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Traumatismos Abdominales/cirugía , Venas Hepáticas/lesiones , Trasplante de Hígado/métodos , Heridas no Penetrantes/cirugía , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico por imagen , Accidentes de Tránsito , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Trasplante Autólogo , Resultado del Tratamiento , Ultrasonografía , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVES: Although traumatic injuries to the superior mesenteric vein (SMV), portal vein (PV), and hepatic vein (HV) are rare, their impact is significant. Small single center reports estimate mortality rates ranging from 29% to 100%. Our aim is to elucidate the incidence and outcomes associated with each injury due to unique anatomic positioning and varied tolerance of ligation. We hypothesize that SMV injury is associated with a lower risk of mortality compared to HV and PV injury in adult trauma patients. METHODS: The Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis. RESULTS: From 1,403,466 patients, 966 (0.07%) had a single major hepatoportal venous injury with 460 (47.6%) involving the SMV, 281 (29.1%) involving the PV, and 225 (23.3%) involving the HV. There was no difference in the percentage of patients undergoing repair or ligation between SMV, PV, and HV injuries (P > .05). Compared to those with PV and HV injuries, patients with SMV injury had a higher rate of concurrent bowel resection (38.5% vs 12.1% vs 7.6%, P < .001) and lower mortality (33.3% vs 45.9% vs 49.3%, P < .01). After controlling for covariates, traumatic SMV injury increased the risk of mortality (odds ratio [OR] 1.59, confidence interval [CI] = 1.00-2.54, P = .05) in adult trauma patients; however, this was less than PV injury (OR = 2.77, CI = 1.56-4.93, P = .001) and HV injury (OR = 2.70, CI = 1.46-4.99, P = .002). CONCLUSION: Traumatic SMV injury had a lower rate of mortality compared to injuries of the HV and PV. SMV injury increased the risk of mortality by 60% in adult trauma patients, whereas PV and HV injuries nearly tripled the risk of mortality.
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Venas Hepáticas/lesiones , Vena Porta/lesiones , Lesiones del Sistema Vascular/epidemiología , Adolescente , Adulto , Niño , Bases de Datos Factuales , Femenino , Venas Hepáticas/diagnóstico por imagen , Venas Hepáticas/cirugía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Vena Porta/diagnóstico por imagen , Vena Porta/cirugía , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiología , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/mortalidad , Lesiones del Sistema Vascular/cirugía , Adulto JovenRESUMEN
We report a case of a refractory cardiogenic shock secondary to myocardial infarction in a 70-year-old patient requiring femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO). At initial transesophageal echocardiography, the venous cannula tip was seen in the inferior vena cava (IVC), but not in right atrium. On day 8, ultrasonic examination identified that the end of the venous cannula was in the hepatic vein (HV). Despite such malposition, no disturbance in extracorporeal membrane oxygenation (ECMO) venous return was observed. Moving or replacing the cannula was considered a high-risk maneuver potentially resulting in hepatic laceration with hemoperitoneum. Because of adequate venous drainage, allowing sufficient blood flow, venous cannula repositioning was delayed until day 10, when a ventricular defect was repaired and ECMO was weaned off. At the time of VA-ECMO implantation, the venous cannula has to be positioned in the right atrium using real time echo monitoring. Visualization of the guide wire in the IVC but not in the right atrium is insufficient to ensure appropriate venous cannula positioning. Indeed, either accidental catheterization or cannula migration into the HV is possible during ECMO. Health care professionals dealing with ECMO have to be aware of this possible malposition, to correct it and prevent insufficient venous drainage or traumatic complications.
