title: Assessment of pelvic hemodynamics during an open repair of an infrarenal abdominal aortic aneurysm.
abstract: OBJECTIVE
  To assess the pelvic circulation during abdominal aortic aneurysm (AAA) repair by measuring the inferior mesenteric artery stump pressure (IMA-SP), penile blood flow, and gluteal blood flow.
  
  
  METHODS
  Twenty males were selected for this study. An aorto-bi-common iliac arteries (CIA) graft replacement was performed in ten patients (Group Bi-CIA). An aorto-right-CIA/left-external iliac artery (EIA) graft replacement was performed in five (Group Lt-EIA). The other five underwent an aorto-right-EIA/left-CIA anastomosis (Group Rt-EIA). The right graft limb was anastomosed first, followed by the left limb in all of the patients. Pelvic circulation was monitored during aortic reconstruction, including the IMA-SP index (IMA-SPI), penile brachial pressure index (PBI) by pulse-volume plethysmography, and gluteal tissue oxygenation metabolism with near-infrared spectroscopy by monitoring the gluteal tissue oxygenation index (TOI) bilaterally.
  
  
  RESULTS
  The PBI and bilateral gluteal TOI became depressed in all patients during proximal aortic clamping. However, there was no significant change in IMA-SPI in each group. The PBI and bilateral gluteal TOI in all groups recovered to the baseline values after completion of bilateral graft limb anastomosis.
  
  
  CONCLUSIONS
  IMA-SPI is likely to reflect collateral circulation mainly from the superior mesenteric artery. The penile blood flow and bilateral gluteal blood flow therefore seem to be supplied via the bilateral hypogastric arteries or the profunda femoris arteries.
authors.affiliation: Division of Vascular Surgery, Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Inuzuka
authors.forename: Naoki
authors.initials: N
authors.lastname: Unno
authors.forename: Naoto
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sagara
authors.forename: Minoru
authors.initials: M
authors.lastname: Suzuki
authors.forename: Motohiro
authors.initials: M
authors.lastname: Nishiyama
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Mano
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Konno
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001794:Blood Pressure; D002081:Buttocks / Q000098:blood supply; D003106:Colon / Q000098:blood supply; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D007668:Kidney / Q000098:blood supply* / Q000601:surgery; D008297:Male; D010388:Pelvis / Q000098:blood supply* / Q000601:surgery; D010413:Penis / Q000098:blood supply; D019990:Perioperative Care; D019265:Spectroscopy, Near-Infrared / Q000295:instrumentation; D013997:Time Factors