Abstract
The extent of periaortic collateral vascularisation has been proposed as a possible mechanism of an altered haemodynamic response to infra-renal aortic cross-clamp in patients undergoing by-pass grafting for aorto-iliac occlusive disease (AOD) compared with patients undergoing abdominal aortic aneurysm (AAA) resection. The haemodynamic responses following clamping, during the clamp time and following clamp release were studied in 18 patients undergoing AAA resection and 12 patients undergoing bypass grafting for AOD. The role of preoperative aortography in predicting cardiovascular performance during aortic vascular surgery was assessed. During the cross-clamp period LVSWI and CI decreased while SVR increased in the AAA group while the AOD group showed an improved CI, stable LVSWI and reduced SVR, which correlated with the extent of periaortic vascularisation on preoperative aortography. Chronic collateral circulation associated with AOD may permit continuous lower extremity perfusion during aortic cross-clamp. The extent of periaortic collateralisation may influence the choice of monitoring techniques and anaesthetic management.
Résumé
Ľimportance de la vascularisation collatérale périaortique a été proposée comme étant un mécanisme pouvant altérer les réponses hémodynamiques au clampage aortique infra-rénal chez les patients devant subir une greffe aorto-iliaque comparativement aux patients devant subir une résection de ľanévrisme de ľaorte abdominale. Les réponses hémodynamiques après clampage, durant le clampage ainsi qu’après déclampage ont été étudiées chez 18 patients subissant une résection ďanévrisme de ľaorte abdominale et 12 patients subissant un pontage aorto-iliaque. Le rôle de ľaortographie préopératoire dans la prédiction de la performance cardiovasculaire durant la chirurgie fut évalué. Lors du clampage aortique, le travail ďéjection indexé du ventricule gauche ainsi que ľindex cardiaque ont diminué alors que la résistance vasculaire systémique a augmenté chez les patients ayant subi une résection de ľanévrisme de ľaorte abdominale. Les patients ayant subi une greffe aorto-iliaque pour maladie athérosclérotique obstructive ont démontré une amélioration de ľindex cardiaque, un travail ďéjection indexé du ventricule gauche stable et une diminution de la résistance vasculaire systémique qui était reliée à ľimportance de la vascularisation péri-aortique telle que démontrée par ľaortographie préopératoire. Ľétablissement ďune circulation collatérale chronique en présence de maladie athérosclérotique obstructive de ľaorte peut permettre une perfusion continue des extrémités lors du clampage aortique. Ľétendue de la collatéralisation péri-aortique peut influencer le choix des techniques de surveillance ainsi que la conduite anesthésique.
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Cunningham, A.J., O’Toole, D.P., McDonald, N. et al. The influence of collateral vascularisation on haemodynamic performance during abdominal aortic surgery. Can J Anaesth 36, 44–50 (1989). https://doi.org/10.1007/BF03010886
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DOI: https://doi.org/10.1007/BF03010886