Utility and application of pulmonary artery catheterization in aortic and aortoiliac disease

To determine how useful pulmonary artery catheterization is in abdominal aortic surgery and which patients are most likely to benefit from the procedure, the author studied 28 patients with aneurysms and 22 with obstructive disease. Patients with multiple risk factors, except those with leaking aneurysms, were assessed before operation by pulmonary artery catheterization and volume loading (15 ml of 5% albumin/kg over 12 hours). All patients who underwent operation were assessed and monitored by pulmonary artery catheterization, beginning immediately postoperatively. In 26 patients the procedure made a substantial contribution to assessment or care of their condition, not suggested by the usual clinical and technical modalities. In four patients the proposed surgery was affected; it was cancelled in one, delayed in two and replaced by a lesser procedure in one. Two other patients, thought to have unacceptable cardiac function, were considered suitable for operation after catheterization was done. Eleven patients with suboptimal cardiac index and 2 with volume overload were recognized early after surgery. Two patients with oliguria following repair of a ruptured aneurysm had optimal cardiac indices and renal perfusion assured by pulmonary artery catheterization, which helped to identify unsuspected pulmonary hypertension in three patients, bleeding in one and intestinal infarction in one. Twenty-seven patients were challenged before surgery with 5% albumin and their response was analyzed. In 7 there was no response to the colloid challenge and they suffered much more morbidity than the 20 patients who had a positive hemodynamic response to challenge.(ABSTRACT TRUNCATED AT 250 WORDS)