Annals of Vascular Surgery

, Volume 9, Issue 4, pp 357–360 | Cite as

Intraoperative determination of intestinal viability by pulse oximetry

  • David F. J. Tollefson
  • Dennis J. Wright
  • Daniel J. Reddy
  • Esperanza B. Kintanar
Original Articles


The utility of transserosal photoplethysmographic pulse oximetry (PO) to assess intestinal viability intraoperatively was evaluated using an experimental canine model. Comparisons of PO were made with continuous-wave Doppler ultrasound (CWDU) and fluorescein (FL) using histopathologic examination for control. Clinical examination estimates were included for reference. Four 20 cm portions of small bowel from each of four dogs were made ischemic by mesenteric ligation. Thus 320 individual 1 cm bowel segments were studied by means of PO, CWDU, FL, and control histologic grading for ischemia. Statistical analysis revealed no significant differences, with PO matching CWDU and FL in intraoperative assessment of small bowel viability. PO, which is readily available in most operating rooms, is a simpler method than CWDU or FL for assessing intestinal viability. This technique is operator independent, easy to interpret and repeat, and is well tolerated. PO is the preferred alternative for objective intraoperative assessment of intestinal viability.


Ischemia Small Bowel Fluorescein Histologic Grade Doppler Ultrasound 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Bulkley GB, Zuidema GD, Hamilton SR, et al. Intraoperative determination of small intestinal viability following ischemic injury. A prospective, controlled trial of two adjuvant methods (Doppler and fluorescein) compared with standard clinical judgement. Ann Surg 1981;193:628–637.PubMedGoogle Scholar
  2. 2.
    Cooperman M, Pace WG, Martin EW, et al. Determination of viability of ischemic intestine by Doppler ultrasound. Surgery 1978;83:705–710.PubMedGoogle Scholar
  3. 3.
    Wright CB, Hobson RW. Prediction of intestinal viability using Doppler ultrasound techniques. Am J Surg 1975;129:642–645.CrossRefPubMedGoogle Scholar
  4. 4.
    Hobson RW II, Wright CB, Rich NM, et al. Assessment of colonic ischemia during aortic surgery by Doppler ultrasound. J Surg Res 1976;20:231–235.CrossRefPubMedGoogle Scholar
  5. 5.
    Lee BY, Trainor FS, Kavner D, et al. Intraoperative assessment of intestinal viability with Doppler ultrasound. Surg Gynecol Obstet 1979;149:671–675.PubMedGoogle Scholar
  6. 6.
    Guide for the Care and Use of Laboratory Animals. U.S. Department of Health and Human Services, Public Health Service Publication No. 85-23, 1985.Google Scholar
  7. 7.
    Chiu CJ, McArdle AH, Brown R, et al. Intestinal mucosal lesion in low-flow states. Arch Surg 1970;101:478–483.PubMedGoogle Scholar
  8. 8.
    Moossa AR, Skinner DB, Stark V, et al. Assessment of bowel viability using 99m technetium tagged albumin microspheres. J Surg Res 1974;16:466–472.CrossRefPubMedGoogle Scholar
  9. 9.
    Katz S, Wahab A, Murray W, et al. New parameters of viability in ischemic bowel disease. Am J Surg 1974;127:136–141.CrossRefPubMedGoogle Scholar
  10. 10.
    Laufman H, Method H. The role of vascular spasm in recovery of strangulated intestine. Surg Gynecol Obstet 1947;85: 675–686.Google Scholar
  11. 11.
    Bussemaker JB, Lindeman J. Comparison of methods to determine viability of small intestine. Ann Surg 1972;176:97–101.PubMedGoogle Scholar
  12. 12.
    Schamaun M. Electromyography to determine viability of injured small bowel segments: An experimental study with preliminary clinical observations. Surgery 1967;62:899–909.PubMedGoogle Scholar
  13. 13.
    Zarins CK, Skinner DB, Rhodes BA, et al. Prediction of the viability of revascularized intestine with radioactive microspheres. Surg Gynecol Obstet 1974;138:576–580.PubMedGoogle Scholar
  14. 14.
    Whitehill TA, Pearce WH, Rosales C, et al. Detection thresholds of nonocclusive intestinal hypoperfusion by Doppler ultrasound, photoplethysmography, and fluorescein. J Vasc Surg 1988;8:28–32.CrossRefPubMedGoogle Scholar
  15. 15.
    Pearce WH, Jones DN, Warren GH, et al. The use of infrared photoplethysmography in identifying early intestinal ischemia. Arch Surg 1987;122:308–310.PubMedGoogle Scholar
  16. 16.
    LaPiana FG, Penner R. Anaphylactoid reaction of intravenously administered fluorescein. Arch Ophthalmol 1968;79: 161–162.PubMedGoogle Scholar
  17. 17.
    Folkow B, Neil E. Gastrointestinal and liver circulations. In Folkow B, Neil E, eds. Circulation. New York: Oxford University Press, 1971.Google Scholar
  18. 18.
    Tremper KK, Barker SJ. Pulse oximetry. Anesthesiology 1989; 70:98–108.PubMedGoogle Scholar
  19. 19.
    Ouriel K, Fiore WM, Geary JE. Detection of occult colonic ischemia during aortic procedures: Use of an intraoperative photoplethysmographic technique. J Vasc Surg 1988;7:5–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Graham B, Paulus DA, Caffee HH. Pulse oximetry for vascular monitoring in upper extremity replantation surgery. J Hand Surg (Am) 1986;11A:687–692.Google Scholar

Copyright information

© Annals of Vascular Surgery Inc. 1995

Authors and Affiliations

  • David F. J. Tollefson
    • 1
  • Dennis J. Wright
    • 2
  • Daniel J. Reddy
    • 4
  • Esperanza B. Kintanar
    • 3
  1. 1.Vascular Surgery ServiceMadigan Army Medical CenterTacoma
  2. 2.Department of Vascular SurgeryAkron General HospitalAkron
  3. 3.Department of PathologyHarper HospitalDetroit
  4. 4.Division of Vascular SurgeryHenry Ford HospitalDetroit

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