Published October 1, 1940
THE DEPRESSOR EFFECT OF SPLENO-RENO-PEXY
HYPERTENSION DUE TO RENAL ISCHEMIA
ON
BY DAVID M. WEEKS, M.D., A L F R E D STEINER, M.D.,
JAMES S. MANSFIELD, M.D., AND JOSEPH VICTOR, M.D.
(From the Research Service, First Division, WelfareHospital, Department of Hospitals, City
of New York, and the Department of Medicine, Collegeof Physicians
and Surgeon,, Columbia University, New York)
(Received for publication, July 9, 1940)
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Goldblatt (12), and many others (18, 33, 20, 32, 4, 8, 24) have shown that
constriction of the renal arteries in dogs results in a sustained elevation of
blood pressure. All procedures to relieve this type of hypertension, with
the exception of bilateral suprarenalectomy (15, 2, 27, 7, 28) and possibly
total extirpation of the pituitary gland (26, 9), have failed. Such varied
procedures as renal denervation (25, 27, 8, 31), sympathectomy (1, 9, 19,
31), anterior nerve root section (14), splanchnicectomy (13, 2), thyroidectomy (11), shunting of renal vein blood through the liver (5, 21), destruction of the spinal cord (10), castration (27), and excision of the carotid
sinuses (17) do not prevent or abolish the hypertension produced by renal
ischemia.
Occasionally, even though the clamps on the renal arteries have been
properly applied, a sustained rise in blood pressure does not occur. In
these instances, an accessory arterial supply to the kidney has been found,
going by way of the capsular or ureteral vessels, or both (12), These
observations suggest that the collateral circulation in kidneys with constricted renal arteries, may prevent the production of persistent hypertension (16). It seemed of interest, therefore, to find out whether a collateral
circulation to the ischemic kidney could be established, and to study the
influence of such a circulation on the hypertension resulting from renal
ischemia.
In a previous report (23) it was noted that pexis of omentum with one
ischemic kidney produced a temporary fall in the blood pressure of hypertensive dogs. This pexis was carried out by wrapping omentum around a
decapsulated kidney. On the other hand, unilateral spleno-reno-pexy in
dogs rendered hypertensive by bilateral constriction of the renal arteries
resulted in a fall in blood pressure to the normal level for the succeeding 9
weeks. Experiments of a similar nature have been reported by Cerqua and
345
Published October 1, 1940
346
SPLENO-RENO-PEXY DEPRESSOR EFFECT ON HYPERTENSIOlq
S a m a a n (3). T h e latter found t h a t unilaterally nephrectomized dogs
developed hypertension when the renal a r t e r y of the remaining k i d n e y was
constricted. This hypertension was reduced following spleno-reno-pexy
and returned after the fused organs were separated.
T h e object of the experiments described in this report was to s t u d y the
production of collateral circulation to one ischemic k i d n e y and its influence
on the blood pressure of hypertensive dogs with bilateral renal ischemia.
T h r e e phases of this p r o b l e m were examined; first, the influence of the
pexis of spleen and one ischemic kidney on the blood pressure of dogs with
bilateral renal ischemia; second, the d e m o n s t r a t i o n of collateral circulation
between the fused organs; and third, the effect of r e m o v a l of the fused
organs on the lowered blood pressure of the previously h y p e r t e n s i v e dogs.
Methods
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Adult mongrel male dogs weighing 7 to 18 kg. were employed. Systolic blood pressure was determined by the Van Leersum carotid loop method (30). Readings were
obtained by palpation distal to the pressure cuff by the same observer each day and under
the same conditions. Hypertension was produced by the silver clamp technique described by Goldblatt et al. (12).
The spleen and one kidney were joined in nine dogs that were hypertensive for periods
up to 4 months. The technique is as follows: Under nembutal anesthesia a cruciate
incision, about 1 cm. deep, was made in the kidney. The long axis ran over the convex
surface from pole to pole. The shorter axis ran transversely at the midpoint of the
longitudinal incision. The edges of this incision were undercut to give a flat raw surface.
