Endovascular aortic repair reduces gluteal oxygenation

Taudorf, Mikkel; Nielsen, Michael Bachmann; Schroeder, Torben V; Lönn, Lars; Nielsen, Henning Bay

doi:10.1177/2058460119850115

Cited by 3 publications

(1 citation statement)

References 34 publications

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“…2 NIRS, commonly used for cerebral and lower limb perfusion monitoring in VA-ECMO, is reported in assessing intraoperative arterial ischemia at the buttock level in patients undergoing abdominal aortic aneurysm repair. 15 We similarly applied gluteal NIRS in our index case and recorded lower rSO 2 readings over the affected side. Further studies are warranted to evaluate the feasibility and efficacy of NIRS in the early detection of gluteal necrosis in VA-ECMO patients.…”

Section: Discussionmentioning

confidence: 94%

Buttock Ischemia in Venoarterial Extracorporeal Membrane Oxygenation: A Case Series

Wong

Tammy²,

Chu³

et al. 2022

ASAIO Journal

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Venoarterialextracorporeal membrane oxygenation (VA-ECMO) is a bridging therapy for refractory cardiogenic shock, and limb ischemia is a concern with femoral cannulation. Because of the rich collateral pelvic circulatory supply, buttock ischemia is not common and is usually a complication after aneurysmal aortic repair or internal iliac artery embolization after pelvic trauma. Gluteal necrosis occurring as an extracorporeal membrane oxygenation complication has not been reported in the literature. In this case series, we report three patients with ischemic buttock after initiating VA-ECMO and discuss the risk factors and the clinical and radiological features supportive of the diagnosis. We review the gluteal and pelvic vascular anatomy, postulate how cannula size, ethnicity, catecholamines, and reversal of gluteal arterial flow contributed to this rare entity in our patients and explain how these findings have changed our institution's practice. ASAIO

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Section: Discussionmentioning

confidence: 94%

Buttock Ischemia in Venoarterial Extracorporeal Membrane Oxygenation: A Case Series

Wong

Tammy²,

Chu³

et al. 2022

ASAIO Journal

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Prospective clinical study for claudication after endovascular aneurysm repair involving hypogastric artery embolization

et al. 2022

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Purpose This prospective study aimed to assess the prognosis of claudication after endovascular aneurysm repair (EVAR) involving hypogastric artery (HGA) embolization. Methods Patients who were scheduled to undergo EVAR involving bilateral or unilateral HGA embolization (BHE or UHE, respectively) between May 2017 and January 2019 were included in this study. Patients underwent the walk test preoperatively, one week postoperatively, and monthly thereafter for six months. The presence of claudication and the maximum walking distance (MWD) were recorded. A near-infrared spectroscopy monitor was placed on the buttocks, and the recovery time (RT) was determined. A walking impairment questionnaire (WIQ) was completed to determine subjective symptoms. Results Of the 13 patients who completed the protocol, 12 experienced claudication in the 6-min walk test. The MWD was significantly lower at one week postoperatively than preoperatively. The claudication prevalence was significantly higher at five and six months postoperatively after BHE than after UHE. BHE was associated with longer RTs and lower WIQ scores than UHE. Conclusions We noted a trend in adverse effects on the gluteal circulation and subjective symptoms ameliorating within six months postoperatively, with more effects being associated with BHE than with UHE. These findings should be used to make decisions concerning management strategies for HGA reconstruction.

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Gluteal Blood Flow Monitoring in Endovascular Aneurysm Repair With Internal Iliac Artery Embolization

Fujioka

Kitamura

Mishima

et al. 2021

Circ J

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paring changes in rSO2 with treatment results. Methods Of the 86 patients who underwent EVAR at our institution between April 2019 and May 2020, 27 patients were included and 2 bedridden patients with a Clinical Frailty Score of ≥7 were excluded from 29 patients with concomitant internal iliac artery embolization. Intraoperative changes in the rSO2 and postoperative incidence of buttock claudication were compared, and an assessment was performed to determine if changes in rSO2 are predictive of buttock claudication. Furthermore, the presence or absence of communication between the superior and inferior gluteal arteries, as well as the intraoperative changes in rSO2, were compared, and analysis was performed to determine whether the change in blood flow to the gluteal muscles at the site of embolization of the internal iliac artery was I n cases of abdominal aortic aneurysms, it is common for the lesion to extend into the iliac artery and form a series of aneurysms. Unilateral and bilateral iliac aneurysms are associated with 40% of abdominal aortic aneurysm cases. 1-3 Endovascular aneurysm repair (EVAR) for such cases requires internal iliac artery embolization to prevent type II endoleak from the internal iliac artery. Although it has been reported that pelvic visceral ischemia and buttock claudication may occur even with unilateral embolization of the internal iliac artery, there is no method of intraoperative blood flow assessment of the internal iliac artery system. 4-6 Previous studies reported that muscle oxygenation and blood flow to regions including the gluteal muscle could be successfully evaluated using near-infrared spectroscopy (NIRS), which enables the comparison of subjects with different adipose tissue thicknesses by physiological calibration. 7,8 The purpose of this study was to evaluate the usefulness of NIRS for monitoring the regional oxygen saturation (rSO2) of gluteal artery blood flow during EVAR by com-Editorial p ????

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Endovascular aortic repair reduces gluteal oxygenation

Cited by 3 publications

References 34 publications

Buttock Ischemia in Venoarterial Extracorporeal Membrane Oxygenation: A Case Series

Buttock Ischemia in Venoarterial Extracorporeal Membrane Oxygenation: A Case Series

Prospective clinical study for claudication after endovascular aneurysm repair involving hypogastric artery embolization

Gluteal Blood Flow Monitoring in Endovascular Aneurysm Repair With Internal Iliac Artery Embolization

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