Abstract
Failure of vascular anastomoses is a devastating complication in free jejunum transplantation. In our study, we used color Doppler sonography to estimate blood flow in free jejunal graft in 21 patients who underwent radical pharyngoesophagectomy. Fast Fourier transform analysis of blood flow, pulsatility index (PI) as a measure of peripheral vascular resistance, and thickening of graft wall were evaluated for their predictive value. Arterial wave forms were classified into three types based on systolic-diastolic differences and magnitude of flow. Type I was physiologic flow, type III overtly pathologic, and type II was the intermediate between the other two types. Three patients who required vascular reanastomoses intraoperatively had a type II pattern that degenerated to type III within 15 minutes, and the PI increased from 3.5 to 4.5 over 1 hour. In the first patient who required retransplantation, the wave form became type III after 18 hours, and disappeared by 24 hours, at which point the PI was unmeasurable. Jejunal thickening increased from 1.0 mm to 5.0 mm after 24 hours, even in healthy grafts. Monitoring blood flow during the first 24 hours after surgery is critical, where a type III wave form or a PI greater than 2.5 is an indication for re-exploration. Doppler sonography offers a noninvasive way to measure blood flow in jejunal grafts, semiquantitatively, and can predict jejunal graft failure.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call