Surgical Complications after Open Abdominal Aortic Aneurysm Repair: Intestinal Ischemia, Buttock Claudication and Sexual Dysfunction

Abstract

While surgical treatment for abdominal aortic aneurysm (AAA) is a standard operation, prevention of complication is important. Intestinal ischemia of the sigmoid colon and/or rectum after AAA surgery is severe and has a high mortality rate although occurrence frequency is low. The most important thing to prevent is the preoperative and intraoperative evaluation of the left hemicolon and rectal circulation. Measurement of inferior mesenteric artery stump pressure is also useful. From the viewpoint of prevention of buttock claudication, it is desirable that internal iliac artery (IIA) blood flow is preserved, but aggressive IIA reconstruction adaptation is considered to be low. For erectile function, it is important that the antegrade blood flow from the IIA to the internal pudendal artery on at least one side is preserved or reconstructed. To prevent retrograde ejaculation, it is important to preserve the superior hypogastric plexus and one side of the lumbar splanchnic nerve, and the hypogastric nerve. Understanding and mastering local anatomy and pathophysiology is important in preventing complications, and we must also remember that we always keep watchful surgical operations in mind in order to prevent tissue damage. (This is a translation of Jpn J Vasc Surg 2019; 28: 99-103.).

Keywords: abdominal aortic aneurysm; buttock claudication; intestinal ischemia; sexual dysfunction.

Fig. 1 Occlusion of the orifice of the inferior mesenteric artery in a patient with infrarenal abdominal aortic aneurysm (arrow). Three-dimensional reconstruction of a computed tomographic angiogram shows the meandering mesenteric artery which provides collateral circulation between the superior and inferior mesenteric arteries (arrow heads).

Fig. 2 Reimplantation of the inferior mesenteric artery into the artificial graft (arrow).

Fig. 3 Reconstruction of the internal iliac artery. The right IIA was directly anastomosed to the EIA in a side-to-end fashion (arrow).

Fig. 4 Intraoperative view of the main sympathetic pathways that supply intrapelvic organs.