The spleen was incised from the free distal edge almost to the pedicle and undercut to
give a flat surface the size of the cut kidney. The cut surfaces of spleen and kidney are
then apposed, and maintained in that position by means of thIee sutures of ribbon catgut. The catgut was brought through the substance of the kidney by means of an
aneurysm needle to prevent its slipping off the rounded poles. It was then continued
around the spleen between the vessels of the pedicle and the ends were fixed with a silk
suture. The wide catgut was drawn tight enough to stop bleeding but not enough to
cause pressure necrosis. In two control operations on hypertensive animals a similar
cut surface of spleen was joined to the muscles of the abdominal wall.
Mter the spleno-reno-pexy was performed the blood pressure of the dogs was determined at frequent intervals for the ensuing 2 to 10 months. Two animals were sacrificed
after 4 and 6 months. Six were operated upon to remove the fused organs. Three of
these survived this last operation, one for 2 weeks and two were still alive 4 and 4½
months later. The blood pressures of the dogs that survived were observed to see what
effect removal of the fused kidney and spleen had on the lowered blood pressures. The
ninth dog is still being followed 2 months after a spleno-reno-pexy was performed.
To study the collateral circulation in the fused kidney and spleen the splenic artery
was injected at a pressure of 125 mm. Hg with India ink suspended in 0.9 per cent NaCI
after the joined organs were removed from the dog. This was performed with seven
preparations. Following the injection, the organs were sliced perpendicular to the plane
of fusion. From 9 to 15 cut surfaces of each pexis were examined histologically for the
presence of ink.
Published October 1, 1940
V~EKS~ STEINER, MANSFIELD~ AND VICTOR
347
ProgocoIs
T h e following are the individual records of each of t h e nine a n i m a l s :
Dog 1 (Fig. 1). Male, mongrel, weight 11.8 kg.
Between June 23 and July 5, 1939, the control systolic blood pressure varied between
135 and 170 mm. Hg. On July 6 a clamp was placed on the right renal artery (R.C.)
and the systolic blood pressure rose to 230 and then gradually fell to 185 mm. Hg. The
left renal artery (L.C.) was clamped on July 25 and thereafter the systolic blood pressure
was maintained at 210-230 mm. Hg.
Svsfolic
blood pressure
Pexis of
spleen and
mm.tt~
2S0 mHypertension
230
'R
..
• •
...
•
•
•
•
•
,9o
;. :
180
H
Q•
e~e
.
1
1, 1
• ~
D
••lit
I
•
•
ink in
kidney
,,
•~
~oq died ffPH 192
Rt. kidney
VIO n o r m a l
130
120
I
I
I
I
I
I
|
I
I
I
I
I
I
I
I
I
I
I
Days 20 30 10 ZO 3o 10 ZO 30 I0 ZO 30 t0 20 30 to Zo 30 10 ZO
June July
Aucj.
Sept
Oct
Hov.
Dec
Months
1
2
FIG. 1. Dog 1. Effect of spleno-renal pexis on experimental hypertension
A control operation joining the cut surface of the spleen with the abdominal wall was
performed on Sept. 12. No change in blood pressure occurred during the 6 weeks of
observation to Oct. 24 when it still was 210-230 mm. Hg.
Pexis of the free edge of the spleen and the left kidney was performed on Oct. 24.
The blood pressure abruptly fell to 175 and remained there until Nov. 9. Then it slowly
rose to 190-210 mm. Hg.
The spleno-reno-pexy was removed on Dec. 14 and the dog died 2 days later with lower
blood pressure, the last reading being 140 mm. Hg, and a non-protein nitrogen of 192
mg. per cent. The right kidney was found to be shrunken at autopsy.
India ink was injected through the splenic artery into the excised fused organs and
was found in the sinusoids of the spleen and the capillaries about the convoluted and
collecting tubules of the kidney. None was present in the renal arteries nor in the
glomeruli.
I n s u m m a r y , pexis of spleen a n d muscles of the a b d o m i n a l wall h a d no
effect on the e l e v a t e d b l o o d pressure whereas fusion of the spleen a n d one
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L
ZOO
Removal
of
pexis
pexis
muscle
. .'_'_:..
210
170
160
150
140
Splenorenal
abdominal
Published October 1, 1940
~4~
SPLEN0-REN0-PEXY DEPRESSOR EFFECT ON I~'PERIcgiCSt0N'
ischemic kidney lowered the blood pressure during 2 months of observation.
A collateral circulation was demonstrated between the sinusoids of the
spleen and the capillaries about the renal tubules. None was present in the
glomeruli.
Dog 7-5 (Fig. 2). Male, mongrel, weight 10.7 kg.
