Serum creatine kinase (CK) and creatine kinase isoenzyme MB (CK-B) were measured and electrocardiogram (ECG) recorded preoperatively and 24, 48 and 72 hours and 7 days after abdominal aortic bypass grafting in ten patients. No ECG abnormality indicating acute myocardial infarction (AMI) appeared and no patient had chest pain. CK-B was below the discrimination value for AMI in all cases preoperatively, but increased significantly after the operation to a maximal median value of 15 (range 5-32) U/l at 48 hours. The time-activity curve of CK paralleled that of CK-B, reaching a maximal median value of 814 (range 289-1972) U/l at 48 hours. On day 7 CK and CK-B had normalized. The CK-B activity relative to CK activity remained below 6% in all patients. Elevated serum CK-B activity should be utilized with caution for the diagnosis of perioperative AMI in patients undergoing aortic bypass grafting.

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Severe hypophosphatemia following elective abdominal aortic bypass grafting.

Serum phosphate levels and urinary phosphate excretion were investigated in ten patients undergoing elective abdominal aortic bypass grafting. The abdominal aorta was cross-clamped peroperatively for 50-95 min. The median serum phosphate was within reference range (0.80-1.55 mmol/l) during cross-clamping and for the first 24 hours after revascularization of the lower limbs. At 48 hours there was statistically significant fall in the serum phosphate level in all patients, with median reaching a nadir of 0.49 mmol/l. At 72 hours this level had risen to 0.69 mmol/l, and reference range had been regained 7 days postoperatively. The median urinary phosphate excretion (mmol) was 38.4 during the first 24 postoperative hours, and 34.7 and 10.0 on the 2 subsequent days. The median ratio of urinary phosphate to creatinine clearance was, respectively, 0.47, 0.37, 0.09 and 0.08 on postoperative days 1, 2, 3 and 7. The study indicated that patients undergoing aortic bypass grafting with protracted regional muscular ischemia may constitute a risk group with respect to development of severe postoperative hypophosphatemia.

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