Effects on Lower Extremity Perfusion When the Lower Extremity Extracorporeal Distal Revascularization (LEEDR) System is Used for Arterial Shunting

Abstract Traumatic injuries to the pelvis, extremities, or extremity vessels have improved outcomes when there is early restoration of perfusion (Laverty et al, Hancock et al). An ex-vivo shunting device, such as the Lower Extremity Extracorporeal Distal Revascularization (LEEDR) system, offers a potential solution to perfuse an ischemic limb in situations where definitive repair is not available, or transfer or delay is inevitable. A large animal model is required to optimize the surgical technique and management strategies. Acknowledging the morphological differences between bipeds and quadrupeds (Edwards et al), the aim of this study is to use a model of prolonged extremity ischemia to determine whether a LEEDR system can be used to mitigate ischemia by reducing compartment pressures and the need for fasciotomies following reperfusion. We sought to develop a method where an extracorporeal shunt from the contralateral common femoral artery to the ipsilateral tibial artery in the setting of limb ischemia to provide distal perfusion. Following a period of controlled ischemia, we developed a model with a low resistance circuit and 150 mL/min pump to perfuse an ischemic extremity at a distal point utilizing the contralateral proximal femoral vessel as outflow.