The control systolic blood pressure was 145-150 from Apr. 22-25, 1937. On Apr. 26
a damp to the right renal artery (R.C.) was followed by an elevation of the systolic
Hyperi'ension
co n trol
Systolic
blood ~res,~ure
Mm.H9
250
el,
~'40
RC
1 •
210
•
190
•
•o•
•eO•
•
Sacrificed
•
•
•
O0
•
170
160
150
1413i
130
120
•
Apt
t,lo ink in
•
May
June
kidney
July
Aucj.
I
2
,Sept.
Fxo. 2. Dog 7-5. Effect of spleno-renal pexis on experimental hypertension
blood pressure to 215.
It then fell to 195 ram. Hg.
A clamp was placed on the left renal
artery (L.C.) on May 12 and the systolic blood pressure then ranged from 210-255
r a m . gig.
A control operation, in which the omentum was manipulated, was carried out on
May 31, without any effect on blood pressure for 2½weeks during which time the pressure
ranged from 200-240 mm. Hg.
Spleno-reno-pexy was performed on June 17. The systolic blood pressure immediately fell to 150-190 for the next 6 weeks. The dog was sacrificed on July 28.
The splenic artery of the excised preparation was not injected with ink.
In summary, a dog with hypertension of 5 weeks duration due to bilateral
renal ischemia showed no change in blood pressure for 2½ weeks a f t e r
l a p a r o t o m y and manipulation of the omentum. However, immediately
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230
2L'(;
pressure affer
Jeno-renol pexie
Published October 1, 1940
349
WEEKS~ STEINER~ MA.NS:FIELD~ AND VICTOR
after unilateral spleno-reno-pexy, the blood pressure fell for the ensuing 6
weeks during which the dog was observed. No attempt was made to study
a collateral circulation between the excised fused organs.
Dog 7-2 (Fig. 3). Male, mongrel, weight 10.7 kg.
The control systolic blood pressure was 150 ram. H g between Apr. 14-18, 1938.
Following constriction of the right renal artery (R.C.) on Apr. 19, it rose to 240 and then
fell to 175 ram. Hg within 3 weeks. The left renal clamp (L.C.) was applied on May 24
Decreased blood
pressure a f t e r
spleno-renal pexis
Systolic
.1
blood pressure
eel
•
"1%:
14G
Sacrificed
"
a •
tBO
170
1GO
lSO
LCT
"cc
a
•
1
a
Oelm
~
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ee
No ink but
sinuses of
P axis
. ) .oin
capdlartes
of tubules
13C
12G
Days 15
Apr.
Months
IS 30 15 30 t5 30 15 30 15 3 1
1 30 15
15 30 15
May ;Yune 3uly Auq.2 •ep~ Oc~ Mov. Dec. .Tan. Feb.
1
3
4
5
6
7
Fro. 3. Dog 7-2. Effect of spleno-renal pexis on experimental hypertension
and the systolic blood pressure rose to 215 mm. Hg. On fun• 17, the left renal clamp
was tightened (L.C.T.) and the systolic blood pressure rose to 255 mm. Hg.
Pexis of the spleen and left kidney was carried out on J u ~ 28. The systolic blood
pressure gradually fell to 175 and remained at about this level until 67 months later at
which time the dog was sacrificed, on Jan. 12, 1939.
No ink test for collateral circulation was made. However, large sinusoids of the scar
between the joined organs communicated with the capillaries of the convoluted tubules.
In summary the hypertension that persisted in this dog for 2 months was
lowered for 6½ months by unilateral spleno-reno-pexy.
Dog B (Fig. 4). Mongrel, male, weight 12.7 kg.
The control systolic blood pressure was 160-200 ram. Hg between Oct. 27 and Nov.
14, 1938. The right renal clamp (R.C.) was applied Nov. 16 and the blood pressure rose
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mmHc
250
24O
23O
220
210
ZOO
190
Published October 1, 1940
350
SPLENO-RENO-PEX¥
DEPRESSOR EFFECT ON HYPERTENSION
to 300 ram. Hg and then fell to 200 ram. Hg within 3 weeks. After applying the left
clamp (L.C.) on Dec. 20, the blood pressure ranged between 220-245 until Jan. 18, 1939.
