Postoperative splanchnic perfusion following the reconstruction of thoracoabdominal aortic aneurysm involving abdominal visceral branches - Report ofa case

A 58-year-old man with thoracoabdominal aortic aneurysm involving visceral arteries underwent graft replacement of the thoracoabdominal aorta and asso ciated reconstruction of abdominal visceral branches. Femorofemoral extraco rporeal bypass, intermittent selective visceral arterial perfusion and a st aging cross-clamping method of the aorta were utilized at surgery. The tota l cross-clamping time of the aorta was 165 minutes. The patient's postopera tive course was uneventful with no incidence of hepatic and renal failure o r paraplegia. Although postoperative systemic blood pressure and cardiac ou tput recovered to normal values within 7 hrs after the release of aortic cl amping, it took 18 hrs for hepatic venous hemoglobin oxygen saturation (Shv O(2)) to recover. Base excess in arterial blood, lactic acid in arterial an d hepatic venous blood, and ketone body ratio in arterial blood (AKBR) and hepatic venous blood (HVKBR) recovered to within, normal ranges after 18 hr s of the release of aortic clamping. ShvO(2) monitoring is a simple and may be a useful parameter in evaluating postoperative splanchnic perfusion and predicting abdominal organ failure at the time of thoracoabdominal aortic reconstruction involving visceral arteries.