Retroperitoneal Approach to Abdominal Aortic Aneurysm Repair Preserves Splanchnic Perfusion as Measured by Gastric Tonometry
| Autor: | R.J. Hannon, C.V. Soong, Muhammad A. R. Sharif, Bernard Lee, Nityanand Arya, L.L. Lau, Ian S. Young |
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| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Manometry Multiple Organ Failure Risk Assessment Blood Vessel Prosthesis Implantation Aortic aneurysm Risk Factors medicine Humans Blood Transfusion Prospective Studies Retroperitoneal Space Splanchnic Circulation cardiovascular diseases Gastric tonometry Aged Aged 80 and over Interleukin-6 business.industry Gastric Acidity Determination General Medicine Middle Aged medicine.disease Systemic Inflammatory Response Syndrome Abdominal aortic aneurysm Interleukin-10 Surgery Systemic inflammatory response syndrome Treatment Outcome Elective Surgical Procedures Gastric Mucosa Anesthesia cardiovascular system Female Splanchnic business Cardiology and Cardiovascular Medicine Perfusion Biomarkers Aortic Aneurysm Abdominal Abdominal surgery |
| Zdroj: | Arya, N, Sharif, M, Lau, L, Lee, B, Hannon, R J, Young, I & Soong, C 2010, ' Retroperitoneal Approach to Abdominal Aortic Aneurysm Repair Preserves Splanchnic Perfusion as Measured by Gastric Tonometry ' Annals of Vascular Surgery, vol 24, no. 3, pp. 321-327 . DOI: 10.1016/j.avsg.2009.06.003 |
| DOI: | 10.1016/j.avsg.2009.06.003 |
| Popis: | We investigated if minimizing bowel manipulation and mesenteric traction using the retroperitoneal approach in open abdominal aortic aneurysm (AAA) repair preserves splanchnic perfusion, as measured by gastric tonometry, and reduces the systemic inflammatory response and dysfunction of the various organs.Patients undergoing elective AAA repair were randomized into three groups. Group I had repair via the retroperitoneal approach, while groups II and III were repaired via the transperitoneal approach with the bowel packed within the peritoneal cavity or exteriorized in a bowel bag, respectively. A tonometer was used to measure gastric intramucosal pH (pHi), as an indicator of splanchnic perfusion, just prior to aortic clamping, during clamping, and at 0.5, 1, 2, 4, 6, and 12 hr after clamp release. Multiorgan dysfunction syndrome (MODS) and systemic inflammatory response syndrome (SIRS) scores were calculated and systemic interleukins (IL-6 and IL-10) measured at predetermined intervals.Thirty-four patients were successfully randomized. The gastric pHi was significantly lower in group II (n=12) and group III (n=11) compared to group I (n=11) during aortic clamping and immediately after clamp release (p0.05). The aortic clamp time, blood loss, MODS and SIRS scores, and systemic cytokine response were similar in all three groups. When the three groups were combined, there were significant positive correlations between the operation time, aortic clamp time, and amount of blood lost and transfused with plasma IL-6 levels and MODS score on the first postoperative day.The retroperitoneal approach for open AAA repair is associated with gastric tonometric evidence of better splanchnic perfusion compared to the transperitoneal approach. |
| Databáze: | OpenAIRE |
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