Clinical principal,safe time limit of various level of abdominal aorta clamping

Qu Du et al: Clinical principal and safe time limit of various level of abdominal aorta clamping — The role of bintree tolerance law in preventing ischemic reperfusion injury ,HaiNan Medical Journal(in China),2009;20(1): 1 - 13 (in chinese)

Key words: Abdominal aorta clamping (AAC); Safe time limit of occlusion; Distal aorta perfusion (DAP); Cerebrospinal fluid drainage (CSFD); Epidural Cooling (EC); Bintree tolerance law (BTL); Ischemic reperfusion injury (IRI); General life time-space-field theory (GLTSF); Ballon occlusion; Systemic inflammation response syndrome (SIRS); Multiple organ failure (MOF); Sequential waterfall chain;

Abstract:
Objective: In order to guarantee the safety of abdominal aorta clamping, the clinical principle and the safe time limit of various level of AAC were investigated in this study.Methods: During 1980-1982, we had carried out a series of studies in the safe time limit and the pathophysiological changes of abdominal aorta clamping (AAC) for the first time. Our results showed that 25 min is the safe time limit of abdominal aorta clamping in dogs in vivo. There are only small and reversible changes in hemodynamics(Heart Rate/HR, Blood pressure/BP, Central venous pressure/CVP, Total peripheral resistance / TPR, Cardiac output/CO，Right carotid and femoral arterial flow/RCF and RFF) and acid-base equilibrium(PH,HCO-3 BEP,BBP), blood biochemisty (Seroenzymes-SGPT,SGOT,AKP and LDH ; Plasma protein-Total protein, Albumin and Globulin; Electrolytes-K+, Na+, Cl-,Ca++ and P-; Blood sugar, Amylase ,NPN; Coagulation state - Prothrombin, Platelet, Fibrinogen) and in the ultrastructures of various organs(cerebral, pulmonary, hepatic, Kinney, pancreatic, intestine and spinal cord) .When the clamping exceeds its safe time limit, it is highly likely that it will induce severe changes, which may be irreversible and difficult to compensate. Based on the theory of General life time space field (GLTSF), we investigated the anatomical principle of AAC, the syndromes during AAC including respiratory distress syndrome (RDS), acute hypertensive cerebral edema (AHCE), multiple organs microthombosis - sicked cells syndrome (MOMSCS) and the syndrome of central respiratory failure (CRF) after declamping ; and the mechanisms of pathophysiological and cellular molecular biology of ischemic reperfusion injury caused by AAC. Recent animal studies and clinical applications as well as literature review in the field were also discussed.
A set of clinical strategy was proposed for prevention and treatment of ischemic reperfusion injury (IRI) of AAC. Furthermore, new techniques such as distal aorta perfusion (DAP), cerebrospinal fluid drainage (CSFD), and epidural cooling (EC) for preventing the complications after AAC were evaluated in this paper.Results: During and after abdominal aorta clamping, if the procedure exceeds the safe time limit, ischemic reperfusion injury（IRI）will occur, followed by systemic inflammatory response syndrome (SIRS) and multiple organ failure (MOF). The safe time limits in various level of AAC including high level (T12 level, above celiac trunk artery) ，medium level (L2 level, above renal artery) and low level (L4 level, above common iliac artery) are between 25 to 30min.Conclusion: The clinical safety of patients will not be compromised if the bintree tolerance law/BTL is strictly followed during abdominal aorta clamping.