Preoperative embolization of the graft superior mesenteric artery assists graft enterectomy in intestinal transplant recipients

Background: Graft enterectomy after intestinal graft failure is challenging. We report our experience in preoperative embolization of graft superior mesenteric artery (SMA) to facilitate intestinal graft removal. Methods: A total of 22 isolated intestinal transplant recipients underwent graft enterectomy from July 1997 to February 2011 at the Miami Transplant Institute, Miller School of Medicine, University of Miami, of whom 6 patients underwent embolization of graft SMA seven times before graft enterectomy. Results: The mean (SD) estimated blood loss in patients with or without embolization was 600 (173) versus 1437 (328) mL, respectively (P=0.02). The mean operation time in patients with or without embolization was 5.2 (1.2) versus 8.7 (1.3) hr, respectively (P=0.04). The mean change between preoperative and postoperative serum creatinine in patients with or without embolization was 0.2 (0.05) versus 0.16 (0.04), respectively (P=0.12). In patients with embolization, the warm ischemia time (from embolization to removal of the graft) was 6.9 (1.1) hr (range, 6-8.5 hr). Intraoperative and postoperative (24 hr) pH values were 7.36 (0.1) and 7.34 (0.1), respectively (P=0.71); intraoperative and postoperative (24 hr) lactate levels were 1.77 (0.8) and 1.56 (0.5) mmol/L, respectively (P=0.57). Conclusions: Preoperative embolization of graft SMA is a useful alternative to assist graft enterectomy in intestinal transplant recipients without causing severe acidosis, renal impairment, and hemodynamic instability.