Pexis of spleen and left kidney on Jan. 18, 1939, was foUowed by a slow decline in
blood pressure to 170 mm. Hg 2 weeks later. It ranged between 130-180 until Oct. 13,
a period of 9 months.
The spleno-reno-pexy was excised on Oct. 14, and the dog died within 12 hours because
of hemorrhage from the renal pedicle.
Hypcr~nsion
.=
$
.o,io
Lowered blood pressure
after spleno-renal pexis
"
blood pressure
rn w~H¢
•
•
250
•
•
•
24O
23O
22O
190
tSO
•
•
1"70
o~Skao
•-
•
•
•
41elo41
•
•
160
oOo
•
•
oe
•
;;.i:
•
• °
• ooooo
•
150
:-"
oe
o•
...
o•
o.
• • •
041000
,o.e
•
oooo
IZhours
t~qdied
•
post
.% . . . .
o1~.
140
Ink
in
kidney
•
•
130
120
i
i
I
t
i
t
i
i
i
i
t
i
i
i
i
I
I
i
I
i
i
~ V 20 30 I0 20 30 I0 20 30 I0 20 30 10 20 ~0 I0 2050 I0 20 3O IO 20
Ocl'. Itov.
Months
hc
FIG. 4. Dog B.
Jen.
Feb.
I
Ma~
z
/~pr.
3
May
4
t
i
t
=
i
i
t
i
i
i
i
I
i
i
t
i
I
i
to 20 3o to 2o 3o 1o203o 1o2o3o 1o2o3o • 1 o 3 o
J'un¢ J u l y
Auq.
Sept: Oct:.
I'lov.
5
6
7
8
~
to
Effect of spleno-renal pexis on experimental hypertension
The India ink injected into the splenic artery of the fused preparation was found in
the capiUariesabout the renal tubules, in the splenic sinusoids, and in the sinuses of the
scar.
None was seen in the renal arteries or glomeruli.
In summary this dog had hypertension for 2 months associated with
damping of both renal arteries. Following unilateral spleno-reno-pexy
there was a fall in blood pressure to the prehypertensive level lasting 9
months, at which time the dog died after removal of the fused organs. A
collateral circulation between the fused organs was demonstrated between
the sinusoids of the spleen and the capillaries of the renal tubules.
Dog C (Fig. 5). Mongrel, male, weight 10.7 kg.
Between May 23-25, 1939,t h e control systolic blood pressure varied from 130-140
ram. Hg. After clamping the left kidney (L.C.) the blood pressure rose to 180 ram. Hg.
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ZlO
Published October 1, 1940
WEEKS~ STEINER~ MANS]~IELD~ AND VICTOR
351
On June 13 the application of the right renal clamp (R.C.) was followed by a rise to 270
and for a month remained between 230-260 mm. Hg.
Pexis of the spleen to the right kidney was performed on July 13. For the next 2½
months the blood pressure was normal ranging between 130 and 155 ram. Hg.
The fused organs were removed on Sept. 26. The dog died in shock 48 hours later.
Following the last operation one reading of 110 mm. Hg was obtained.
India ink injected into the splenic artery, after removal of the fused organs, was not
found at the site of pexis. Obviously the area supplied by the injected splenic artery
Systolic
blood ~ressure
Decreased blood
pressure after
rn mttcj
spleno- renal pexis
ttyperhmsion
zc~
:
2OO
190
/
"
•
,
I
RC
I
"
LC
180
170
160
150
140
130
120
110
ee
o,
r
Days
r
FIG. 5. Dog C.
i
i
Molnkin
kidney or
spleen
Dog died 44 hours
, ;, post oper.
i
! 10 2'0 30 10 20 3aO I0 20 30 I0 20 30
~'une
Months
i
e,eeeeeeoeo 00
' ' N e , ee • , e ' ~ eoee
July
Aug.
1
Sept.
2
Effect of spleno-renal pexis on experimental hypertension
did not include the entire spleen since about one-third of this organ, near the pexis, did
not contain ink. No ink was found in the kidney either.
I n s u m m a r y , s p l e n o - r e n o - p e x y t o one k i d n e y of an h y p e r t e n s i v e d o g w i t h
bilateral renal ischemia lowered the blood pressure to t h e p r e h y p e r t e n s i v e
level. N o collateral circulation was d e m o n s t r a t e d b e t w e e n t h e fused
organs. U n d o u b t e d l y this was due t o a f a u l t y injection of t h e I n d i a ink.
