal aorta clamping

Current state of interventional procedures to treat pernicious placenta previa accompanied by placenta accreta spectrum: A review

Pernicious placenta previa (PPP) accompanied by placenta accreta spectrum (PAS) is a life-threatening placental implantation that causes a variety of complications, including antepartum hemorrhage, postpartum hemorrhage, hemorrhagic shock, preterm birth, and neonatal asphyxia. Along with continuous improvements in medical technology, interventional procedures have been widely used to prevent intraoperative hemorrhage associated with PPP. The commonly used interventional procedures include abdominal aorta clamping, prophylactic balloon occlusion of the internal or common iliac arteries, and uterine artery embolization. The above-mentioned interventional procedures have their respective advantages and disadvantages. The best procedure for different situations continues to be debated considering the complex pattern of blood supply to the uterus in patients with PPP. The specific choice of interventional procedure depends on the clinical situation of the patient with PPP. For grade III PAS, the need for uterine artery embolization is assessed based on blood loss and preoperative hemostatic effect following abdominal aorta clamping. Repair or hysterectomy may be performed following uterine artery embolization if there is a hybrid operating room for grade III PAS patients with extensive sub-serosal penetration of the uterus and repair difficulty. For grade II PAS (shallow placental implantation), prophylactic balloon occlusion may not be necessary before surgery. Uterine artery embolization can be performed in case of postoperative hemorrhage.

Large blood vessel stretch in lumbar spine through anterior surgical approach: An experimental study in adult goat

BACKGROUND

Various anterior lumbar surgical approaches, including the minimally invasive approach, have greatly improved in recent years. Vascular complications resulting from ALIF are frequently reported. Little information is available about the safety of large blood vessel stretch. We evaluated the right side stretch limit (RSSL) of the abdominal aorta (AAA) and the inferior vena cava (IVC) without blood flow occlusion and investigated stretch-induced histological injury and thrombosis in the iliac and femoral arteries and veins and the stretched vessels.

MATERIALS AND METHODS

The RSSL of blood vessels in five adult goats was measured by counting the number of 0.5-cm-thick wood slabs that were inserted between the right lumbar edge and the stretch hook. Twenty seven adult goats were divided into three groups to investigate histological injury and thrombosis under a stretch to 0.5 cm (group I) 1.5 cm (group II) for 2 h, or no stretch (group III). Blood vessel samples from groups I and II were analyzed on postsurgical days 1, 3, and 7. Thrombogenesis was examined in the iliac and femoral arteries and veins.

RESULTS

The RSSL of large blood vessels in front of L4/5 was 1.5 cm from the right lumbar edge. All goats survived surgery without complications. No injury or thrombosis in the large blood vessels in front of the lumbar vertebrae and in the iliac or femoral arteries and veins was observed. Under light microscopy, group I showed slight swelling of endothelial cells in the AAA and no histological injury of the IVC. The AAA of group II showed endothelial cell damage, unclear organelles, and incomplete cell connections by electron microscopy.

CONCLUSIONS

The AAA and IVC in a goat model can be stretched by ≤0.5 cm, with no thrombosis in the AAA, IVC, iliac or femoral arteries and veins.