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Catéteres/efectos adversos , Oxigenación por Membrana Extracorpórea/efectos adversos , Falla de Prótesis , Choque Cardiogénico/etiología , Anciano , Oxigenación por Membrana Extracorpórea/instrumentación , Resultado Fatal , Venas Hepáticas/diagnóstico por imagen , Venas Hepáticas/lesiones , Venas Hepáticas/cirugía , Humanos , Masculino , Infarto del Miocardio/cirugíaRESUMEN
BACKGROUND Carbon dioxide (CO2) is believed to be the safest gas for laparoscopic surgery, which is a standard procedure. We experienced severe cerebral infarction caused by paradoxical CO2 embolism during laparoscopic liver resection with injury of the hepatic vessels despite the absence of a right-to-left systemic shunt. CASE REPORT A 60-year-old man was diagnosed with hepatocellular carcinoma in the right hepatic lobe secondary to alcoholic liver disease. We planned the laparoscopy-assisted liver resection. During the surgery, the root of the right hepatic vein was injured. A 1.5-cm hole was accidentally made in the right hepatic vein, while mobilizing the right hepatic lobe laparoscopically. End-tidal CO2 dropped from 39 to 15.5 mmHg, and systemic blood pressure dropped from 121 to 45 mmHg, returning to normal with the administration of inotropes. The transesophageal echocardiography revealed numerous bubbles in the left atrium and ventricle. The Bispectral Index monitoring system showed low brain activity, suggesting cerebral infarction due to paradoxical gas embolism. The hepatectomy was completed by conversion to open laparotomy. The patient went into a coma and suffered quadriplegia after surgery, despite the cooling of his head and the administration of Thiamylal. Brain MRI revealed cerebral infarction in the broad area of the cerebral cortex right side predominantly, with poor blood flow confirmed by the brain perfusion single-photon emission CT. Rehabilitation was gradually achieved with Botox injections. CONCLUSIONS Cerebral infarction by paradoxical gas embolism is a rare complication in laparoscopic surgery, but it is important to be aware of the risk and to be prepared to treat it.
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Infarto Cerebral/etiología , Embolia Aérea/complicaciones , Venas Hepáticas/lesiones , Complicaciones Intraoperatorias , Laparoscopía/efectos adversos , Carcinoma Hepatocelular/cirugía , Conversión a Cirugía Abierta , Embolia Aérea/etiología , Hepatectomía , Humanos , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: After laparoscopic cholecystectomy, laparoscopic fundoplication has become another gold standard of minimal invasive surgery. The level of satisfaction of patients undergoing endoscopic surgery is almost 90%. Laparoscopic fundoplication, like other surgery methods, can also be burdened with grave complications, which could result in a fatal outcome even if the surgery is performed by a skilled surgeon. Even the authors themselves encounter complications despite their rich experience (more than 3,500 laparoscopic operations in the diaphragmatic hiatus area in more than 20 years). CASE REPORT: The authors report on a rare left hepatic vein injury during laparoscopic hiatoplasty and fundoplication according to Toupet for giant paraoesophageal hiatal hernia. CONCLUSION: For its low percentage of complications, laparoscopic fundoplication is considered as a safe operative method for gastroesophageal reflux disease and hiatal hernias. However, severe complications may still arise during the surgery and the surgeon should be familiar with them, be prepared for them and be able to manage such complications.Key words: gastroesophageal reflux disease hiatal hernia laparoscopic fundoplication left hepatic vein.