Dog 6 (Fig. 6). Male, mongrel, weight 9.5 kg.
Between Nov. 3, 1938, and Jan. 2, 1939, the control systolic blood pressure was 120150 ram. Hg. On Jan. 3 a clamp on the right renal artery (R.C.) brought the systolic
blood pressure to 210 and it then fell to 140 mm. Hg. Clamping the left renal artery
(L.C.) on Jan. 10 raised the pressure to 200 and then it fell to 130. On Jan. 24 the left
clamp was tightened (L.C.T.) and the systolic blood pressure rose to 175 mm. Hg. On
Downloaded from on June 16, 2017
250
240
230
220
210
Pexis
removed
Published October 1, 1940
352
SPLENO-RENO-PEXY DEPRESSOR E]?~ECT ON HYPERTENSION
Feb. 15, the right clamp was tightened (R.C.T.) and the systolic blood pressure ranged
between 175-190. The left clamp was again tightened (L.C.T.), on Mar. 23 and the
systolic pressure ranged between 190-200 mm. Hg.
Pexis of spleen and left kidney on Mar. 29, was followed by a fall of the systolic blood
pressure to 140 within a week. The blood pressure went lower and finally ranged from
115-150 ram. Hg until Oct. 16, a period of 6½ months.
The fused organs were excised on Oct. 17, and the blood pressure rose to 235 mm. Hg
during the next 2 weeks. The dog died on Nov. 1 with a non-protein nitrogen of 400
rag. per cent.
5ys'l'olic
pressure
mrn.Hq
24G
blood
23O
Decreased
22O
?.1o
blood
•
pressure o f f e r •
removal of
• Doq
blood
Elevated
pressure a f t e r
spleno-renal pexis
Hype~ension
RC ~C LCT RCT
LCTl
p e x i s
jfdied
19o
tSO
170
•
160
e•
•
•
.__'. :__g.
o . .
150
•
•
•
I
•
..:
IINlllQ O0 O
t
-
1
•
el
140
o
13(~ 1
°:.
12G m
flo -
eeoee •
o~o
•
Ink in
I
kidney
i.--.4
Disfemper
i
Da
i
i
I
i
t
q
i
s
q
,
i
a
I
io ~o 3o io zo ~o io 2o 3o ao zo 30 io zo 3o
Hov.
Nonths
Oec
Jan.
h~b. Mar,
I
I
I
f
i
I
i
i
t
I
I
t
I
I
t
i
a
i
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I
~ozo ~o ~o2o 3o io zo 30 ~o zo 3o io 2o 3o ,o zo ~ ~ zo
Ape May :Tune July Aug. Sept. Oct..
I
Z
3
45
6
Fro. 6. Dog 6. Effect of spleno-renal pexis on experimental hypertension
Following injection of the India ink suspension into the splenic artery of the excised
preparation, ink particles were found in the capillaries about the renal tubules as well as
in the veins. In one of the 15 blocks obtained from this pexis ink was found in arteries
and arterioles and glomeruli of a scarred area. Serial sections through this block showed
that the ink came from a splenic artery brought into the scar by the operation. This
artery anastomosed with smaller arteries of the kidney that finally reached the glomeruli.
It should be emphasized that this was the only block showing ink within the renal
arteries in this entire series.
I n s u m m a r y a dog with hypertension of 2 m o n t h s duration due to bilateral
renal ischemia had a reversal of the hypertension to normal levels following
unilateral spleno-reno-pexy. This normal blood pressure persisted for 6½
m o n t h s of observation. After removal of the fused organs the blood pres-
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Z00
Published October 1, 1940
353
WEEKS, STEINER, MANSI~IELD, AND VICTOR
sure rose to hypertensive levels and the dog died in uremia 2 weeks later.
Collateral circulation was demonstrated between the splenic sinusoids and
the capillaries of the renal tubules. In only one of 15 blocks through the
pexis was there ink in arteries or glomeruli and this was shown to be due to
anastomosis of one of the splenic and one of the renal arteries.
Dog D (Fig. 7). Mongrel, male, weight 12.7 kg.
From May 23-25, 1939, the control systolic blood pressure was 120 mm. Hg. On
May 26 the right renal clamp (R.C.) was applied and the blood pressure rose to 170 ram.
