Detection of occult colonic ischemia during aortic procedures: use of an intraoperative photoplethysmographic technique.

Abstract

A photoplethysmographic technique was used in 30 consecutive patients who had abdominal aortic reconstruction to assess colonic viability intraoperatively. A sterile pulse oximeter probe was used to measure arterial pulsatility and transcolonic oxygen saturation (TCOS) in the proximal, midportion, and distal sigmoid colon before and after the reconstruction. No attempt at inferior mesenteric revascularization was made, irrespective of the photoplethysmographic results. The status of the colon was assessed between the third and sixth postoperative day by a colonoscopist unaware of the intraoperative data. Before the reconstructive procedure photoplethysmography displayed pulsatile flow in all patients with a mean TCOS of 95% +/- 0.4%. After reconstruction, 28 patients (93%) demonstrated unchanged pulsatility with mean TCOS of 94% +/- 0.4%. Despite ligation of a patent inferior mesenteric artery in 10 of these patients, all 28 had normal colonoscopic examinations. By contrast, two patients (6.7%) had a loss of photoplethysmographic pulsatility with unmeasurable TCOS. Both of these patients had ligation of an initially patent inferior mesenteric artery and demonstrated evidence of ischemic mucosal changes at colonoscopy. Intraoperative colonic photoplethysmography represents an easily performed, accurate method for predicting colonic viability. A loss of pulsatility suggests inadequate postreconstructive colonic perfusion and mandates revascularization of the inferior mesenteric artery.