Tonometric assessment of sigmoid perfusion during aortobifemoral reconstruction for arteriosclerosis.
OBJECTIVE
To assess the effect of inferior mesenteric artery reimplantation on perfusion of the mucosa of the sigmoid colon in patients undergoing aortobifemoral reconstruction for arteriosclerotic disease.


METHODS
Random control study.


METHODS
University hospital.


METHODS
8 Men and 2 women with peripheral vascular disease and angiographically patent superior and inferior mesenteric arteries.


METHODS
Patients were randomised to have the inferior mesenteric artery reimplanted in the Y-graft or not. Sigmoid perfusion was measured with a tonometer and expressed as the intramucosal pH (pHi) during operation (baseline) and for four days afterwards.


METHODS
Measurements of pHi, arterial blood gases, and acid base balance, and signs of ischaemia of the gut.


RESULTS
In both groups the pHi was reduced after clamping the aorta, but returned to baseline on the first postoperative day. One patient had a cardiac arrest from which he was resuscitated and his pHi measurements were subsequently low.


CONCLUSIONS
pHi does seem to reflect changes in the circulation of the sigmoid mucosa. Even if the inferior mesenteric artery is patent, reimplantation is only rarely indicated in patients undergoing aortobifemoral reconstruction.
Department of Surgery, University of Turku, Finland.
K
K
Kuttila
J
J
Perttila
E
E
Vänttinen
J
J
Niinikoski
D000714:Anastomosis, Surgical; D001012:Aorta, Abdominal / Q000601:surgery*; D001161:Arteriosclerosis / Q000378:metabolism / Q000601:surgery*; D001783:Blood Flow Velocity; D012809:Colon, Sigmoid / Q000098:blood supply / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007083:Iliac Artery / Q000601:surgery*; D007413:Intestinal Mucosa / Q000098:blood supply / Q000378:metabolism / Q000503:physiopathology*; D008026:Ligation; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery*; D008875:Middle Aged; D011182:Postoperative Care; D012092:Replantation