J.Jpn. Surg. Soc.. 87(9): 1109-1112, 1986

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Report on the annual meeting

ACUTE AND CHRONIC VISCERAL ISCHEMIA

Acute visceral ischemia are divided into three types, acute occlusion of visceral arteries, nonorganic occlusion of visceral vessels and acute mesenteric venous occlusion. We treated 10 cases of acute visceral ischemia, but all died during one to 5.1 days (mean 12.1) after the onset of symptoms. Acute occlusion of visceral arteries occurred in 6 cases, the embolus from the heart of auricular fibrillation in one case and the thrombus developed in the arteriosclerotic portion of visceral arteries in 5. Nonorganic occlusion were appeared in one with the gangrenous cholecystitis. Acute mesenteric venous thrombi were detected in two cases after the exploration of abdominal cavity.
Five cases with the chronic visceral ischemia were treated by various procedures, 2 cases performed aorto-SMA bypass with the autosaphenous vein, one case received aorto-coeliac bypass using the same material, 2 cases dilated visceral arteries by balloon catheter and one case resected small bowel combined vascular reconstruction. Four cases of these patients recovered without any postoperative trouble and the graft or dilated arteries are keeping patency. One patient with occluded three visceral arteries by periarteritis nodosa was performed aorto-SMA bypass and resection of small bowel about 70cm having necrotic perforation, but he died 4 days after the surgery.
Re-anastomosis of IMA to the graft were performed in 40 cases of 112 aortic operations to prevent postoperative ischemia of left colon. But 4 cases of these 40, persisted diarrhea over 3 days postoperatively. Now, I think, it is necessary to reconstruct IMA at the aortic operation, unless IMA is occluded operatively.

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