Intraoperative Colon Mucosal Oxygen Saturation During Aortic Surgery

Background: Colonic ischemia after aortic reconstruction is a devastating complication with high mortality rates. This study evaluates whether Colon Mucosal Oxygen Saturation (CMOS) correlates with colon ischemia during aortic surgery. Materials and methods: Aortic reconstruction was performed in 25 patients, using a spectrophotometer probe that was inserted in each patient's rectum before the surgical procedure. Continuous CMOS, buccal mucosal oxygen saturation, systemic mean arterial pressure, heart rate, pulse oximetry, and pivotal intra-operative events were collected. Results: Endovascular aneurysm repair (EVAR) was performed in 20 and open repair in 5 patients with a mean age of 75 ± 10 (±SE) years. CMOS reliably decreased in EVAR from a baseline of 56% ± 8% to 26 ± 17% (P < 0.0001) during infrarenal aortic balloon occlusion and femoral arterial sheath placement. CMOS similarly decreased during open repair from 56% ± 9% to 15 ± 19% (P < 0.0001) when the infrarenal aorta and iliac arteries were clamped. When aortic circulation was restored in both EVAR and open surgery, CMOS returned to baseline values 56.5 ± 10% (P = 0.81). Mean recovery time in CMOS after an aortic intervention was 6.4 ± 3.3 min. Simultaneous buccal mucosal oxygen saturation was stable (82% ± 6%) during aortic manipulation but would fall significantly during active bleeding. There were no device related CMOS measurement complications. Conclusions: Intra-operative CMOS is a sensitive measure of colon ischemia where intraoperative events correlated well with changes in mucosal oxygen saturation. Transient changes demonstrate no problem. However, persistently low CMOS suggests colon ischemia, thus providing an opportunity to revascularize the inferior mesenteric artery or hypogastric arteries to prevent colon infarction.