Preoperative embolization of the graft superior mesenteric artery assists graft enterectomy in intestinal transplant recipients.
BACKGROUND
Graft enterectomy after intestinal graft failure is challenging. We report our experience in preoperative embolization of graft superior mesenteric artery (SMA) to facilitate intestinal graft removal.


METHODS
A total of 22 isolated intestinal transplant recipients underwent graft enterectomy from July 1997 to February 2011 at the Miami Transplant Institute, Miller School of Medicine, University of Miami, of whom 6 patients underwent embolization of graft SMA seven times before graft enterectomy.


RESULTS
The mean (SD) estimated blood loss in patients with or without embolization was 600 (173) versus 1437 (328) mL, respectively (P=0.02). The mean operation time in patients with or without embolization was 5.2 (1.2) versus 8.7 (1.3) hr, respectively (P=0.04). The mean change between preoperative and postoperative serum creatinine in patients with or without embolization was 0.2 (0.05) versus 0.16 (0.04), respectively (P=0.12). In patients with embolization, the warm ischemia time (from embolization to removal of the graft) was 6.9 (1.1) hr (range, 6-8.5 hr). Intraoperative and postoperative (24 hr) pH values were 7.36 (0.1) and 7.34 (0.1), respectively (P=0.71); intraoperative and postoperative (24 hr) lactate levels were 1.77 (0.8) and 1.56 (0.5) mmol/L, respectively (P=0.57).


CONCLUSIONS
Preoperative embolization of graft SMA is a useful alternative to assist graft enterectomy in intestinal transplant recipients without causing severe acidosis, renal impairment, and hemodynamic instability.
Division of Transplantation, Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA. jfan@med.miami.edu
Ji
J
Fan
Akin
A
Tekin
Seigo
S
Nishida
Jang
J
Moon
Gennaro
G
Selvaggi
David
D
Levi
Debbie
D
Weppler
Andreas G
AG
Tzakis
D000293:Adolescent; D000328:Adult; D000368:Aged; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery / Q000637:transplantation*; D008297:Male; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D057234:Preoperative Period