Assessment of pelvic hemodynamics during an open repair of an infrarenal abdominal aortic aneurysm

Abstract

To assess the pelvic circulation during abdominal aortic aneurysm (AAA) repair by measuring the inferior mesenteric artery stump pressure (IMA-SP), penile blood flow, and gluteal blood flow. Twenty males were selected for this study. An aorto-bi-common iliac arteries (CIA) graft replacement was performed in ten patients (Group Bi-CIA). An aorto-right-CIA/left-external iliac artery (EIA) graft replacement was performed in five (Group Lt-EIA). The other five underwent an aorto-right-EIA/left-CIA anastomosis (Group Rt-EIA). The right graft limb was anastomosed first, followed by the left limb in all of the patients. Pelvic circulation was monitored during aortic reconstruction, including the IMA-SP index (IMA-SPI), penile brachial pressure index (PBI) by pulse-volume plethysmography, and gluteal tissue oxygenation metabolism with near-infrared spectroscopy by monitoring the gluteal tissue oxygenation index (TOI) bilaterally. The PBI and bilateral gluteal TOI became depressed in all patients during proximal aortic clamping. However, there was no significant change in IMA-SPI in each group. The PBI and bilateral gluteal TOI in all groups recovered to the baseline values after completion of bilateral graft limb anastomosis. IMA-SPI is likely to reflect collateral circulation mainly from the superior mesenteric artery. The penile blood flow and bilateral gluteal blood flow therefore seem to be supplied via the bilateral hypogastric arteries or the profunda femoris arteries.