Intraoperative monitoring of penile and buttock blood flow during endovascular abdominal aortic aneurysm repair.
OBJECTIVE
The purpose of this study was to assess the pelvic circulation during endovascular abdominal aortic aneurysm repair (EVAR) with a new monitoring system measuring penile and buttock blood flow.


METHODS
We measured penile brachial pressure index (PBI) during EVAR by pulse-volume-plethysmography (form PWV/ABItrade mark). We also measured bilateral gluteal tissue oxygen metabolism with near-infrared spectroscopy to provide a gluteal tissue oxygenation index (TOI). Twenty-two men who underwent aortouni-iliac stentgraft with crossover bypass for exclusion of abdominal aortic aneurysm were studied. Twelve patients underwent aorto-uni-common iliac artery stentgraft (CIA) and ten underwent aorto-uni-external iliac artery stentgraft (EIA).


RESULTS
In all patients, there was an immediate reduction in PBI during the EVAR procedure. After revascularization of the ipsilateral limb of the stent graft, the recovery of PBI was significantly less in EIA group. After the completion of crossover bypass, PBI in both groups recovered to the baseline values. In both groups there was a bilateral reduction in gluteal TOI during malperfusion of the internal iliac artery. After revascularization of ipsilateral limb of the stent graft, the ipsilateral TOI recovered to the baseline level in CIA patients, but recovery was incomplete in EIA patients. In contrast, contra-lateral TOI remained low in both groups after revascularization of ipsilateral limb of the stent graft. Only after completion of crossover bypass did the contra-lateral TOI recover to baseline level in both groups.


CONCLUSIONS
Both TOI at the buttocks and PBI are a sensitive reflection of pelvic haemodynamics. Penile blood flow and bilateral gluteal blood flow are supplied via different circulations and both should be monitored for full assessment of the pelvic circulation.
Inuzuka
K
K
Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192, Japan. inu@hama-med.ac.jp
Unno
N
N
Mitsuoka
H
H
Yamamoto
N
N
Ishimaru
K
K
Sagara
D
D
Suzuki
M
M
Konno
H
H
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D002081:Buttocks / Q000098:blood supply*; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007430:Intraoperative Care; D008297:Male; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000378:metabolism; D010413:Penis / Q000098:blood supply*; D010991:Plethysmography; D012039:Regional Blood Flow; D015607:Stents
D010100:Oxygen