Intraoperative colon mucosal oxygen saturation during aortic surgery

Area of Science:

• Vascular Surgery
• Gastroenterology
• Critical Care Medicine

Background:

• Colonic ischemia is a severe complication following aortic reconstruction, associated with high mortality.
• Early detection of colon ischemia is crucial for preventing adverse outcomes.

Purpose of the Study:

• To evaluate the correlation between Colon Mucosal Oxygen Saturation (CMOS) and the incidence of colon ischemia during aortic reconstruction surgery.
• To assess the utility of CMOS as a real-time monitoring tool for intraoperative colon perfusion.

Main Methods:

• A prospective study involving 25 patients undergoing aortic reconstruction (20 EVAR, 5 open repair).
• Continuous CMOS, buccal mucosal oxygen saturation, and hemodynamic parameters were monitored intraoperatively.
• A spectrophotometer probe was inserted rectally to measure CMOS.

Main Results:

• CMOS significantly decreased during aortic clamping/occlusion in both EVAR and open repair groups (P < 0.0001).
• CMOS returned to baseline levels upon restoration of aortic circulation (P = 0.81) with a mean recovery time of 6.4 minutes.
• Buccal mucosal oxygen saturation remained stable, unlike CMOS, during aortic manipulation.

Conclusions:

• Intra-operative CMOS is a sensitive indicator of colon ischemia during aortic surgery.
• Persistently low CMOS values suggest potential colon ischemia, prompting timely intervention.
• Monitoring CMOS offers a window for revascularization of mesenteric arteries to prevent colon infarction.