[Ischemic colitis after vascular surgery reconstruction of an abdominal aortic aneurysm]

Abstract

Between 1978 and 1994, a total of 678 patients were operated on for infrarenal (abdominal) aortic aneurysm at the Department of Surgery of Lübeck Medical University. Rupture had occurred in 165 patients, 351 were treated electively, and 162 presented with severe symptoms but no rupture. Only CT, angiography and intraoperative judgement were used for diagnosis. Reconstruction of the inferior mesenteric artery (IMA) was performed only in exceptional cases. Severe ischemic colitis occurred in 1.03% (in no case following elective surgery, in 0.66% of patients presenting with symptoms, and in 3.6% of patients in whom rupture had occurred prior to the operation). Three patients presented with mild ischemia, two with grade B ischemic colitis and three with transmural infarction. One patient had to be operated on for ischemic colitis despite open reconstruction of the IMA. We conclude from our data that there is no need to reconstruct the IMA as a routine procedure; this topic has been a controversial issue in the literature. We do reimplant a patent IMA when there is only oozing from the IMA and/or a borderline perfusion of the sigma following the operation, with at least one open internal iliac artery. When rupture had occurred, reconstruction should be performed if there is the slightest suspicion because of the increased risk, but only if the patient's cardiopulmonary condition allows this to be done. Analysis of our patients with ischemic colitis demonstrates the importance of maintaining stable circulatory conditions to prevent intestinal ischemia. Further diagnostic procedures (Doppler ultrasound, measuring of oxygen saturation or pH) may identify more patients at risk, but at the moment we do not consider these to be routine procedures.