Related Experiment Videos
Revascularization of internal iliac arteries during aortoiliac surgery: a multicenter study
P Pittaluga1, M Batt, R Hassen-Khodja
1Service de Chirurgie Vasculaire, Hôpital Saint Roch, Nice, France.
Insights
Internal iliac artery revascularization did not significantly impact outcomes like colonic ischemia or gluteal claudication in aortoiliac surgery. Mesenteric artery revascularization also showed no significant effect on colonic ischemia incidence.
Area of Science:
- Vascular Surgery
- Surgical Outcomes
- Aortoiliac Interventions
Background:
- Elective aortoiliac surgery is performed for abdominal aortic aneurysms and occlusive lesions.
- Internal iliac artery (IIA) and inferior mesenteric artery (IMA) revascularization are sometimes performed during these procedures.
Purpose of the Study:
- To evaluate the impact of IIA revascularization on postoperative colonic ischemia and gluteal claudication.
- To assess the effect of IMA revascularization on postoperative colonic ischemia.
Main Methods:
- A retrospective analysis of 1785 patients undergoing elective aortoiliac surgery across 35 French centers in 1995.
- Data collected included type of surgery (aneurysm vs. occlusive disease), IIA and IMA revascularization rates, and incidence of postoperative colonic ischemia and gluteal claudication.
Main Results:
- IIA revascularization was performed in 11.2% of patients; IMA revascularization in 9%.
- Postoperative colonic ischemia occurred in 1.2% and gluteal claudication in 1.7% of patients.
- IIA revascularization did not significantly alter the rates of colonic ischemia or gluteal claudication for either aneurysm or occlusive disease.
- IMA revascularization also showed no significant effect on the incidence of postoperative colonic ischemia.
Conclusions:
- Routine IIA revascularization does not appear to significantly influence the risk of postoperative colonic ischemia or gluteal claudication in elective aortoiliac surgery.
- Revascularization of the IMA does not significantly impact postoperative colonic ischemia rates.
Abstract:
In 1995, a total of 1785 patients underwent elective aortoiliac surgery at 35 centers in France, including 1024 for abdominal aortic aneurysm (57.4%) and 761 for occlusive aortoiliac lesions (42.6%). Direct revascularization of the internal iliac artery was performed in 11.2% of patients with both distal anastomoses located below the iliac bifurcations (18.4% with aneurysm vs. 6.8% with occlusive lesions, p < 0.001). Associated revascularization of the inferior mesenteric artery was performed in 9% of patients (11.5% with aneurysms vs. 5.5% with occlusive lesions, p < 0.001). Postoperative colonic ischemia was observed in 21 patients (1.2%) (1.2% with aneurysms vs. 1.2% with occlusive lesions) and claudication in the gluteal region was observed in 31 patients (1.7%) (1.5% with aneurysms vs. 2.1% with occlusive lesions). Revascularization of the internal iliac artery, regardless of the technique, had no significant effect on the incidence of postoperative colonic ischemia and claudication in the gluteal region-neither after surgery for aneurysm (0.6% vs. 2.1% and 1.2% vs. 1.9%, respectively) nor after surgery for occlusive lesions (0.9% vs. 0.4% and 1.5% vs. 2.6%, respectively). Whether performed routinely or not, revascularization of the mesenteric artery has no significant effect on the incidence of postoperative colonic ischemia (1.1% vs. 1.3%).