[Prevention of postoperative ischemic colitis in aorto-iliac vascular reconstruction]

In consecutive series with 1740 aorto-iliac reconstructions (1970-1989) 32 patients (1.8%) with postoperative ischemic colitis have been registered. In a retrospective follow-up (1970-1983, group I, n = 1121) the incidence of this postoperative complication (ischemic colitis grade C) reached to 0.7%. In a further prospective follow-up (group II, 1984-1989, n = 619) the operative procedure was influenced by: 1) intraoperative stump pressure in the inferior mesenteric artery, 2) by the penile brachial index (PBI), 3) pre- and postoperative rectoscopy, and 4) measurement of perfusion in branches in the inferior mesenteric artery. The frequency of ischemic colitis could not be reduced. Grade C colitis reached to 1.3%. Rectosigmoidoscopy as a routine method before and after operation caused an remarkable decrease of the time interval between operation and diagnosis of ischemic colitis in group II (from 11 days to 24/48 h). As a result the mortality rate of transmural colon necrosis (grade C) could be reduced from 50% (group I) to 13.6% (group II). The IMA stump pressure alone (limit of 40 mm Hg) doesn't help to decide if reimplantation of the IMA necessary. The stump pressure with Doppler ultrasound flow registration in the branches of the IMA gains a greater sensitivity by a "two vessel clamping" (infrarenal aorta and digital compression of the SMA) (sensitivity 100%). During the last 230 surgical interventions the incidence of ischemic colitis ranged 0.9%.