Blood Pressure and Renal Blood Flow Response
to Occlusion of Visceral Arteries
MARIO ONNIS, M.D., HARms B. SHUMACKER, JR., M.D., GUSTAVo BOUNOUS,
From the Department of Surgery and the Heart Research Center, Indiana University
School of Medicine, Indianapolis, Indiana
THE PRESENT study was undertaken in
order to investigate systemic blood pres-
sure and renal blood flow responses to
acute clamping of the major abdominal
visceral arteries.
Materials and Methods
Adult mongrel dogs varying in weight
from 11.8 to 17.3 kilograms were used.
They were anesthetized by the intravenous
injection of 5.0 per cent thiopental sodium.
An endotracheal tube was inserted and
oxygen was administered rhythmically by
means of a mechanical respirator. Mean
arterial blood pressure was monitored by
a U-tube mercury manometer connected
with a plastic catheter inserted into the
aorta via a femoral artery. Temperature
was measured by a telethermometer placed
in the mid portion of the esophagus. Renal
blood flow was determined by a direct
method which has been described previ-
ously.2 The arteries to be occluded were
dissected free using nonsterile technic.
After renal blood flow and arterial pressure
had been measured during a ten-minute
control period, the arteries were clamped
with a noncrushing arterial clamp. Renal
blood flow and systemic arterial pressure
were measured every five minutes during
* Submitted for publication January 17, 1962.
Aided by PHS research grant (H-203 C5)
from the National Heart Instituite, National In-
stitutes of Health, Public Health Service, and
by grants from the American Heart Association
and James Whitcomb Riley Memorial Association.
56
'
M.D.
the 30-minute period of arterial occlusion
and every five minutes during a 15-minute
period after release of the clamp.
Four groups of eight dogs each were
studied. In the first the superior mesenteric
artery was occluded, in the second the
celiac axis, in the third the hepatic artery,
and in the fourth both inferior and superior
mesenteric arteries and the celiac axis. In
an additional group of four dogs thoraco-
lumbar sympathectomy and splanchnicec-
tomy were performed in two stages by a
technic described previously.4 Approxi-
mately eight days later arterial pressure
and renal blood flow were studied before,
during, and after clamping of both mesen-
teric arteries and the celiac axis.
Results
Clamping of the Superior Mesenteric
Artery. In this group the mean arterial
blood pressure during the control period
varied from 110 to 140 and averaged 124
mm. Hg (Fig. 1). A mild increase in
arterial pressure occurred during the period
of superior mesenteric arterial clamping in
seven of the eight animals. Blood pressure
remained essentially unchanged in the ex-
ceptional instance. On the average the
arterial blood pressure rose 15 mm. Hg.
The blood pressure fell in every instance
when the clamp was removed from the
mesenteric artery. Renal blood flow values
during the control period ranged from 18.9
to 27.2 and averaged 21.9 cc./kg./min. A
Volume 157
Number 1
OCCLUSION OF VISCERAL ARTERIES
very slight increase in renal flow occurred
during the period of clamping in each ani-
mal. The average increase was little, only
approximately 10 per cent above the con-
trol values. Upon release of the clamp a
very slight decrease in the renal blood flow
was observed in six of the eight dogs. The
average renal blood flow returned to the
control level.
Clamping of the Celiac Axis. In this
group the mean arterial blood pressure
during the control period varied from 120
