No abstract

Epidural perfusion cooling is a safe method to employ in clinical situations. Our contemporary management strategies enabled patients to undergo thoracoabdominal aneurysm repair with excellent early and late survival and acceptable morbidity.

Endovascular stent grafting EVSG using the MK stent with extra-anatomic arch vessel bypass under SCP using LHB could be a useful and less invasive method for patients with aortic arch aneurysm who are at a high surgical risk.

Conclusion:A measurement of colonic mucosal oxygen saturation correlates with the stoppage and restoration of aortic flow during aortic surgery.Summary: Colon ischemia complicating aortic reconstruction has a high mortality rate. The authors developed a method of measuring colonic mucosal ischemia during aortic surgery that correlates with interoperative events. A spectrophotometer probe is inserted into a patient's rectum before aortic reconstruction. The device allows continuous measurement of colonic mucosal oxygen saturation (CMOS). It was tested in 25 patients undergoing aortic reconstruction. Buccal mucosal oxygen saturation, mean arterial pressure, heart rate, pulse oximetry, and arrest and restoration of flow in the aorta were also recorded during each operative procedure.An endovascular aneurysm repair (EVAR) was performed in 20 patients and an open repair was performed in five patients. During EVAR, CMOS decreased from a baseline of 56% Ϯ 8% to 26% Ϯ 17% during the period of infrarenal aortic balloon occlusion (P Ͻ .0001). During open repair, CMOS also decreased from 56% Ϯ 9% to 15% Ϯ 19% during clamping of the infrarenal aorta and iliac arteries (P Ͻ .0001). With restoration of aortic flow in both open procedures and EVAR, CMOS returned to baseline values (56.5% Ϯ 10%, P ϭ .81 compared with baseline). The time for CMOS to recover after restoration of aortic flow was 6.4 Ϯ 3.3 minutes. Comment:The technique offers a potential method of monitoring colonic perfusion intraoperatively. Obviously, a number of details still need to be determined, such as what is the lowest level of colonic mucosal oxygen saturation that will sustain colonic viability. In addition, the potential ability of this technique to monitor for postoperative colonic ischemia seems like an interesting line of inquiry.

No abstract