J.Jpn. Surg. Soc.. 82(10): 1268-1279, 1981

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Original article

INTESTINAL ISCHEMIA FOLLOWING AORTOILIAC RECONSTRUCTION

The pathophysiology of the intestinal ischemia following aortoiliac reconstruction was studied on the basis of clinical and experimental observations. lschemic changes in distal colon were seen in 6% of patients who had aortoiliac reconstruction for sclerotic occlusive disease and in 17.9% of those having graft replacement for abdominal aortic aneurysm. Colon ischemia occurred more frequently in patients whose preoperative arteriogram showed occlusive lesions in at least two of the both hypogastric and inferior mesenteric arteries, and in those who had an aortofemoral bypass bilaterally with prosthetic grafts.
A series of experiments was performed in dogs whose inferior mesenteric and the lowermost lumbar arteries were divided and the terminal abdominal aorta was ligated. These arterial ligations lowered the submucosal blood flow in the distal colon by 59%, and resulted in transient ischemic colitis. The dogs were anesthetized again three months later, and underwent a bovine graft bypass at the site of ligation of the abdominal aorta. The release of a clamp on the graft caused a decrease in submucosal blood flow in the distal colon by 45% in contrast to a decrease in flow through the superior mesenteric artery by only 9%.
These results indicate that the hemodynamic alterations in the colonic marginal artery and in the occlusive iliac arteries may play an important role in the development of the colonic ischemia following aortoiliac reconstruction.

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