[Ischemic damage of the distal digestive tract after angioplastic surgery of the infrarenal aorta for aneurysm or aorto-ilio-femoral obstruction (Leriche's syndrome)]

Abstract

Ischemic damage to the distal part of the digestive tract is rare after elective surgery for aorto-ilio-femoral aneurysm or Leriche's syndrome, but is frequent after resection of a ruptured aneurysm in older patients, who are operated on in a state of hypovolemic shock. During the past 20 years, we observed 25 ischemic manifestations of the distal digestive tract from a total of 916 surgical patients. Of these patients, 180 had an aneurysm which was ruptured in 73 cases, and 736 underwent surgery for an aorto-ilio-femoral stenosis or obstruction. Transient ischemia, which affects in a majority of cases the left colon, usually heals without leaving any sequellae. Irreversible damage which progresses to gangrenous necrosis of all or part of the colon holds an important share of the postoperative death rate. To avoid these accidents, it is important to reestablish in a correct manner all vascular axes, to avoid states of hypovolemic shock which, through a "small output syndrome", result in vascular thromboses, and finally to monitor aneurysmal patients in intensive care units so as to rapidly detect and treat ischemic complications to the digestive tract.