Anterior Rectal Resection in a Patient with Aortoiliac Occlusive Disease and Coexisting Collateral Pathways:
Floryn Cherbanyk1, Jean-Loup Gassend1, Olivier Martinet1
1Department of Surgery, Riviera-Chablais Hospital, 1820 Montreux, Switzerland.
Insights
Chronic aortoiliac occlusive disease can lead to critical collateral pathways. Pre-operative mapping of these vital blood vessels is essential to prevent surgical complications and ensure patient safety.
Area of Science:
- Vascular Surgery
- Gastrointestinal Oncology
- Medical Imaging
Background:
- Chronic aortoiliac occlusive disease (CAIOD) commonly impacts iliac arteries and the aorta, potentially affecting renal arteries and the inferior mesenteric artery.
- Compensatory collateral networks develop to maintain lower body perfusion in CAIOD patients.
- Surgical intervention on these collaterals can lead to severe complications.
Purpose of the Study:
- To highlight the importance of pre-operative collateral pathway mapping in patients with CAIOD undergoing abdominal surgery.
- To present a case demonstrating successful adaptation of surgical strategy based on detailed vascular imaging.
Main Methods:
- CT angiography was utilized to visualize and map collateral circulation in a patient with CAIOD.
- Doppler ultrasound was employed to precisely locate these identified collateral pathways.
- A multidisciplinary approach integrated imaging findings into surgical planning.
Main Results:
- Pre-operative imaging successfully mapped the collateral network in a 63-year-old patient with CAIOD.
- The surgical plan for rectosigmoid adenocarcinoma resection was modified based on the collateral anatomy.
- The patient underwent successful anterior resection with an uneventful recovery, preserving vital collateral flow.
Conclusions:
- Pre-operative investigation and mapping of collateral vessels are crucial in patients with aortoiliac obliteration before surgery.
- A multidisciplinary approach is recommended to manage the complexities of CAIOD and associated surgical risks.
- Adapting surgical techniques to individual vascular anatomy improves patient outcomes in complex cases.
Abstract:
Chronic aortoiliac occlusive disease most often affects the common iliac arteries and distal aorta but can progress all the way to the renal arteries, occluding the inferior mesenteric artery. A compensatory collateral network typically develops to preserve lower body perfusion. Inadvertent compression or ligation of such collaterals during surgery can have catastrophic consequences. In this article, we present the case of a 63-year-old patient with aortoiliac occlusive disease, requiring surgery for an adenocarcinoma of the rectosigmoid junction. A CT angiography was performed in order to map out the collateral pathways that had developed and Doppler ultrasound was used to mark their positions. The surgical procedure was adapted to his specific anatomy. A successful anterior resection was performed, and the patient made an uneventful recovery. In cases of aortoiliac obliteration, the existence of collaterals must be kept in mind and investigated with a multidisciplinary approach before any surgery is considered.