5ysfolic
Decreosed blood
pressure o f f e r
6pleno-renol pexi6
blood pressure
mm.H 9
260
Elevofed blood
pressure after
pexis removed
Hype~en,$ion
•
210
I~00
190 tC
180
170 o •
160
150
140 to
130
120 De
I10
•
eee
LC
%•
!
-
IMP
~0o
•
•
gOo ~IO
•
•
•o
I~•llmao
o0o
• • olOm
•
ONI, NO
NO
Io
0o 0
oo
• Ink in
kidney
•
June
Monfhs
FIG. 7. Dog D.
July
Au9 .
I
~.p F.
Ock
2
3
Nov.
4
Dee.
5
Jan.
Effect of spleno-renal pexis on experimental hypertension
Hg. Following constriction of the left renal artery (L.C.) the systolic blood pressure
ranged between 210-230 mm. Hg until July 17.
Pexis of the spleen and left kidney was performed on July 19. The systolic blood
pressure slowly decreased to 150-160 during the following month, then slowly rose to
180-190, 5 months after the pexis was made.
The spleno-reno-pexy was excised on Dec. 12. The blood pressure rose to between
220-240 mm. Hg within 2 days and has remained at that level, 4 months later.
India ink injected into the splenic artery of the excised preparation was found in the
splenic sinusoids and pulp, the capillaries about the renal tubules of the cortex and
medulla, and also in the larger veins of the medulla. None was present in the arteries
or glomeruli.
In summary, after 7 weeks of hypertension, unilateral spleno-reno-pexy
lowered the systolic blood pressure. 5 months later, removal of the pexis
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1-
~3C
Published October 1, 1940
354
SPLI~2gO-1LENO-PEX¥DEPRESSOR EPlc]gCT ON" HYPERTENSION"
r e s u l t e d in a r e t u r n of h y p e r t e n s i o n . C o l l a t e r a l c i r c u l a t i o n w a s d e m o n s t r a t e d b e t w e e n t h e s i n u s o i d s of t h e s p l e e n a n d t h e c a p i l l a r i e s a b o u t t h e
renal convoluted and collecting tubules.
Dog 8 (Fig. 8). Male, mongrel, weight about 10 kg.
The control blood pressure was 135-155 ram. Hg from Nov. 3-17, 1938, After
clamping the fight renal artery (R.C.) raised the blood pressure to 230 mm. Hg, it was
Systolic
bloodpressure
mrl~ n¢
300
290
280
Hype~ension
RC
LC
LCT
270
260
|
•
e°
230
•
00
•
e• O~
leo
220
•
•
210
IP~O~
eaam~
•anBo
20
190
~:
•
lSO
•
•
170
qu)~
• .
•
•
I&0
•
150
e
•
• gO •
:
•
m,
• •
I m ~ o
•
• •o•
~oo
e•
• ,18D~
•
•
06
130
•e o ~
• •
•
ID
• O
~
~
OIIID I
O •aogOI, ~ • • r o D • O N O ~
O0
O•O•gmJ
~
•
O Innee
•
• •
Ink in
kidney
120
IIO
100 a l l t l T t
F I I I I I r T I l l l l l l l l f l ] l l l f l l l l l l r l l l l l l l l l l F I I F I I
k T5 II 19275 152129 61422307 15.~ 3 1119Z74 IZ~02B 6 R22307 iS 2530 816 24 2 1018263 II Ig 274.12 2028 61422307 152331 8
PIOV. I~:.
~'a~ Feb. P'1,ar. Apr.
Hayj ,June/uly
Auq.
Sep'¢. O~.
rtov.
Dec, ,,Tan.
I'lonfhs
I
2
3
-,6
7
8
9
FIG. 8. Dog 8.
Effect of spleno-renal pexis on experimental hypertension
followed by a fall to 160 ram. Hg within 3 weeks. On Dec. 20, the clamp to the left renal
artery (L.C.) elevated the blood pressure to 195-210 mm. Hg. Tightening the left
clamp (L.C.T.) on Jan. 13, 1939, raised the systolic pressure to 220-240 ram. Hg.
Pexis of the spleen and left kidney on Feb. 8 was followed by a fall in blood pressure
to 140-180 mm. Hg for 9 months.
Removal of the fused organs on Nov. 8, 1939, was followed by an elevation of blood
pressure to 220-240 mm. Hg for the next 5 months. The dog is still hypertensive 6
months later.