to 155 mm. Hg and averaged 130 (Fig. 2).
In seven of the eight animals the blood
pressure began to fall slightly shortly after
the clamp had been placed on the celiac
axis. In the exceptional case the blood
pressure remained the same throughout.
On the average the blood pressure fell
about 15 mm. Hg. It fell somewhat more
after the clamp was released in five of the
eight animals. In the other three the blood
pressure tended to remain at about the
1505
N
ic A s0
30
02
5 10 15 20 25 30 5 10 15
T I ME IN MIN UT ES
FIG. 1. Chart showing response of arterial blood
pressure and renal blood flow to clamping of
superior mesenteric artery. In this figure and in
Figures 2-6 the continuous line represents the
average mean arterial blood pressure, the broken
line the average renal blood flow. The cross
matched areas show the range of values. The ar-
row pointing down signifies time of application
of clamp, the arrow pointing lp, time of its
release.
57
E
130T
120-~~~~~~~~~~~~
100 0
0 ~~~~~~~~~~~~~0
14 5-0 1 0 25 3 0 1
0 10 15 20 25 30 5 1
20
FIG. 2. Chart showing response to clamping of
celiac axis.
same level as during the terminal period of
aortic clamping. In this group the renal
blood flow values during the control period
ranged from 19.5 to 32.5 cc/kg/mm. and
averaged 23.7 cc./kg./min. A slight fall in
renal blood flow was observed in all ani-
mals during the period of clamping. The
average renal blood flow gradually fell to
18.5 cc./kg./mmn., or a little less than 80
per cent of the control value. WVhen the
clamp was released the changes in renal
flow were inconsistent. A slight increase
occurred in six and a decrease in two. On
the whole no appreciable change took
place in mean values.
Clamping of Hepatic Artery. The mean
arterial blood pressure during the control
period varied from 100 to 145 and averaged
134 mm. Hg (Fig. 3). The response of
blood pressure and renal flow was some-
what similar to that in the previous group.
Some mild decrease in blood pressure dur-
ing the period of clamping was observed
in six of the eight animals. On the average
it fell to a level only approximately 10 mm.
58 ONNIS, SHUMACKEFI AND BOUNOUS
5 10 15 20 25 30 5 10
T I M E I N M I N U T E S
FIG. 3. Chart showing response to clamping of
hepatic artery.
below the control value. The renal blood
flows in the control period varied from
17.5 to 27 and averaged 21.3 cc./kg./min.
Some decrease was observed during the
period of clamping in all animals. The
average renal blood flow at the end of the
period was 14.5 cc./kg./min., or a little
less than 70 per cent of the control value.
After the clamp was released the blood
pressure tended to fall a little in all in-
Annals of Surgery
January 1963
about 60 mm. Hg. The renal blood flow
during the control period in this group
varied from 18.5 to 26.2 and averaged 21.5
cc./kg./min. A decrease was observed dur-
ing the period of clamping in every in-
stance. The average renal blood flow fell
to 8.5 cc./kg./min. or approximately 40
per cent of the control value. When the
clamp was released, an increase in renal
flow was observed in each animal. On the
whole the renal flow increased to almost
twice the level observed during the termi-
nal period of clamping (to 15.5 cc./kg./
min.).
Clamping of Mesenteric Arteries and
Celiac Axis in Sympathectomized Ani-
15 mals. A striking difference in renal blood
flow response was noted in this group in
spite of a similar, though less marked, re-
sponse in blood pressure. (Fig. 5). In these
animals the average blood pressure during
the control period was only 82 mm. Hg.
N
Da
M4
z