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Fundoplicación , Venas Hepáticas , Hernia Hiatal , Fundoplicación/efectos adversos , Fundoplicación/métodos , Reflujo Gastroesofágico , Venas Hepáticas/lesiones , Hernia Hiatal/cirugía , Humanos , LaparoscopíaRESUMEN
The purpose of this study was to evaluate the longterm outcomes of stent placement for a hepatic venous outflow obstruction in adult liver transplantation recipients. From June 2002 to March 2014, 23 patients were confirmed to have a hepatic venous outflow obstruction after liver transplantation (18 of 789 living donors [2.3%] and 5 of 449 deceased donors [1.1%]) at our institute. Among these patients, stent placement was needed for 16 stenotic lesions in 15 patients (12 males, 3 females; mean age, 51.7 years). The parameters that were documented retrospectively were technical success, clinical success, complications, recurrence, and the patency of the stent. The technical success rate was 100% (16/16). Clinical success was achieved in 11 of the 15 patients (73.3%). A major complication occurred in only 1 patient-a hepatic vein laceration during the navigation of the occluded segment. The median follow-up period was 33.5 months (range, 0.5-129.3 months), and the overall 1-, 3-, and 5-year primary patency rates of the stent were all 93.8%. One case of occlusion of the stent without clinical signs and symptoms was observed 5 days after the initial procedure. In this patient, the stent was recanalized by balloon angioplasty and showed patent lumen for 48 months of the subsequent follow-up period. In conclusion, stent placement is a safe and effective treatment modality with favorable longterm outcomes to treat hepatic venous outflow obstruction in adult liver transplantation recipients. Liver Transplantation 22 1554-1561 2016 AASLD.
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Síndrome de Budd-Chiari/cirugía , Trasplante de Hígado/efectos adversos , Complicaciones Posoperatorias/cirugía , Stents , Grado de Desobstrucción Vascular , Adulto , Angioplastia de Balón , Síndrome de Budd-Chiari/diagnóstico por imagen , Síndrome de Budd-Chiari/etiología , Femenino , Estudios de Seguimiento , Venas Hepáticas/lesiones , Humanos , Laceraciones/etiología , Masculino , Persona de Mediana Edad , Flebografía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Recurrencia , Estudios Retrospectivos , Stents/efectos adversos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía DopplerRESUMEN
Cement (polymethylmethacrylat) is frequently and increasingly used in vertebral surgery. Complications can occur by spillage of this material; however the vast majority of the patients remain free of symptoms and do not require any specific therapy.Internists, gastroenterologists and radiologists regularly performing abdominal ultrasound and computed tomography should be aware of this complication.A case of spillage of cement in the right hepatic vein is presented.
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Cementos para Huesos/efectos adversos , Extravasación de Materiales Terapéuticos y Diagnósticos/diagnóstico por imagen , Extravasación de Materiales Terapéuticos y Diagnósticos/etiología , Venas Hepáticas/diagnóstico por imagen , Vertebroplastia/efectos adversos , Anciano , Diagnóstico Diferencial , Venas Hepáticas/lesiones , Humanos , Hallazgos Incidentales , Masculino , Ultrasonografía/métodosAsunto(s)
Implantación de Prótesis Vascular/métodos , Puente Cardiopulmonar , Venas Hepáticas/lesiones , Esquí/lesiones , Lesiones del Sistema Vascular/terapia , Vena Cava Inferior/lesiones , Adolescente , Terapia Combinada , Angiografía por Tomografía Computarizada , Venas Hepáticas/diagnóstico por imagen , Venas Hepáticas/cirugía , Humanos , Masculino , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/cirugíaRESUMEN
We report on a rare case of blunt traumatic hepatic arteriovenous fistula arising from a pseudoaneurysm in a 35-year-old woman. Transarterial embolization was performed with n-butyl-2-cyanoacrylate, under inflow control with loose coil packing within the pseudoaneurysm and outflow control by balloon occlusion of the hepatic vein. A promising therapeutic outcome was achieved without any serious adverse events. Thus, the combination of these techniques to control inflow and outflow was successfully used to treat this rare hepatic vascular injury.
