Outcome of splanchnic blood flow determination in patients with suspected chronic intestinal ischaemia. A retrospective survey.
BACKGROUND
Different diagnostic examinations have been applied in the management of patients with suspected intestinal ischaemia. In some centres, invasive determination of a meal-induced increase in splanchnic blood flow is used in the diagnostic process and in the selection of patients for surgery. However, no studies have evaluated the impact of splanchnic blood flow determination on therapy in such patients.


OBJECTIVE
The aim of the present study was therefore to analyse the outcome of splanchnic blood flow determination in patients with suspected chronic intestinal ischaemia.


METHODS
Seventy-three consecutive patients with suspected intestinal ischaemia were included during a 5-year period. Splanchnic blood flow was determined at baseline and after a standardized meal. The patients were classified into three groups according to the level of meal-induced increase in splanchnic blood flow: A, normal response (splanchnic blood flow > or = 200 ml/min); B, possible abnormal response (splanchnic blood flow 51-199 ml/min); and C, definitive abnormal response (splanchnic blood flow < or = 50 ml/min). Where surgery took place, the type of operation was noted.


RESULTS
Forty patients had a normal meal-induced response, 23 patients had a possible abnormal response and 10 patients had a definitive abnormal response, which gave evidence of chronic intestinal ischaemia. In the total patient population, the increase in splanchnic blood flow was significantly correlated to an increase in hepatic oxygen uptake (r = 0.38, P < 0.002) and to body weight (r = 0.36, P < 0.01). A total of seven patients (10%) underwent successful revascularization.


CONCLUSIONS
Ten of the patients with suspected chronic intestinal ischaemia had abnormal meal-induced splanchnic blood flow and 30% of these patients underwent angioplasty. Future studies are needed to validate the determination of splanchnic blood flow in relation to splanchnic angiography and other imaging modalities in patients with chronic intestinal ischaemia.
Møller
Søren
S
Department of Clinical Physiology, Hvidovre Hospital, University of Copenhagen, Denmark. soeren.moeller@hh.hosp.dk
Madsen
Jan Lysgård
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D002908:Chronic Disease; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009930:Organic Chemicals; D019518:Postprandial Period; D012189:Retrospective Studies; D013152:Splanchnic Circulation / Q000502:physiology*; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods
D004396:Coloring Agents; D009930:Organic Chemicals; C035709:iodocyanine green