Prevention and management of sigmoid and pelvic ischemia associated with aortic surgery

Area of Science:

• Vascular Surgery
• Abdominal Aortic Aneurysm Repair
• Ischemia Management

Background:

• Colonic and pelvic ischemia are significant complications following aortic reconstruction, leading to severe morbidity and mortality.
• Complications include impotence, claudication, infarction, necrosis, and neurological injury.
• Prevention of ischemia is paramount due to the often irreversible nature of the damage.

Purpose of the Study:

• To emphasize the importance of maintaining adequate colonic and pelvic blood supply after aortic reconstructive procedures.
• To outline strategies for preventing ischemia during both open and endovascular aortic repair.
• To highlight the need for vigilance in preserving pelvic perfusion.

Main Methods:

• During open repair: routine reimplantation or selective ligation of the inferior mesenteric artery based on intraoperative assessment.
• During open repair: maintaining antegrade perfusion in patent internal iliac arteries and reconstructing the deep femoral artery.
• During endovascular repair: preserving pelvic perfusion by maintaining antegrade flow to at least one patent internal iliac artery.

Main Results:

• Endovascular aneurysm repair shows a lower rate of colonic and pelvic ischemia compared to open repair.
• However, all complications seen after open repair have also been reported after endovascular repair.
• The primary principle remains prevention, as treatment of established ischemia is often ineffective.

Conclusions:

• Vascular surgeons must prioritize strategies to guarantee adequate colonic and pelvic blood supply during all aortic reconstruction procedures.
• Proactive measures during both open and endovascular repair are essential to prevent ischemic complications.
• Prevention is the key to managing pelvic ischemia associated with aortic reconstruction.