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Aneurisma Falso/terapia , Fístula Arteriovenosa/terapia , Embolización Terapéutica/métodos , Arteria Hepática/lesiones , Hígado/lesiones , Heridas no Penetrantes/complicaciones , Adulto , Aneurisma Falso/etiología , Fístula Arteriovenosa/etiología , Oclusión con Balón/métodos , Enbucrilato/administración & dosificación , Femenino , Arteria Hepática/anomalías , Venas Hepáticas/anomalías , Venas Hepáticas/lesiones , Humanos , Resultado del TratamientoRESUMEN
We present a case of nephrotic syndrome associated with right atrial and supra hepatic vein part of inferior vena caval thrombosis. This patient presented with dyspena, lower extremity edema and back pain after a vehicle accident and blunt trauma to the abdomen. Trauma should be considered not only as a thrombophilic pre-disposition, but also as a predisposing factor to IVC endothelium injury and thrombosis formation. Echocardiography revealed supra hepatic vein IVC thrombosis floating to the right atrium. A C-T scan with contrast also showed pulmonary artery emboli to the left upper lobe. With open heart surgery, the right atrial and IVC clot were extracted and the main left and right pulmonary arteries were evaluated for possible clot lodging. The patient had an uneventful postoperative recovery and thrombosis has not reoccurred with periodical follow-up examinations.
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Accidentes de Tránsito , Atrios Cardíacos/lesiones , Venas Hepáticas/lesiones , Trombosis/etiología , Vena Cava Inferior/lesiones , Adulto , Ecocardiografía , Atrios Cardíacos/diagnóstico por imagen , Venas Hepáticas/diagnóstico por imagen , Humanos , Masculino , Trombosis/diagnóstico por imagen , Grado de Desobstrucción VascularRESUMEN
BACKGROUND: Laparoscopic hepatectomy (LH) has now been widely performed in experienced centers. However, hepatic vein injury (HVI) during LH is especially dangerous, because it may cause conversion, air embolization, fatal hemorrhaging, or even death. MATERIALS AND METHODS: Perioperative characteristics of 4 patients who underwent LH suffering HVI were recorded, including 2 for right HVIs, 1 for middle HVI, and 1 for left HVI. Ultrasonic shears was used for liver mobilization. Linear stapler was adopted to cut off hepatic vein. A 4-0 prolene was used to repair HVI. RESULTS: In case 1 laparoscopic right hemihepatectomy was performed for hepatic hemangioma. The root of right hepatic vein was injured. Repairing time was about 10 minutes and hemorrhaging was about 150 mL. In case 2 laparoscopic segmentectomy for S7 and S8 was performed for hepatic hemangioma. The right hepatic vein was injured. Repairing time was about 8 minutes and hemorrhaging was about 220 mL. In case 3 laparoscopic trisegmentectomy for S2-S4+S5, S8 was performed for hepatic echinococcosis. The middle hepatic vein was injured. Repairing time was about 8 minutes and hemorrhaging was about 110 mL. In case 4 laparoscopic left lateral segmentectomy was performed for hepatocellular carcinoma. The left hepatic vein was injured. Repairing time was about 7 minutes and hemorrhaging was about 80 mL. All the HVIs were successfully repaired by a 4-0 #20 prolene. No complications were observed. CONCLUSIONS: Skillful stitching, experienced surgeons, and smooth cooperation can effectively handle HVI. However, conversion to laparotomy should be performed timely if uncontrolled hemorrhaging occurs, to ensure patients' safety.