stances and the renal blood flow to increase r

U,
slightly or to remain at approximately the 0
0
U
same level. 0 r,
Clamping of Celiac Axis and Both 0
.3
m
0

Mesenteric Arteries. In this group a sub- .2

Pr

stantial rise in blood pressure and fall in I.4

aqI

1tR
renal flow was observed during the period 3
of clamping. (Fig. 4). During the control z
3.

M0
period the blood pressures ranged from 110
to 145 and averaged 125 mm. Hg. Increase
in blood pressure was observed during the
period of clamping in each instance. The
average blood pressuire increased to a level 0 5 10 15 20 25 30 5
approxil nately 30 m11. al)Ove the (onrl
t T I M E I N M I N U T E S

valtie. 'Whlenl the clamp was released a

FIG. 4. Chart showing response to cla.mping of
pronounced fall occurred in each animal. celiac axis and superior and inferior mesenteric
On the average the blood pressure fell arteries.
Volume 157 OCCLUSION OF VISCERAL ARTERIES
Number 1 59
It increased during the period of clamping
to a maximal value of 114 mm. Hg. After the
clamps were released the average arterial
blood pressure fell precipitously to a level 090

of around 40 mm. Hg and then rose to a 80

final value of 55. The average renal blood 70

S5
flow was 20.7 cc./kg./min. during the con- rn
T I M E
I N 1 I N U T E S0
~~~~~~~~~~~~0
trol period. It rose to 26 cc./kg./min. dur- 60 a
ing the period of clamping, fell upon re- 0150 321
0

lease of the clamp to 17.1 and then rose ,

to nearly the control level (19.7 cc./kg./ 30 24~

min ).
In Figure 6 the arterial blood pressure
and renal flow responses in the normally 1.12
arere ( et e
innervated and sympathectomized animals
are contrasted. Figure 7 summarizes the
5 10 15 20 25 30 5 10 15

pressure and renal flow values in all groups T I ME I N MI NU TE S

at the end of the period of arterial oc-

Fic.5. Chart showing response
lomy Incnrs,tebl6 clamping of to
clusion. celiac and superior and inferiorrsuefl
axis mesenteric

Comments arteries (left).

In our studies the mean arterial blood pres- animal had normal innervation or had been
sure increased slightly when the superior subjected previously to bilateral thoraco-
mesenteric artery was occluded and more lumbar sympathectomy and splanchnicec-
so when the superior and inferior mesen- tomy. In contrast, the blood pressure fell
teric arteries and celiac axis were occluded. in those animals in which the celiac axis
This was true regardless of whether the was occluded and in those in which the

w
04
:
g4 z
0
0

Do

X,o-
0 5 10 15 20 25 30 5 10 15 0 5 10 15 20 25 30 5 10 15
T I ME IN MIN UT ES T I ME IN MIN UT ES

FIG. 6. Chart comparing responses in normal dogs and in those previously suibjected to thoraco-
lutmbar sympathectomy and splanchnicectomy (right) to clamping of celiac axis, superior aInd inferior
mesenteric arteries.
60 ONNIS. SHIU\l \CKER AND) BOU\OUS \AlIIl- 'ur-erv
Jaln tiat ! 1966

3 4:
0

W.
0 'in(.. 7. Chart siiiim-
z mrizing bloodl prc.ssurc
U (ABP antd (rle l floxv
)

(RBF ) rcsponsts in all

D'Olips.
ffi0-f
z

_Z
44

lhepatic artery- alone as occlidecd. Beninati o.bservation x-mould lend xw eight to thle be-
andcl Ghigginio I haid noted a sliglht increase lief that the hypecrtensive reaction (1()es not
in systemic lbl1o0( pressure i1poi( occluision
) resuilt fIro mil xasocouistr-ictionl ani(d is b)cst ex-

of the stuperior miesenteric artery. 'More plainedI tIpon a hydrodvnamic hasis as a

recently Ilevmiiains andl hiis associates ald
observed that the 1lood pressuire increasedl
fromii 20 to 44 mim. Hg ( average 28 ) uipon
clamllpinlg of the suiperior meseniteric artery.
0
They foundi(I the inierease axeraged 130Mm.
HIg xvleni the celiac axis an(1 superior an(I
iniferior meselnteric arteries Nx7ere occltu(led.
conse(quienice of a studden clhanige in the dis-
tribuition of blood flow aind reduction in
effective xvascuilar- bed. Any rncal xvasocon-
striction occtirriiig dutrinig C.ombincld meseii-
teric anil celiac clamping, is not felt re-
sponsible for elevation in blood piressture
sinc-e ympatlectomy al)olishes the formiiier
s

It their opinion that this lhpertensive

xxwas l)llt does niot affect the latter.
response slhoulcl Inot 1)e considered of reflex Otlher interesting ob)servations w ere imalde
origin siince it xvas niot affected 1)v the ad- concerning the behavior of renal b0loo0d
miniistratioli of helxamiietlhomliiim. Selkiurt flowx during occlusion of the v'arious ab-
nd Rotle observed ineerase
