Document Detail


Limb ischemia after EVAR: an effect of the obstructing introducer?
MedLine Citation:
PMID:  19090629     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To evaluate the splanchnic and limb metabolic effects of open repair (OR) of abdominal aortic aneurysms (AAA) versus endovascular aneurysm repair (EVAR) in a pilot study utilizing microdialysis. METHODS: Nine AAA patients (8 men; mean age 74 years, range 61-85) were treated with EVAR and 9 had an OR (5 men; mean age 70 years, range 55-85). In the EVAR cases, which were performed percutaneously, the external iliac artery was obstructed by the introducer to a mean functional stenosis of 70% (52%-100%). Catheters for microdialysis were placed subcutaneously above the ankle of the right leg and freely in the abdominal cavity to measure the levels of lactate and pyruvate. The lactate/pyruvate ratio was calculated as a measure of ischemia. Measurements started at the end of surgery and continued for 2 days. Mean values were compared using the Mann-Whitney U test. RESULTS: The mean value of intraperitoneal lactate during the first day after EVAR was 1.5+/-0.7 mM versus 2.6+/-0.8 mM after OR (p = 0.019). The lactate/pyruvate ratio was 10.2+/-2.2 after EVAR and 12.3+/-2.6 after OR (p = 0.113). Leg lactate mean values were 4.2+/-2.0 mM after EVAR versus 1.8+/-0.6 mM after OR (p<0.001). The lactate/pyruvate ratio was 20.1+/-8.3 for EVAR and 13.7+/-3.3 for OR (p = 0.040). These differences between EVAR and OR continued for the second day. CONCLUSION: Intraperitoneally, metabolism was slightly increased after OR; however, it was not suggestive of splanchnic ischemia. Leg findings reflected a more extensive ischemia after EVAR over 48 hours, which was a somewhat unexpected finding that may be related to the introducer's impact on blood flow to the limb during the intervention. Although no clinical consequences were recorded, the finding suggests some benefit of minimizing as much as possible the time of reduced perfusion to the limb.
Authors:
Thomas Jonsson; Thomas Larzon; Kjell Jansson; Berndt Arfvidsson; Lars Norgren
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  15     ISSN:  1526-6028     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-18     Completed Date:  2009-03-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  695-701     Citation Subset:  IM    
Affiliation:
Department of Surgery, Orebro University Hospital, Orebro, Sweden. Thomas.Jonsson@surgsci.uu.se
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MeSH Terms
Descriptor/Qualifier:
Abdomen / blood supply
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / surgery*
Arterial Occlusive Diseases / complications,  etiology*,  metabolism
Ascitic Fluid / metabolism
Biological Markers / metabolism
Equipment Design
Female
Humans
Iliac Artery*
Ischemia / etiology*,  metabolism
Lactic Acid / metabolism
Lower Extremity / blood supply*
Male
Microdialysis
Middle Aged
Pilot Projects
Pyruvic Acid / metabolism
Splanchnic Circulation
Time Factors
Treatment Outcome
Vascular Surgical Procedures / adverse effects*,  instrumentation
Chemical
Reg. No./Substance:
0/Biological Markers; 127-17-3/Pyruvic Acid; 50-21-5/Lactic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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