Pressure-suit combined with pelvic stop-flow: A feasibility study in a bovine model

Background: Isolated pelvic perfusion exposes tissue to high drug doses and may benefit patients with advanced malignancy. However, leakage is a limit to this technique. Aims: The aim of the study is to increase the perfusion ratio between local and systemic compartments on isolated pelvic perfusion. We hypothesised that an inflated pressure-suit placed above the level of aortic and caval stop flow could decrease leakage from the regional to the systemic blood compartment in a bovine model. Method: As the size of the pressure-suit was adapted for use in humans, we performed our experimental study on 6 calves which are big enough to fit into the suit. We used an inflated pressure-suit placed at low (40 mmHg) and high pressures (125 mmHg) above the level of aortic and caval stop-flow. A pharmacokinetic study with cisplatinum was performed in both compartments. Results: After injection of the drug, the mean ratio of drug concentration in the locoregional/systemic compartment was 43.1. After 30 min, this mean ratio was 4 and 9.7 for a pressure-suit pressure of 40 mmHg and 125 mmHg, respectively. At pressure-suit pressures of 40 mmHg and 125 mmHg, pelvic perfusion achieved pelvic/systemic exposure ratios of 5.9 and 14.9 at 30 min, respectively. Leakage at 30 min was higher when the pressure-suit was inflated at low pressure (40 mmHg, mean 18%). When the pressure-suit was inflated at high pressure, leakage was lower (125 mmHg, mean 7%). Conclusions: The pressure-suit increased the perfusion ratio between pelvic and systemic compartments in a bovine model.