The India ink injected into the splenic artery of the excised fused organs was found
in the capillaries about the renal tubules. None was seen in the renal arteries or
glomeruh.
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240
140
sp;eno-rcnal pexn$
1
250
Eleva+~d blood
pressuPe a f t ~ pex'ns r e m o v a l
Decreased blood
pressure after'.
Published October 1, 1940
WEEKS, STEINER, MANSFIELD, AND VICTOR
355
In summary, in this hypertensive dog with bilateral renal ischemia, unilateral spleno-reno-pexy lowered the blood pressure to normal values for 9
months. Removal of the fused organs from the animal produced a return
in the hypertension for 6 months. A collateral circulation was demonstrated between the capillaries of the renal tubules and the sinusoids of the
spleen.
In summary, this dog had hypertension for 6 weeks. No significant
change in blood pressure followed pexis of its spleen with the abdominal
wall. 3 months later, or after 4½ months of hypertension, spleno-reno-pexy
lowered the blood pressure significantly.
Analysis of the Findings
Influence of Unilateral Spleno-Reno-Pexy on Hypertension of Dogs with
Bilateral Renal Ischemia.--Unilateral spleno-reno-pexy was performed on
nine hypertensive dogs with bilaterally constricted renal arteries. The
blood pressure was reduced in every instance after this procedure. In six
cases the decreased blood pressure reached the prehypertensive levels.
The decreased blood pressure persisted throughout the period of observation, that is from 2 to 9½ months in eight instances. In one dog (Fig. 1)
there was a temporary fall for 1 month, followed by a gradual elevation
toward the hypertensive level. This case differed from the others in that
the pexis was made by joining the cut surface of the spleen with the decapstriated cortex of the kidney instead of the cut surface of the kidney.
The rate at which the blood pressure fell after the spleno-reno-pexy
varied in the different animals. In three the fall was precipitous (Figs. 1,
2, and 5). The other cases showed a gradual decline over a period of 2 to 4
weeks.
That the fall of blood pressure was not due to laparotomy or splitting the
spleen is shown by the three controls in which these procedures produced no
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Dog 9. Male, mongrel, weight 10 kg.
The control systolic blood pressure was 170-180 ram. Hg between Dec. 4-6, 1939.
On Dec. 7, a clamp was placed on the right renal artery and the blood pressure was
maintained at 220-230 mm. Hg. A clamp was then applied to the left renal artery
(L.C.) on Dec. 19, and the pressure went to 230-260 ram. Hg.
A control operation in which the cut surface of the spleen was sutured to the muscle
of the anterior abdominal wall, was performed on Jan. 16, 1940. There was no significant change in the blood pressure level which ranged from 220-245 mm. Hg until
Mar. 27.
Pexis of the other end of the spleen to the left kidney on Mar. 27 resulted in a gradual
fall in blood pressure to 175-190 in 2 weeks where it remained for the 2 months during
which it was observed.
Published October 1, 1940
356
SPLENO-RENO-PEXY
DEPRESSOR
EFFECT
ON
HYPERTENSION
significant changes in blood pressure, dogs 1, 7-5, and 9. That postoperative shock plays no r61e in this fall in blood pressure is apparent from the
fact that the dogs walk about and eat well the day after the operation.
Effect of Removal of the Spleno-Reno-Pexy on the Lowered Blood Pressure
of Previously Hypertensive Dogs.--The fused spleen and kidney were excised
in six of the dogs. Three of these survived this operation more than 3 days.
In each of the animals that survived the blood pressure returned to the
hypertensive level, or above, in from 3 to 7 days (Figs. 6 to 8).
The three dogs that lived only 12, 44, and 60 hours after this operation
died from hemorrhage, shock, or uremia, Figs. 4, 5, and 1, respectively.
Demonstration of Collateral Circulation between the Spleens and Ischemic
Kidneys That Were Joined by Pexis.--After intervals of from 2 to 10 months
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following spleno-reno-pexy, the fused organs were removed. A suspension
of India ink was injected into the splenic artery of six of these excised
preparations. In all instances the spleen became dark during the injection
and occasionally the ink flowed from the renal veins. The joined organs
were then sliced perpendicular to the plane of fusion. From 9 to 15 cut
surfaces of each pexis were examined histologically. Five of the six preparations showed ink in the kidney, in the gross and microscopically. The
other showed ink in about two-thirds of the spleen but none was present
near the pexis or in the kidney. This was probably due to the fact that the
artery that was injected did not supply the entire spleen with blood.
