Inferior Mesenteric Artery Stump Pressure

Ernst, Calvin B.; Hagihara, Patrick F.; Daugherty, Michael E.; Griffen, Ward O.

doi:10.1097/00000658-197806000-00009

Cited by 113 publications

(10 citation statements)

References 8 publications

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“…IMA ligation remains a potential risk factor for hypoperfusion of the left-sided colon during rectosigmoid cancer surgery [6]. Following IMA ligation, colonic ischemia may occur, if the IMA stump pressure decreases to 40 mmHg or the mean IMA/systemic BP ratio was less than 0.4, which is considered the critical closing pressure during aortic aneurysm surgery [15]. A critically low MAP index of less than 40% of the systemic artery pressure was considered to present a high risk of colonic ischemia [15].…”

Section: Discussionmentioning

confidence: 99%

“…Following IMA ligation, colonic ischemia may occur, if the IMA stump pressure decreases to 40 mmHg or the mean IMA/systemic BP ratio was less than 0.4, which is considered the critical closing pressure during aortic aneurysm surgery [15]. A critically low MAP index of less than 40% of the systemic artery pressure was considered to present a high risk of colonic ischemia [15]. However, another study did not identify the significance of IMA index for predicting anastomotic leakage after left colon resection [16].…”

Section: Discussionmentioning

confidence: 99%

“…Systemic MAP was also measured in the radial artery of the patient's wrist. Ischemic colitis was reported to occur when the mean IMA/systemic BP ratio was less than 0.4 in aortic aneurysm patients [15]. Anastomotic leakage was also reported with a MAP ratio less than 0.4 after left colon resection [16].…”

Section: Methodsmentioning

confidence: 99%

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Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients

et al. 2019

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Purpose Colon perfusion status is one of the most important factors for the determination of postoperative anastomotic complications. Colonic hypoperfusion can be induced by inferior mesenteric artery (IMA) ligation in some patients. This study aimed to evaluate atherosclerotic risk assessment and vascular parameters of CT angiography as predictors of colonic hypoperfusion. Methods This prospective study was conducted at a tertiary referral hospital and included 46 rectosigmoid colon cancer patients undergoing laparoscopic anterior resection between August 2013 to July 2014. Atherosclerotic risk scores were assessed using the Framingham cardiovascular risk score system. The IMA length, branching pattern, atherosclerotic calcification, and intermesenteric artery and mesenteric vascular diameters were evaluated using CT angiography. Mesenteric marginal artery pressures were measured before and after IMA clamping. The mean arterial pressure (MAP) index was calculated by dividing the mesenteric marginal MAP into the systemic MAP to determine the mesenteric hypoperfusion status after IMA clamping. A critically low MAP index was defined as <0.4. Results Critically low MAP index (<0.4) was observed in 6 cases (13.0%) after IMA clamping. Atherosclerotic calcification of the IMA and superior mesenteric artery occurred in 11 (23.9%) and 5 patients (10.9%), respectively. Low MAP index was associated with high atherosclerotic risk score and short IMA length, rather than atherosclerotic calcification and other vascular parameters of the major mesenteric arteries. Multivariate analysis indicated that high atherosclerotic risk and short IMA length were independent predictors of critically low MAP index. Conclusion Atherosclerotic risk assessment and IMA length were useful predictors of the mesenteric hypoperfusion status following IMA ligation during laparoscopic rectosigmoid colon surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients

et al. 2019

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“…A quantitative but invasive method of determining the PPP by catheterization of the inferior mesenteric artery stump has been proposed [8]as a method to establish the necessity of inferior mesenteric artery reimplantation after abdominal aortic aneurysmectomy. PPG has been established as a method of predicting ischemic colitis secondary to the surgical treatment of aortic aneurysm by assessing the magnitude of the arterial wave [6].…”

Section: Discussionmentioning

confidence: 99%

Use of Photoplethysmography to Determine Gastrointestinal Perfusion Pressure: An Experimental Canine Model

García‐Granero¹,

García²,

Alós³

et al. 2003

Dig Surg

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Objectives: To develop an experimental model to assess the parietal perfusion pressure (PPP) of the digestive tract using photoplethysmography. Materials and Methods: Twenty-two mongrel dogs were used. Progressive external compression was applied to the intestinal wall and the PPP was assessed with photoplethysmography. The study group was divided into two groups. In group 1 PPP was measured at the levels of the stomach, duodenum, jejunum and transverse colon. In group 2 PPP was measured after temporary occlusion of the truncal and marginal circulation of the jejunum to provide further variables. Results: The PPP decreased significantly for each successive distal section. Correlation coefficients and indices for PPP and mean arterial pressures were statistically significant (p < 0.005). Truncal occlusion provoked a drop in PPP whereas marginal occlusion scarcely modified the basal results. Conclusions: Photoplethysmography, through measurements of the residual arterial wave amplitude, is a valid method of determining quantitatively the PPP of the digestive tract and could be useful in a clinical environment.

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“…In general, the necessity of reconstruction is determined based on IMA blood flow checked intraoperatively, and IMA reconstruction is considered necessary when IMA stump pressure is ≤40 mmHg, or IMA stump pressure/systemic blood pressure ratio is ≤0.4. 5)…”

Section: Intestinal Ischemiamentioning

confidence: 99%

Surgical Complications after Open Abdominal Aortic Aneurysm Repair: Intestinal Ischemia, Buttock Claudication and Sexual Dysfunction

Kudo

2019

Annals of Vascular Diseases

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While surgical treatment for abdominal aortic aneurysm (AAA) is a standard operation, prevention of complication is important. Intestinal ischemia of the sigmoid colon and/or rectum after AAA surgery is severe and has a high mortality rate although occurrence frequency is low. The most important thing to prevent is the preoperative and intraoperative evaluation of the left hemicolon and rectal circulation. Measurement of inferior mesenteric artery stump pressure is also useful. From the viewpoint of prevention of buttock claudication, it is desirable that internal iliac artery (IIA) blood flow is preserved, but aggressive IIA reconstruction adaptation is considered to be low. For erectile function, it is important that the antegrade blood flow from the IIA to the internal pudendal artery on at least one side is preserved or reconstructed. To prevent retrograde ejaculation, it is important to preserve the superior hypogastric plexus and one side of the lumbar splanchnic nerve, and the hypogastric nerve. Understanding and mastering local anatomy and pathophysiology is important in preventing complications, and we must also remember that we always keep watchful surgical operations in mind in order to prevent tissue damage. (This is a translation of Jpn J Vasc Surg 2019; 28: 99–103.)

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Inferior Mesenteric Artery Stump Pressure

Cited by 113 publications

References 8 publications

Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients

Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients

Use of Photoplethysmography to Determine Gastrointestinal Perfusion Pressure: An Experimental Canine Model

Surgical Complications after Open Abdominal Aortic Aneurysm Repair: Intestinal Ischemia, Buttock Claudication and Sexual Dysfunction

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