Abstract
Near-infrared spectroscopy (NIRS) may be a useful method for monitoring the regional oxygen saturation (rSO2) of the lower extremity during endovascular aortic repair. Eighteen patients with thoracic descending and/or abdominal aortic aneurysm were enrolled in this study. NIRS probes were placed bilaterally on the calves. Muscular rSO2 (mrSO2) was monitored every 30 s throughout the operation. In the leg in which the femoral artery was clamped, mrSO2 values were selected at 3 or 4 points–just before clamping (control value), 30 min after clamping, 10 min after the first declamping, and 10 min after the second declamping following repair of the femoral artery, if necessary. In all patients, mrSO2 decreased significantly during clamping, from 64 ± 11 % (mean ± SD) of the control value to 32 ± 15 %. After declamping, mrSO2 recovered to 69 ± 14 % of the control value in 16 patients. In the 2 other patients, however, mrSO2 did not recover after the first declamping, because of femoral artery dissection. After additional repair, mrSO2 recovered quickly to the control value. These data suggested NIRS may objectively and quantitatively reflect oxygenation of the lower extremities, and may indicate an ischemic event that needs additional repair during endovascular aortic repair.
References
Heringlake M, Garbers C, Käbler JH, Anderson I, Heinze H, Schön J, Berger KU, Dibbelt L, Sievers HH, Hanke T. Preoperative cerebral oxygen saturation and clinical outcomes in cardiac surgery. Anesthesiology. 2011;114:58–69.
Ricci Z, Garisto C, Favia I, Schloderer U, Giorni C, Fragasso T, Picardo S. Cerebral NIRS as a marker of superior vena cava oxygen saturation in neonates with congenital heart disease. Paediatr Anaesth. 2010;20:1040–5.
Moritz S, Kasprzak P, Arlt M, Taeger K, Metz C. Accuracy of cerebral monitoring in detecting cerebral ischemia during carotid endarterectomy: a comparison of transcranial Doppler sonography, near-infrared spectroscopy, stump pressure, and somatosensory evoked potentials. Anesthesiology. 2007;107:563–9.
Andropoulos DB, Stayer SA, Diaz LK, Ramamoorthy C. Neurological monitoring for congenital heart surgery. Anesth Analg. 2004;99:1365–75.
Redlin M, Boettcher W, Huebler M, Berger F, Hetzer R, Koster A, Kuebler WM. Detection of lower torso ischemia by near-infrared spectroscopy during cardiopulmonary bypass in a 6.8-kg infant with complex aortic anatomy. Ann Thorac Surg. 2006;82:323–5.
Berens RJ, Stuth EA, Robertson FA, Jaquiss RD, Hoffman GM, Troshynski TJ, Staudt SR, Cava JR, Tweddell JS, Bert Litwin S. Near infrared spectroscopy monitoring during pediatric aortic coarctation repair. Paediatr Anaesth. 2006;16:777–81.
Inuzuka K, Unno N, Yamamoto N, Sagara D, Suzuki M, Nishiyama M, Tanaka H, Mano Y, Konno H. Assessment of pelvic hemodynamics during an open repair of an infrarenal abdominal aortic aneurysm. Surg Today. 2010;40:738–44.
Bonaros N, Wiedemann D, Nagiller J, Feuchtner G, Kolbitsch C, Kaufmann M, Bonatti J, Schachner T. Distal leg protection for peripheral cannulation in minimally invasive and totally endoscopic cardiac surgery. Heart Surg Forum. 2009;12:158–62.
Fukui D, Urayama H, Tanaka K, Kawasaki S. Use of near-infrared spectroscopic measurement at the buttocks during abdominal aortic surgery. Circ J. 2002;66:1128–31.
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.
Nakayama M, Iwasaki S, Ichinose H, Yamamoto S, Kanaya N, Namiki A. Monitoring of skeletal muscle oxygenation using near-infrared spectroscopy during abdominal aortic surgery. J Anesth. 2002;16:127–30.
Sako H, Hadama T, Miyamoto S, Anai H, Wada T, Iwata E, Hamamoto H, Tanaka H, Morita M. Limb ischemia and reperfusion during abdominal aortic aneurysm surgery. Surg Today. 2004;34:832–6.
Nakayama M, Iwasaki S, Ichinose H, Yamamoto S, Kanaya N, Namiki A. Intraoperative acute lower extremity ischemia detected by near-infrared spectroscopy. J Cardiothorac Vasc Anesth. 2001;15:624–5.
Rabellino M, García-Nielsen L, Zander T, Baldi S, Estigarribia A, Zerolo I, Cheves H, Llorens R, Maynar M. Primary stenting immediately after surgery in occluded anastomoses of aortoaortic tube graft: a case report. Cardiol Res Pract. 2010;20:521326.
Teeuwen C, Eikelboom BC, Ludwig JW. Clinically unsuspected complications of arterial surgery shown by post-operative digital subtraction angiography. Br J Radiol. 1989;62:13–9.
Johnston KW. Multicenter prospective study of nonruptured abdominal aortic aneurysm. Part II. Variables predicting morbidity and mortality. J Vasc Surg. 1989;9:437–47.
Köveker G, de Vivie ER, Hellberg K, Ruschewski W, Heisig B. Early and long-term results after surgical treatment of abdominal aortic aneurysm. Thorac Cardiovasc Surg. 1981;29:394–8.
Berland TL, Cayne NS, Veith FJ. Access complications during endovascular aortic repair. J Cardiovasc Surg. 2010;51:43–52.
Ting AC, Cheng SW, Ho P, Chan YC, Poon JT, Yiu WK, Cheung GC. Endovascular repair for abdominal aortic aneurysms: the first hundred cases. Hong Kong Med J. 2008;14:361–6.
Newman JS, Adler RS, Bude RO, Rubin JM. Detection of soft-tissue hyperemia: value of power Doppler sonography. AJR Am J Roentgenol. 1994;163:385–9.
Barnes RW. Office Doppler techniques in vascular disease. J Fam Pract. 1981;13:711–20.
Benzon HT, Toleikis JR, Meagher LL, Shapiro BA, Ts’ao CH, Avram MJ. Changes in venous blood lactate, venous blood gases, and somatosensory evoked potentials after tourniquet application. Anesthesiology. 1988;69:677–82.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Wakimoto, M.M., Kadosaki, M., Nagata, H. et al. The usefulness of near-infrared spectroscopy in the anesthetic management of endovascular aortic aneurysm repair. J Anesth 26, 932–935 (2012). https://doi.org/10.1007/s00540-012-1435-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-012-1435-1