Use of Near-Infrared Spectroscopic Measurement at the Buttocks During Abdominal Aortic Surgery.

Abstract

uring abdominal aortic surgery, dynamic changes occur in the circulation of the pelvic area, but until now there was no method of evaluating them. Recently, near-infrared spectroscopy (NIRS) 1 has been used to evaluate muscle deoxygenation 2,3 and various vascular diseases, 4-7 including intermittent claudication accompanying arteriosclerosis obliterans. [8][9][10][11] In this study we examined how NIRS of the buttocks might reflect changes in the arterial flow of the pelvic area during aortic surgery, and tried to evaluate the circulatory changes caused by abdominal aortic clamping and reperfusion of individual distal arteries. MethodsWe studied 22 patients who underwent aneurysmectomy and prosthetic graft replacement for abdominal aortic aneurysm (AAA). The patients comprised 21 men and 1 woman, aged 73±6 years. Twenty-one of the patients underwent bifurcated graft replacement, and 1 underwent a straight graft replacement. The patients who received bifurcated grafts were divided into groups A and B. Group A comprised 17 patients who underwent reconstruction of the bilateral common iliac artery and ligation of the inferior mesenteric artery (IMA) in the usual manner. Patients who first underwent reconstruction of the left common iliac artery were classified as group A•I (6 cases) and those who first underwent reconstruction of the right common iliac artery were classified as group A•II (11 cases). Group B comprised 4 patients who underwent other patterns of arterial reconstruction for extended iliac aneurysms. The NIRS probe was mounted on the center of the left buttock (approximately 5 cm cranial to the center of the large gluteal muscle) during the AAA repair operation. Measurements were taken using a NIRS oxygen electrode monitor (OMRON HEO-200). Changes in oxy-and deoxy-hemoglobin (Hb) concentration after clamping of the abdominal aorta were measured. We focused mainly on changes in oxy-Hb. Oxy-and deoxy-Hb concentrations changed proportionately in all cases. The recovery time (RT) was defined as the interval from aortic declamping (or declamping of the main artery feeding the left buttock) to the point where the oxy-and deoxy-Hb curves crossed over. The mean changes in Hb values and RTs were expressed as the mean ± SD. ResultsDistinct types of circulatory changes in the gluteal muscles were detected by NIRS. In all cases the Hb values reflected decreased arterial flow because of aortic clamping During abdominal aortic surgery, dynamic changes occur in the pelvic circulation. Near-infrared spectroscopy (NIRS) was used in this study to evaluate arterial flow in the buttocks as a monitor of arterial flow in the pelvic area during abdominal aortic surgery. Twenty-two patients who underwent abdominal aortic aneurysmectomy comprised the study group. The NIRS probe was mounted on the left buttock during surgery, and the changes in oxy-and deoxy-hemoglobin (

A Novel Hypoxia Imaging Endoscopy System

“…Visible light spectroscopy (VLS) appears to be similar to NIRS on some counts [81] with its mean VLS StO2 shown to be not significantly different from NIRS StO2 reported in human studies [67][68][69][70][71][72][73][74][75][76]. Again, the fractional contribution of venous blood to the cerebral NIRS signal has been reported to be 0.84 ± 0.21 ranging from 0.60 to 1.00 [82][83][84].…”

“…In the search for noninvasive, continuous modalities for monitoring ischemia, electrical bioimpedance cardiac output monitoring has been proposed but shown to be incompatible with the thermodilution methods [65,66]. Again, while near-infrared spectroscopy (NIRS) [67] is shown to respond to both hypoxemia [68,69] and ischemia [70][71][72], its clinical use has been limited to large organs, such as the brain [73,74,[85][86][87] with its broad normal ranges reported to be between 48% and 88% [75,76]. Similarly, wide normal ranges are reported for sublingual capnography [77][78][79].…”

Near infrared spectroscopy monitoring during pediatric aortic coarctation repair

“…Rigg et al (10) demonstrated changes in regional cerebral oxygenation associated with retrograde cerebral perfusion on cardiopulmonary bypass. Others have shown that changes in rSO 2 track changes in perfusion of the liver, calf muscles during aerobic exercise, gluteal muscle and visceral perfusion during abdominal aortic surgery (11–13). Hoffman et al (9) have suggested that the two‐site rSO 2 monitoring in pediatric patients undergoing the Norwood procedure may provide important trend information about two differentially controlled vascular beds.…”

“…Rigg et al (10) demonstrated changes in regional cerebral oxygenation associated with retrograde cerebral perfusion on cardiopulmonary bypass. Others have shown that changes in rSO 2 track changes in perfusion of the liver, calf muscles during aerobic exercise, gluteal muscle and visceral perfusion during abdominal aortic surgery (11)(12)(13).…”

Pain description in patients with isolated proximal (without distal) exercise-related lower limb arterial ischemia

“…Thallium scintigraphy has been shown to be accurate in detecting exercise-related ischemia in the lower limb, but it is expensive, technically demanding and thus cannot be used as a routine investigation. The recent development of near infrared spectroscopy (NIRS) is promising and seems to be efficient in detecting ischemia at both the buttock 17,25 and ankle level. 26 Nevertheless, its validation against 'gold-standard' arteriography in large groups has not yet been performed.…”