Fig 1.
Preparation of an animal model of ALI.
After surgical exposure of both carotid arteries (white arrows) and one carotid vein (black arrow) under sterile conditions, two 8 Fr arterial sheaths (white arrows) and one 9 Fr vein sheath (black arrow) were inserted. Note that a micro-catheter (grey arrow) is inserted in the right carotid artery, an 8 Fr multi-purpose guiding catheter in the left carotid artery, and a 9 Fr multi-purpose guiding catheter in the left carotid vein. Abbreviations: ALI, acute limb ischemia.
Fig 2.
Representative images of the porcine model of ALI.
The pigs underwent intravascular induction of ALI. Baseline angiography (A), Embolization of the CIA. ALI was generated by the deployment of an Amplatzer Vascular Plug II in the CIA, followed by an angiography to verify occlusion (B), representative angiography after CIA occlusion (C), Baseline venography (D), Venous blood flow restriction with partial balloon inflation (E). Abbreviations: ALI, acute limb ischemia; CIA, common iliac artery.
Fig 3.
Experimental study protocol and blood sampling for evaluating oxygen saturation (right SFA and the right CIV).
Blood sampling for evaluating oxygen saturation was obtained from the right SFA and the right CIV at baseline (T0), just after the arterial occlusion with embolization (T1), at 10 minutes (T2), at 20 minutes (T3), and at 40 minutes (T4). Next, an intentional partial (90%) venous occlusion was achieved by inflating the vascular balloon at the level of the right CIV. Subsequently, blood sampling was repeated at 5 minutes (T5) after the partial venous occlusion, at 15 minutes (T6), and at 25 minutes (T7). The left leg in two pigs served as a control limb; the left CIA was embolized while the left CIV was not occluded. In those legs, blood sampling was obtained 40 minutes after the left CIA occlusion in the left CIV with the same method as above (T5-1, T6-1, and T7-1). Abbreviations: CIA, common iliac artery; SFA, superficial femoral artery; CIV, common iliac vein.
Fig 4.
Blood sampling of the right SFA (A) and right CIV (B) at different moments (From T0 to T7). Effect of partial venous occlusion on venous oxygen saturation over time (from T4 to T7) (C). Abbreviations: SFA, superficial femoral artery; CIV, common iliac vein.
Fig 5.
Representative image of the venous blood pressure response in the ischemic limb.
White arrows show a recording of the mean venous pressure, at baseline (T0), just after the arterial occlusion (T1), and 25 minutes after partial vein occlusion (T7). A decline after arterial occlusion (B) and an elevation after partial vein occlusion were observed in the mean venous pressure (C).
Fig 6.
Spearman correlation was performed for bivariate correlations between hypoxic damage by arterial embolization (defined as T4 minus T0 in vein saturation) and treatment effect with partial venous occlusion (defined as T7 minus T4 in vein saturation) to establish a relationship.
Table 1.
Blood sampling of the SFA and CIV at different moments (From T0 to T7).
Table 2.
Comparision of the venous oxygen saturations between the experimental limbs with arterial embolization and the control limbs.