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Hepatectomía/efectos adversos , Venas Hepáticas/lesiones , Laparoscopía/efectos adversos , Adulto , Carcinoma Hepatocelular/cirugía , Equinococosis Hepática/cirugía , Femenino , Hemangioma/cirugía , Humanos , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana EdadAsunto(s)
Implantación de Prótesis Vascular/métodos , Venas Hepáticas/lesiones , Hígado/lesiones , Lesiones del Sistema Vascular/cirugía , Vena Cava Inferior/lesiones , Heridas no Penetrantes/cirugía , Adulto , Venas Hepáticas/diagnóstico por imagen , Venas Hepáticas/cirugía , Humanos , Hígado/irrigación sanguínea , Hígado/diagnóstico por imagen , Masculino , Tomografía Computarizada por Rayos X , Lesiones del Sistema Vascular/diagnóstico por imagen , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/cirugía , Heridas no Penetrantes/diagnóstico por imagenRESUMEN
AIMS: Subtle lesions of terminal hepatic venules (THVs) may be overlooked in liver biopsies from haematopoietic stem cell transplant (HSCT) receipients when graft-versus-host disease is the clinical concern. The aim of this study was to evaluate the frequency of THV injury resembling sinusoidal obstruction syndrome (SOS). METHODS AND RESULTS: Sixty-three consecutive biopsies from allogeneic HSCT recipients were scored for injured THVs. Forty-nine (78%) biopsies had injured THVs, and 10 (16%) were diagnosed with SOS (mean ± standard deviation of injured THVs/biopsy: 90 ± 9%). Biopsies diagnosed with other diseases also had injured THVs (36 ± 33%). Biopsies from patients with cyclophosphamide plus fractionated total body irradiation conditioning and biopsies taken within 100 days post-HSCT had significantly more occluded THVs (respectively: 40 ± 38%, P = 0.0188; and 35 ± 35%, P = 0.0076) than those with other conditioning regimens or in biopsies taken >100 days post-HSCT. All biopsies taken at any time in the 6-year post-HSCT period had similar amounts of THV phlebosclerosis (23 ± 25%). CONCLUSIONS: Our results demonstrate a high incidence of THV injuries resembling SOS in post-HSCT liver biopsies. THV injuries were detectable for several years post-HSCT, and were concurrent with other diagnoses. Our results also suggest that SOS may be underdiagnosed.
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Enfermedad Injerto contra Huésped/diagnóstico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Venas Hepáticas/patología , Enfermedad Veno-Oclusiva Hepática/diagnóstico , Trasplante de Hígado/efectos adversos , Vénulas/patología , Adulto , Anciano , Biopsia , Femenino , Venas Hepáticas/lesiones , Enfermedad Veno-Oclusiva Hepática/etiología , Humanos , Incidencia , Hígado/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Vénulas/lesionesAsunto(s)
Equinococosis Hepática/complicaciones , Venas Hepáticas/lesiones , Hígado/lesiones , Choque Hemorrágico/etiología , Heridas no Penetrantes/complicaciones , Equinococosis Hepática/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Rotura/complicaciones , Rotura/diagnóstico por imagen , Factores de TiempoRESUMEN
BACKGROUND: Retrohepatic vena cava (RVC) injuries are technically challenging and often lethal. Atriocaval shunting has been promoted as a modality to control haemorrhage from these injuries, but evidence from controlled studies supporting its benefit is lacking. We hypothesised that addition of an atriocaval shunt to perihepatic packing would improve outcomes in our penetrating RVC injury swine model. METHODS: After a survivable atriocaval shunting model was refined in 4 swine without an injury, 13 additional female Yorkshire swine were randomised into either perihepatic packing and atriocaval shunt (PPAS, n=7) or perihepatic packing alone (PP, n=6) treatment arms prior to creating a standardised, 1.5 cm stab wound to the RVC. Haemodynamic parameters, intravenous fluid, and blood loss were recorded until mortality or euthanisation after 4h. Statistical tests used to test differences include the Wilcoxon rank sums test, Fisher exact test and analysis of covariance. A p-value ≤0.05 was considered statistically significant. RESULTS: Immediately before and after RVC injury, no difference in temperature, cardiac output, heart rate, mean arterial pressure or mean pulmonary artery pressure was detected (all p>0.05) between the two groups. While the RVC injury did affect measures parameters in PPAS swine over time, haemodynamic compromise and blood loss were not significantly greater in PPAS than PP swine. Survival time was significantly different with all PPAS swine dying within 2h (mean survival duration 39 (SD 58)min) while all 6 PP swine survived the entire 4h study period. CONCLUSIONS: While perihepatic packing alone slowed haemorrhage to survivable rates during the 4h study period, atriocaval shunt placement led to rapid physiologic decline and death in our standardised, penetrating RVC model.
