Routine reimplantation of patent inferior mesenteric arteries limits colon infarction after aortic reconstruction

Abstract

Ischemic colitis resulting in colonic infarction after aortic reconstruction is a highly lethal complication. Reimplantation of all patent inferior mesenteric arteries should improve this problem but can be justified only if the procedure is effective and safe. To investigate this, 337 aortic reconstructions done between July 1982 and May 1989 were reviewed. Patent inferior mesenteric arteries had been reimplanted when possible during 151 aortic reconstructions done between April 1986 and May 1989. Before this, patent inferior mesenteric arteries were selectively ligated on the basis of intraoperative bowel inspection, colonic mesenteric Doppler signals, and inferior mesenteric arteries stump pressures during 186 aortic procedures. No patient had colonic infarction as a result of ischemia during the period in which patent inferior mesenteric arteries were reimplanted if possible. In contrast, five patients (2.7%; p less than 0.05) had colonic infarction and perforation during the period of selective inferior mesenteric arteries ligation resulting in four deaths. The operative mortality rate was less during the period of inferior mesenteric arteries reimplantation (4.0% vs 14.5%; p less than 0.05), and transfusion requirements were unchanged. Thus routine reimplantation of patent inferior mesenteric arteries limits colonic infarction and operative deaths after aortic reconstruction.