average an domIinal xisceral ar-teries. Clamping of the
of 13 min. Hg uiponi oceluisioi) of the suipe- suiper-ior mlecseniteric artery brought about
rior mesenteric arterx anid the celiac axis. only a questional)le increase in renal blood
They (licl Inot find(I that this response xvas flow. In contrast, claim1pin1g of the cCeliac
appreciably affected l)v vagal sectioni and(I axis or of the hlepatic artery alonle brought
believed it could be better explainedI on a al)out a dlefiniite signiific-anit decrease in
hv(1rodvnamic rathlr thian1 reflex basis. a reinal 1)l00(1 flowx This r-esponse was exag-
In oulr exper-iien1ts, the hix pertensix e re- gerated xw hen the celiac, axis and(i both
sponse xv-as quiite simnilar folloxing clamip- mileseniter-ic aIrterieis xereocclut(led, the
inig of imiesenter-ic ar-ter-ies an(I( the celiac 1)lood0 flow falling', abruptly to atppr-oxi-
axis in normal (logs auijI in those pleviouslv mnately 4() per cent of the molltrl alue.
subjected to exteinsive thoraco-lumbar svml- The reducltionl in flowx whichl occurred xhilil
pathectomy an(I splanchnicecttomy. This the hepatic artery or the c eliac axis xvas
Volume 157 OCCLUSION OF VISCERAL ARTERIES
Nuimher I
occluded in contrast to the slight increase
which followed occlusion of the superior
mesenteric artery alone makes it evident
that depression in renal function is at least
in part related to decrease in hepatic artery
flow. This provides experimental support
for the clinical observations of depressed
renal function in certain states in which
hepatic function is reduced. No obvious
explanation is available for the intensifica-
tion of the reduction in renal blood flow
when occlusion of superior and inferior
mesenteric arteries was added to occlusion
of the celiac axis. The fact that under these
circumstances renal blood flow did not
fall but indeed increased a little in animals
previously subjected to sympathetic dener-
vation and splanchnicectomy makes it evi-
dent that the reduction in renal blood flow
observed in normal dogs is related to in-
creased renal vascular tone during the
period of arterial occlusion. This observa-
tion would suggest that efforts to abolish
increased renal vascular tonus might con-
ceivably be worthwhile in clinical states
characterized by reduced hepatic and renal
function.
Summary
Mean arterial blood pressure and renal
blood flow responses to clamping of visceral
arteries were studied.
Mean blood pressure increased slightly
when the superior mesenteric artery was
occluded. It increased more when both
mesenteric arteries and the celiac axis were
occluded both in normal dogs and in those
previously subjected to thoraco-lumbar
sympathectomy and splanchnicectomy. This
suggests that the hypertensive reaction is
not due to reflex vasoconstriction but to a
change in the distribution of blood flow
61
6
and a reduction in the effective vascular
bed. Blood pressure fell when the celiac
axis or the hepatic artery was occltuded.
Only questionable increase in renal
blood flow was observed during clamping
of the superior mesenteric artery. Renal
flow, in contrast, decreased when the celiac
axis or the hepatic artery was occluded.
This decrease was exaggerated when the
mesenteric arteries were occluded as well
as the celiac axis. The observed decrease
in renal flow was at least in part related to
decreased hepatic artery flow and lends
some experimental support to observed
clinical states of reduced renal function in
cases of reduced hepatic function. The
fact that sympathectomy and splanchni-
cectomy abolish the fall in renal flow other-
wise observed with clamping of the me-
senteric arteries and celiac axis indicates
that this reaction results from increased
renal vascular tonus.
Bibliography
1. Bennati, D. and C. W. Ghiggino: Effecto de
Hypertension Arterial Provocado por la Oc-
clusion Temporara de Arterias de l'area
Splannica. An. Fac. Med. Montev., 41:53,
1956.
2. Bounous, G., H. B. Shumacker, Jr. and H.
King: Studies in Renal Blood Flow I. Some
General Considerations. Ann. Surg., 151:1,
1960.
3. Heymans, C., A. F. De Schaepdryver and G. R.
De Vleeschouwer: Abdominal Baro-Chemo-
sensitivity in Dogs: Circulation Research,
8:347, 1960.
4. Jontz, J. G., C. S. Su, H. B. Shumacker, Jr.
and G. Bounous: Influence of Renal Denerva-
tion Upon Renal Blood Flow. Surg. Gynec.
& Obst., 110:622, 1960.
5. Selkurt, E. E. and C. F. Rothe: Splanchnic
Baroreceptors in the Dogs. Am. J. Physiol.,
99:335, 1960.