Evaluation of buttock claudication with hypogastric artery stump pressure measurement and near infrared spectroscopy after abdominal aortic aneurysm repair.

Abstract

We explored the usefulness of intraoperative measurement of hypogastric artery (HGA) stump pressure (HGA-SP) and postoperative near infrared spectroscopy (NIRS) in evaluating buttock claudication (BC) after abdominal aortic aneurysm (AAA) repair. Retrospective clinical study. Twenty patients who were undergoing AAA repair were enrolled. The HGA was ligated bilaterally in 5 patients, unilaterally in 12, and preserved in 3. The HGA-SP was measured intraoperatively. Postoperatively, NIRS was used to evaluate buttock muscle ischemia during walking. Six patients had unilateral and 1 bilateral BC after AAA repairs. The median HGA-SP brachial pressure index (HBI) was 0.62 (range: 0.45-0.64) in 8 claudicating buttocks and 0.76 (range: 0.63-0.90) in 13 asymptomatic buttocks (p < 0.0005). The HBI was <0.65 in all claudicating buttocks, whereas it was >0.63 in asymptomatic buttocks. In all 8 claudicating buttocks, NIRS showed the ischemic pattern with recovery time lasting more than 240 s. An HBI below 0.65 may be a predictor of BC after AAA repair. NIRS appears to be a useful noninvasive method for evaluating BC after AAA.