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Published on: November 21, 2019
[Prevention of intestinal ischemia after abdominal aortic reconstructive surgery]
Darius Abromaitis1, Aleksandras Antusevas
1Department of Vascular Surgery, Kaunas University of Medicine Hospital, Eiveniu 2, 50009 Kaunas, Lithuania. dariusabr@centras.lt
Insights
This study investigated intestinal ischemic complications after abdominal aortic surgery. Reconstructing the inferior mesenteric artery is crucial for preventing colon ischemia and improving patient outcomes.
Area of Science:
- Vascular Surgery
- Gastrointestinal Surgery
- Surgical Complications
Background:
- Intestinal ischemic complications pose a significant risk after abdominal aortic reconstructive surgery.
- Understanding risk factors and prevention strategies is vital for patient safety.
Purpose of the Study:
- To estimate the incidence of intestinal ischemic complications following abdominal aortic reconstructive surgery.
- To identify risk factors associated with these complications.
- To propose methods for preventing intestinal ischemia.
Main Methods:
- A retrospective analysis of 172 patients undergoing aortic reconstruction between 2000-2003.
- Evaluation of inferior mesenteric artery stump pressure and reconstruction strategies.
- Stratification of patients based on aortoiliac occlusive disease and abdominal aortic aneurysm (ruptured vs. non-ruptured).
Main Results:
- Overall intestinal ischemia rate was 3.5% (6/172), with a 13% mortality rate after abdominal aortic surgery.
- Colon ischemia occurred in 1.1% of aortoiliac occlusive disease cases.
- In abdominal aortic aneurysm cases, ischemia rates were 9.1% for ruptured and 4.4% for non-ruptured aneurysms, with significant mortality.
- Inferior mesenteric artery reconstruction was performed in 49 patients; however, 2 in the ruptured aneurysm group still developed ischemia.
Conclusions:
- The inferior mesenteric artery plays a critical role in maintaining left colon circulation.
- Preoperative aortography, appropriate surgical strategy, and necessary inferior mesenteric artery reimplantation are key to preventing colon ischemia.
- Early identification and management of risk factors can reduce postoperative intestinal ischemia after abdominal aortic surgery.
Unlabelled:
The aim of this study was to estimate rate of intestinal ischemic complications after abdominal aortic reconstructive surgery, to evaluate risk factors and to provide means of prevention of complication.
Material And Methods:
Study group consisted of 172 patients who underwent aortic reconstruction in 2000-2003 in the Department of Vascular Surgery of Kaunas University of Medicine Hospital. Six patients underwent intestinal ischemia in the postoperative period, i. e. 3.5%; four of them died. This indicated that 13% of patients died after abdominal aortic surgery. Ninety-four patients underwent operation for aortoiliac occlusive disease, colon ischemia occurred in 1 case (1.1%). Seventy-eight patients underwent abdominal aortic aneurysm; 33 patients -- ruptured aneurysm, and 45 -- aneurysm without rupture. In ruptured abdominal aortic aneurysm group with III degree colon ischemia there were 3 cases (9.1%); 2 of them died, which formed 11% of all deaths in this group. In the group of non-ruptured abdominal aortic aneurysm with III degree colon ischemia there were 2 cases (4.4%). Both patients died, which formed 50% of all deaths in this group. For all patients operated for abdominal aortic aneurysm, a. mesenterica inferior stump pressure was evaluated. In case of stump pressure 50 mmHg and more a. mesenterica inferior was ligated. If pressure was lower than 50 mmHg a. mesenterica inferior was reimplanted into vascular graft. Forty-nine reconstructions of a. mesenterica inferior were made in abdominal aortic aneurysm group: 25 in ruptured cases, and 24 in non-ruptured cases. Despite the fact that a. mesenterica inferior was reconstructed, 2 patients had colon ischemia after this reconstruction in the group of ruptured aneurysm. In the group of non-ruptured aneurysm, colon ischemia developed only after ligation of a. mesenterica inferior. We conclude that a. mesenterica inferior is very important for normal circulation of left colon. Correct evaluation of preoperative aortography, correct operative strategy, and reimplanted a. mesenterica inferior if it is necessary -- are the main means of colon ischemia prevention after abdominal aortic surgery.
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