Objectives Swine ( Sus Scrofa) are utilized broadly in research settings, given similarities to human vessel size and function; however, there are some important differences for clinicians to understand in order to interpret and perform translational research. This review article uses angiograms acquired in the course of a translational research program to present a description of the functional anatomy of the swine. Methods Digital subtraction angiography and computed tomography angiography were obtained throughout the course of multiple studies utilizing power injection with iodinated contrast. Subtracted two-dimensional images and three-dimensional multiplanar reformations were utilized post image acquisition to create maximal intensity projections and three-dimensional renderings of using open-source software (OsiriX). These imaging data are presented along with vessel measurements for reference. Results An atlas highlighting swine vascular anatomy, with an emphasis on inter-species differences that may influence how studies are conducted and interpreted, was compiled. Conclusions Swine are utilized in broad-reaching fields for preclinical research. While many similarities between human and swine vasculature exist, there are important differences to consider when conducting and interpreting research. This review article highlights these differences and presents accompanying images to inform clinicians gaining experience in swine research.
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Type II renal tubular acidosis (RTA) is a rare defect in bicarbonate transport that can cause serious metabolic derangements. We report the case of a spontaneous, isolated intraoperative episode of severe type II RTA in an elderly woman who presented for radical neck dissection, mandible excision, and flap creation. Intraoperatively, she developed a stark metabolic acidosis with hypokalemia, progressively worsening base excess, and prolific urine output. Aggressive resuscitation with bicarbonate corrected all metabolic abnormalities. There was no identifiable trigger and the patient was successfully discharged with no further recurrences during hospitalization. The inability to identify the clinical presentation of RTA perioperatively can lead to poor outcomes.
Background: Intraoperative computed tomography (CT) imaging with endovascular catheter delivery of intra-arterial (IA) contrast could potentially provide higher signal attenuation in directed anatomic locations with lower contrast volumes. We compared image quality and attenuation timing of IA versus IV contrast protocols for abdominal imaging. Methods: Five anesthetized swine had internal jugular access and ascending aortic pigtails placed percutaneously via the brachial artery. The IV contrast protocol utilized 100 mL of iodinated contrast at 5 mL/sec over 20/sec. The IA protocol delivered 50 mL at 5 mL/sec over 10/sec. A 16-slice CT scanner with a 10 mm detector acquired static serial images at 1 image/second for 45 secs. Region-of-interest markers were used to select the aorta and portal vein to capture arterial and venous attenuation via Hounsfield Units (HU) per second. Attenuation curves were assessed using a Pearson’s correlation. Adequate attenuation was defined as >100 HU a priori and image quality assessed using Contrast-to-Noise Ratio (CNR). Results: Both contrast protocols achieved adequate image attenuation with an aortic peak of 665 ± 226 (Mean HU ± SD) for IA and 414 ± 141 for IV. IA contrast achieved faster peak aortic attenuation compared to IV contrast [8 vs 20 sec; p<0.001] (Fig 1). Portal values (attenuation and time to peak) were similar for IA vs IV: [146 ± 46 vs 169 ± 39; 34 vs 42 sec; p<0.05]. IA administration achieved a superior CNR in less time compared to IV [10 vs 23 sec; p<0.001]. All curves were modeled using non-linear least squares regression and achieved an R 2 >0.94; p<0.001. Conclusion: IA contrast achieves adequate opacification and a superior CNR compared to IV contrast, while using a smaller volume for intraoperative directed imaging. The incorporation of intraoperative CT with IA contrast could radically change imaging protocols for endovascular aortic repair.
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