Postoperative splanchnic perfusion following the reconstruction of thoracoabdominal aortic aneurysm involving abdominal visceral branches. Report of a case.
A 58-year-old man with thoracoabdominal aortic aneurysm involving visceral arteries underwent graft replacement of the thoracoabdominal aorta and associated reconstruction of abdominal visceral branches. Femoro-femoral extracorporeal bypass, intermittent selective visceral arterial perfusion and a staging cross-clamping method of the aorta were utilized at surgery. The total cross-clamping time of the aorta was 165 minutes. The patient's postoperative course was uneventful with no incidence of hepatic and renal failure or paraplegia. Although postoperative systemic blood pressure and cardiac output recovered to normal values within 7 hrs after the release of aortic clamping, it took 18 hrs for hepatic venous hemoglobin oxygen saturation (ShvO2) to recover. Base excess in arterial blood, lactic acid in arterial and hepatic venous blood, and ketone body ratio in arterial blood (AKBR) and hepatic venous blood (HVKBR) recovered to within normal ranges after 18 hrs of the release of aortic clamping. ShvO2 monitoring is a simple and may be a useful parameter in evaluating postoperative splanchnic perfusion and predicting abdominal organ failure at the time of thoracoabdominal aortic reconstruction involving visceral arteries.
Oshima
K
K
Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan.
Morishita
Y
Y
Ishikawa
S
S
Tsuda
K
K
Ohtaki
A
A
Takahashi
T
T
Suzuki
M
M
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001784:Blood Gas Analysis; D019917:Blood Vessel Prosthesis Implantation; D002445:Celiac Artery / Q000601:surgery; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery; D008875:Middle Aged; D011184:Postoperative Period; D012077:Renal Artery / Q000601:surgery; D013152:Splanchnic Circulation; D014781:Viscera / Q000098:blood supply* / Q000378:metabolism
D006454:Hemoglobins