Morphometric Analysis of the Aorto-Esophageal Relationship in Swine for Trans-Esophageal Aortic Blood Flow Occlusion

Abstract

Background: Trans-esophageal aortic blood flow occlusion (TEABO) is an emerging technology undergoing laboratory research that offers a strategy for temporary hemorrhage control. The purpose of this study was to evaluate the anatomical relationship between the esophagus and descending thoracic aorta in two breeds of swine to support a porcine model for future TEABO investigations. Methods: Thoracoabdominal computed tomography scans were compared in Hanford miniature swine and Yorkshire swine. Measurements were taken at the five vertebral levels proximal to the gastroesophageal junction. Data collected included the distance between the center of the esophagus and the center of the descending aorta, the angle between the vertebral column, descending aorta, and esophagus, and the length the thoracic esophagus travels anteriorly to the descending aorta. Results: Ten Hanford swine and ten Yorkshire swine were compared. In Hanford swine, the distal thoracic esophagus travels anteriorly to the descending aorta for a mean distance of 11.5 ± 2.3 cm. In Yorkshire swine, the thoracic esophagus travels to the right of the descending aorta. The mean angle between the vertebral body, descending aorta, and esophagus was 79.6 to 97.8 degrees higher in Hanfords compared with Yorkshires (P < 0.0001 at all five vertebral levels compared). The mean distance between the esophagus and descending aorta was 0.2 cm to 0.6 cm higher in Hanfords compared with Yorkshires with a significant difference found at only two vertebral levels (P = 0.01 and P = 0.02). Conclusions: Hanford miniature swine possess an aorto-esophageal relationship comparable to humans and should be the preferred animal model for TEABO studies. © 2021 CC BY 4.0 – in cooperation with Depts. of Cardiothoracic/ Vascular Surgery, General Surgery and Anesthesia, Örebro University Hospital and Örebro University, Sweden.