Renal and Splanchnic Circulation During Infrarenal Aortic Cross-Clamping

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Abstract
• The effect of infrarenal cross-clamping of the aorta on regional splanchnic and renal circulations was studied in seven dogs. Regional blood flow was determined with differentially labeled microspheres (9 and 15 μm in diameter) that were injected simultaneously into the left atrium. Blood flow was measured 30 minutes after surgical preparation was completed (stage I), 20 minutes after infrarenal aortic crossclamping (stage II), and 20 minutes after supplemented sodium nitroprusside infusion (stage III). infrarenal aortic crossclamping was accompanied by a slight increase in the cardiac output (CO) without significant changes in mean arterial pressure (MAP). Blood flow through the gut, hepatic artery, and cortical layer of the kidneys, as determined with 15-μm spheres, was not changed. Nonentrapment of 9-μm spheres in the gut and renal cortex was increased substantially. Blood flow through the juxtamedullary layer of the kidneys was increased. Sodium nitroprusside supplementation decreased MAP by 30%; CO values returned to baseline level. Hepatic artery blood flow, compared with both baseline values and values during aortic cross-clamping, increased significantly. Blood flow, determined with 15-μm spheres, through the gut and renal cortex did not change, and nonentrapment of 9-μm spheres decreased to baseline values. The data suggest a certain shift of blood flow to the juxtamedullary layer of the kidneys during aortic cross-clamping and normalization of intrarenal blood flow distribution during supplemented sodium nitroprusside infusion. Controlled vasoplegia with sodium nitroprusside may help modify peripheral circulatory disturbances in the kidneys and splanchnic system during infrarenal aortic cross-clamping. (Arch Surg1984;119:1394-1399)