Prostaglandin application improves macro- and microcirculation after aorto-hepato-mesenteric bypass in chronic mesenteric ischemia.

Chronic mesenterial ischemia (CMI) is an uncommon cause of abdominal afflictions. The spectrum of therapeutic options ranges from mesenteric artery angioplasty and stenting to surgical revascularization. We used orthogonal polarization spectral (OPS) imaging to assess microcirculation after revascularization of the celiac artery and the superior mesenteric artery. Furthermore, we applicated a prostaglandin I2 derivate (iloprost, Ilomedin®, BayerVital GmbH, Leverkusen, Germany) after bypass reperfusion and demonstrated the effect of this vasodilatative agent to microcirculatory parameters. Our patient was a 52-year-old woman who suffered from a complete obstruction of the celiac artery as well as high-grade stenosis of the superior mesenteric artery (SMA). Therefore, we performed an open revascularization using the greater saphenous vein of the left thigh as graft (reversed vein bypass from the supraceliac aorta sequentially to the celiac artery (termino-lateral anastomosis) and the superior mesenteric artery (termino-terminal anastomosis)). After bypass reperfusion, we administered 3 μg iloprost as bolus directly into the bypass. The agreement of the patient was obtained before the aforementioned procedure and the measurements. Immediately following laparotomy, bypass reperfusion and iloprost administration, we measured the microcirculation of stomach, pancreas, small intestine and right hemi-colon. Microhemodynamic analysis included the quantitative analysis of capillary diameter (D), functional capillary density (FCD) and red blood cell velocity (RBCV). Using these parameters, we calculated the individual capillary volumetric flow rate (capillary blood flow (CBF); in picoliter/s; pl/s) and the perfusion index (PI).