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Hemostasis Quirúrgica , Venas Hepáticas/lesiones , Hígado/lesiones , Lesiones del Sistema Vascular/patología , Lesiones del Sistema Vascular/terapia , Venas Cavas/lesiones , Animales , Modelos Animales de Enfermedad , Embolización Terapéutica , Femenino , Hemostasis Quirúrgica/métodos , Venas Hepáticas/patología , Hígado/patología , Distribución Aleatoria , Porcinos , Venas Cavas/patologíaRESUMEN
Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, non-operative management (NOM) is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma. Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2% (70/72). The success rates of NOM in the patients with grade I-III, IV and V liver trauma were 100%, 94.4% and 83.3%. The complication rates were 10.0% and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived. NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.
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Fístula Biliar/etiología , Embolización Terapéutica , Hemoperitoneo/terapia , Hígado/lesiones , Heridas no Penetrantes/terapia , Heridas Penetrantes/terapia , Adolescente , Adulto , Anciano , Fístula Biliar/cirugía , Femenino , Hemodinámica , Hemoperitoneo/etiología , Hemoperitoneo/fisiopatología , Venas Hepáticas/lesiones , Humanos , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Vena Porta/lesiones , Radiografía , Estudios Retrospectivos , Tasa de Supervivencia , Índices de Gravedad del Trauma , Resultado del Tratamiento , Heridas no Penetrantes/clasificación , Heridas no Penetrantes/complicaciones , Heridas Penetrantes/clasificación , Heridas Penetrantes/complicaciones , Adulto JovenRESUMEN
We report the case of a 67-year-old man with remnant left liver torsion causing acute hepatic venous outflow obstruction after right hepatectomy for giant hepatocellular carcinoma, which was successfully treated with surgery. After the primary surgery, he developed significant liver dysfunction and renal failure. Doppler ultrasonography disclosed gradual reduction of hepatic perfusion. Abdominal computed tomography revealed that the swollen remnant liver was dislocated in the right subphrenic space. After surgical repositioning of the left lobe into its anatomical position, the hepatic congestion immediately disappeared, and the hemodynamic parameters improved. The falciform and round ligaments were fixed to the anterior abdominal wall to keep the remnant liver in the anatomical position. His postoperative course was uneventful. Doppler ultrasonography was useful to assess hepatic perfusion for screening of acute hepatic venous outflow obstruction and abdominal computed tomography is definitive for diagnosis. Fixation of remnant liver may be effective for preventing hepatic venous outflow obstruction after right hepatectomy, particularly for giant tumor.
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Síndrome de Budd-Chiari/etiología , Carcinoma Hepatocelular/cirugía , Hepatectomía/efectos adversos , Neoplasias Hepáticas/cirugía , Complicaciones Posoperatorias/etiología , Anciano , Síndrome de Budd-Chiari/diagnóstico por imagen , Venas Hepáticas/lesiones , Venas Hepáticas/cirugía , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Torsión MecánicaRESUMEN
Noncompressible truncal hemorrhage and brain injury currently account for most early mortality of warfighters on the battlefield. There is no effective treatment for noncompressible truncal hemorrhage, other than rapid evacuation to a surgical facility. The availability of an effective field treatment for noncompressible truncal hemorrhage could increase the number of warfighters salvaged from this frequently-lethal scenario. Our intent was to develop a porcine model of noncompressible truncal hemorrhage with a â¼ 50% one-hour mortality so that we could develop new treatments for this difficult problem. Normovolemic normothermic domestic swine (barrows, 3 months old, 34-36 kg) underwent one of three injury types through a midline incision: 1) central stellate injury (N = 6); 2) excision of a portal vein branch distal to the main PV trunk (N = 6); or 3) hemi-transection of the left lateral lobe of the liver at its base (N = 10). The one-hour mortality of these injuries was 0, 82, and 40%, respectively; the final mean arterial pressure was 65, 24, and 30 mm Hg, respectively; and the final hemoglobin was 8.3, 2.3, and 3.6 g/dL, respectively. Hemi-transection of the left lateral lobe of the liver appeared to target our desired mortality rate better than the other injury mechanisms.