[Prevention of intestinal ischemia after abdominal aortic reconstructive 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.