With respect to the collateral circulation the most significant points
were found in the histological preparations. In the kidney, the ink particles were present in the capillaries about the renal tubules of the cortex and
medulla as well as in the smaller and larger renal veins. No ink was found
in the arteries, arterioles, or glomeruli, of four of the five preparations. In
the exceptional case, dog 6 (Fig. 6), ink was found in the arterial and
glomerular circulation in one small region adjacent to the scar of the pexis.
Serial sections through this locus showed that a small splenic artery coursed
through the scar and anastomosed with renal arteries, arterioles, and finally
glomerular capillaries. This picture was seen in only one of the 15 blocks
studied in this kidney. Elsewhere ink was seen in the capillaries about the
renal tubules, just like the distribution in the four other spleen-kidney
preparations.
The spleens injected with ink showed the black granules in their arteries,
sinusoids, pulp, and veins. Many of the dilated endothelial fined channels
extending into the scar between the kidney and spleen were rich in ink. A
somewhat similar distribution of collateral circulation has been observed
following omento-reno-pexy with normal kidneys (22).
Published October 1, 1940
WEEKS, STEINER, MANSFIELD, AND VICTOR
357
From these studies it appears that the circulation from the spleen to the
fused ischemic kidney goes through the splenic sinusoids and the sinusoids
and capillaries of the scar between the fused organs. From these vessels
there are communications with the capillaries about the renal tubules of the
cortex and of the medulla, and from these to the renal veins.
DISCUSSION
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Spleno-reno-pexy lowered the systolic blood pressure in each of nine dogs
rendered hypertensive by bilateral renal ischemia. In a previous experiment it was found that omento-reno-pexy produced a temporary fall in the
blood pressure of hypertensive dogs. The present observations show that
spleno-reno-pexy produced persistent decreases in systolic blood pressure
of hypertensive dogs. Cerqua and Samaan (3) have recently reported that
spleno-reno-pexy in unilaterally nephrectomized dogs with hypertension
due to constriction of the remaining renal artery lowers the blood pressure.
The duration of the lowered blood pressure is not indicated in the data of
their experiments. The difference in the duration of blood pressure response to pexis of the ischemic kidney with spleen or omentum may be due
to quantitative differences in collateral circulation or to some other factors,
possibly humoral.
Removal of the spleno-reno-pexy by excision caused a return of the
previous hypertension in three dogs that survived the operation. These
combined data indicate that t h e splenic pexis with one ischemic kidney
neutralizes the effects of arterial constriction not only in that kidney but
also in the other ischemic kidney. Cerqua and Samaan found that separation of the splenic-renal pexis in two unilaterally nephrectomized dogs with
lowered blood pressure was followed by a return of the original hypertension.
Whether this neutralization of pressor action by the collateral circulation
between spleen and kidney, is due to the prevention of formation of pressor
material or its more efficient destruction or elimination, has not been
ascertained.
The spleno-reno-pexy produces a collateral circulation between the
splenic sinusoids and the capillaries about the renal tubules. Ordinarily no
collateral circulation from the spleen to the glomeruli of the kidneys can be
demonstrated. These observations suggest that in dogs with renal ischemia,
the lowering of the blood pressure by means of collateral circulation may be
due to neutralization of pressor material or the inhibition of its formation
or to both processes in the tubules of the kidney. In other words, they
indicate that if pressor substances are formed in the kidney due to ischemia
they are probably formed in the renal tubules.
Published October 1, 1940
358
SPLENO-RENO-PEXYDEPRESSOR EFFECT ON HYPERTENSION
In conclusion it can be stated that:
1. In hypertensive dogs with bilateral renal ischemia, unilateral splenoreno-pexy lowers the systolic blood pressure for as long as 9½ months.
2. Following removal of the fused spleen and kidney the decreased blood
pressure of the dogs with renal ischemia returns to the hypertensive level.
3. The spleno-reno-pexy produces a collateral circulation between the
splenic sinusoids and the capillaries about the renal tubules. The glomeruli
are not usually involved in this collateral circulation.
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WEEKS, STEINER~ MANS~FIELD~AND VICTOR
359
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