The role of intravenous fluorescein in the detection of colon ischemia during aortic reconstruction

R. Thomas Bergman, Peter Gloviczki, Timothy J. Welch, James M Naessens, Thomas C. Bower, John W. Hallett, Peter C. Pairolero, Kenneth J. Cherry

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Intravenous fluorescein is an accurate predictor of small bowel viability, but its effectiveness in assessing colon perfusion during aortic surgery has not been evaluated. Over a 10 year period 186 of 3,306 patients undergoing aortic reconstruction received 500 to 1000 mg of intravenous fluorescein intraoperatively to evaluate colon viability. Prior history of colectomy, hypogastric or mesenteric arterial occlusive disease, or ruptured aneurysm placed these patients at risk to develop ischemic colitis. Patients were operated on for aneurysmal disease (n=94), occlusive disease (n= 66), or a combination of both (n=26): 171 exhibited uniform normal perfusion patterns under Wood's lamp illumination, while in 11 it was "patchy." None of these patients developed full-thickness ischemic colitis (observed specificity: 100%). Fluorescence of the rectosigmoid was absent in four patients. One of these patients with a ruptured aneurysm underwent immediate sigmoid resection, while three underwent inferior mesenteric artery reimplantation. The fluorescein pattern subsequently normalized in two patients, but one underwent sigmoid resection for an expanding mesenteric hematoma. The second patient recovered without complications. The final patient continued to show a segmental sigmoid defect and postoperatively developed full-thickness injury requiring sigmoidectomy. During the same period 18 other patients developed transmural colon ischemia from 3,120 aortic reconstructions (0.6%), with a mortality rate of 56%. None had received intraoperative fluorescein. Selective use of intravenous fluorescein may reduce the mortality of ischemic colitis following aortic reconstruction.

Original languageEnglish (US)
Pages (from-to)74-79
Number of pages6
JournalAnnals of Vascular Surgery
Volume6
Issue number1
DOIs
StatePublished - Jan 1992

Fingerprint

Fluorescein
Colon
Ischemia
Ischemic Colitis
Sigmoid Colon
Ruptured Aneurysm
Perfusion
Inferior Mesenteric Artery
Arterial Occlusive Diseases
Mortality
Colectomy
Replantation
Lighting
Hematoma
Fluorescence
Wounds and Injuries

Keywords

  • aortic reconstruction
  • fluorescein
  • Intestinal ischemia
  • intravenous fluorescein
  • ischemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bergman, R. T., Gloviczki, P., Welch, T. J., Naessens, J. M., Bower, T. C., Hallett, J. W., ... Cherry, K. J. (1992). The role of intravenous fluorescein in the detection of colon ischemia during aortic reconstruction. Annals of Vascular Surgery, 6(1), 74-79. https://doi.org/10.1007/BF02000672

The role of intravenous fluorescein in the detection of colon ischemia during aortic reconstruction. / Bergman, R. Thomas; Gloviczki, Peter; Welch, Timothy J.; Naessens, James M; Bower, Thomas C.; Hallett, John W.; Pairolero, Peter C.; Cherry, Kenneth J.

In: Annals of Vascular Surgery, Vol. 6, No. 1, 01.1992, p. 74-79.

Research output: Contribution to journalArticle

Bergman, RT, Gloviczki, P, Welch, TJ, Naessens, JM, Bower, TC, Hallett, JW, Pairolero, PC & Cherry, KJ 1992, 'The role of intravenous fluorescein in the detection of colon ischemia during aortic reconstruction', Annals of Vascular Surgery, vol. 6, no. 1, pp. 74-79. https://doi.org/10.1007/BF02000672
Bergman, R. Thomas ; Gloviczki, Peter ; Welch, Timothy J. ; Naessens, James M ; Bower, Thomas C. ; Hallett, John W. ; Pairolero, Peter C. ; Cherry, Kenneth J. / The role of intravenous fluorescein in the detection of colon ischemia during aortic reconstruction. In: Annals of Vascular Surgery. 1992 ; Vol. 6, No. 1. pp. 74-79.
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