Abstract
Purpose
To assess the pelvic circulation during abdominal aortic aneurysm (AAA) repair by measuring the inferior mesenteric artery stump pressure (IMA-SP), penile blood flow, and gluteal blood flow.
Methods
Twenty males were selected for this study. An aorto-bi-common iliac arteries (CIA) graft replacement was performed in ten patients (Group Bi-CIA). An aorto-right-CIA/left-external iliac artery (EIA) graft replacement was performed in five (Group Lt-EIA). The other five underwent an aorto-right-EIA/left-CIA anastomosis (Group Rt-EIA). The right graft limb was anastomosed first, followed by the left limb in all of the patients. Pelvic circulation was monitored during aortic reconstruction, including the IMA-SP index (IMA-SPI), penile brachial pressure index (PBI) by pulse-volume plethysmography, and gluteal tissue oxygenation metabolism with near-infrared spectroscopy by monitoring the gluteal tissue oxygenation index (TOI) bilaterally.
Results
The PBI and bilateral gluteal TOI became depressed in all patients during proximal aortic clamping. However, there was no significant change in IMA-SPI in each group. The PBI and bilateral gluteal TOI in all groups recovered to the baseline values after completion of bilateral graft limb anastomosis.
Conclusions
IMA-SPI is likely to reflect collateral circulation mainly from the superior mesenteric artery. The penile blood flow and bilateral gluteal blood flow therefore seem to be supplied via the bilateral hypogastric arteries or the profunda femoris arteries.
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References
Connolly JE, Ingegno M, Wilson SE. Preservation of the pelvic circulation during infrarenal aortic surgery. Cardiovasc Surg 1996;4:65–70.
Shigematsu H, Nunokawa M, Hatakeyama T, Aramoto H, Ohshiro H, Kobayashi I, et al. Inferior mesenteric and hypogastric artery reconstruction to prevent colonic ischaemia following abdominal aortic aneurysmectomy. Cardiovasc Surg 1993;1:13–18.
Ernst CB, Hagihara PF, Daugherty ME, Griffen WO Jr. Inferior mesenteric artery stump pressure: a reliable index for safe IMA ligation during abdominal aortic aneurysmectomy. Ann Surg 1978;187:641–646.
Inuzuka K, Unno N, Mitsuoka H, Yamamoto N, Ishimaru K, Sagara D, et al. Intraoperative monitoring of penile and buttock blood flow during endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2006;31:359–365.
Unno N, Inuzuka K, Yamamoto N, Sagara D, Suzuki M, Konno H. Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. J Vasc Surg 2006;44:1170–1175.
Unno N, Inuzuka K, Mitsuoka H, Ishimaru K, Sagara D, Konno H. Automated bedside measurement of penile blood flow using pulse-volume plethysmography. Surg Today 2006;36:257–261.
Iliopoulos JI, Pierce GE, Hermreck AS, Haller CC, Thomas JH. Hemodynamics of the inferior mesenteric arterial circulation. J Vasc Surg 1990;11:120–124;discussion 125–6.
Mehta M, Veith FJ, Ohki T, Cynamon J, Goldstein K, Suggs WD, et al. Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients: a relatively innocuous procedure. J Vasc Surg 2001;33:S27–S32.
Arko FR, Lee WA, Hill BB, Fogarty TJ, Zarins CK. Hypogastric artery bypass to preserve pelvic circulation: improved outcome after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2004;39:404–408.
DePalma RG, Levine SB, Feldman S. Preservation of erectile function after aortoiliac reconstruction. Arch Surg 1978;113:958–962.
Sugano N, Inoue Y, Iwai T. Evaluation of buttock claudication with hypogastric artery stump pressure measurement and near infrared spectroscopy after abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2003;26:45–51.
Flanigan DP, Schuler JJ, Keifer T, Schwartz JA, Lim LT. Elimination of iatrogenic impotence and improvement of sexual function after aortoiliac revascularization. Arch Surg 1982;117:544–550.
Queral LA, Whitehouse WM, Jr, Flinn WR, Zarins CK, Bergan JJ, Yao JS. Pelvic hemodynamics after aortoiliac reconstruction. Surgery 1979;86:799–809.
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Inuzuka, K., Unno, N., Yamamoto, N. et al. Assessment of pelvic hemodynamics during an open repair of an infrarenal abdominal aortic aneurysm. Surg Today 40, 738–744 (2010). https://doi.org/10.1007/s00595-009-4126-2
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DOI: https://doi.org/10.1007/s00595-009-4126-2