Immediate detection of postreconstructive ischaemia by intra-operative Doppler ankle pressure index monitoring during aortic reconstructions.
From March 1980 to February 1988, 368 aorto-iliac or aorto-femoral bilateral reconstructions were performed for aneurysmal or occlusive disease. In order to demonstrate early postreconstructive ischaemic complications, the intra-operative Doppler Ankle Pressure Index (API) was measured immediately before reconstruction (PRE), just after declamping (DEC) and 5, 15, 30 and 45 min thereafter. Each limb of the reconstruction (736) was considered individually and subdivided as follows: Group (A) 705 immediately successful (96% of limbs and 92% of patients); Group (B) 22 (3% of limbs and 5% of patients) in which, on the grounds of API data, an ischaemic complication was regarded as imminent and treated by graft revision or a peripheral thromboembolectomy (intra-operative corrections); Group (C) 9 (1% of limbs and 2% of patients) in which the diagnosis of ischaemic complications was made postoperatively when the patients underwent successful reoperation. All 736 reconstructions were patent and functional at discharge of the patient. By a retrospective analysis the intra-operative APIs were studied and the features (single or associated) suggesting an ischaemic complication examined. These were: (1) no flow at the time of declamping or its disappearance during the operation (10 cases, 1.25% of limbs) all detected and successfully corrected intra-operatively.(ABSTRACT TRUNCATED AT 250 WORDS)
Giulini
S M
SM
Department of Surgical Sciences, University of Brescia, Italy.
Colombi
A
A
Bonardelli
S
S
Maffeis
R
R
De Lucia
M
M
Coniglio
A
A
Tosoni
F
F
Floriani
M
M
Tiberio
G
G
D000842:Ankle / Q000098:blood supply*; D001011:Aorta / Q000601:surgery*; D001795:Blood Pressure Determination / Q000379:methods*; D006083:Graft Occlusion, Vascular / Q000175:diagnosis*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D008991:Monitoring, Physiologic / Q000379:methods; D012086:Reoperation; D014463:Ultrasonography; D014656:Vascular Surgical Procedures