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Abstract]
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[Members Only And Two Factor Auth.] J.Jpn. Surg. Soc.. 91(9): 1463-1465, 1990
Report on the annual meeting
PREVENTION OF ACUTE COLONIC ISCHEMIA FOLLOWING REPAIR OF ABDOMINAL AORTIC ANEURYSM
Colonic gangrene following repair of abdominal aortic aneurysm (AAA) is a fatal complication. It has been emphasized that the preservation of blood flow of the inferior mesenteric artery (IMA) and the internal iliac artery (IIA) is important to prevent postoperative ischemic colitis. But in cases which have sufficient collateral blood supply to the pelvis from the superior mesenteric artery (SMA), the IMA and the IIA should be ligated sefely. Estimating the SMA by a preoperative imaging technique and through lntraopertive monitoring using our transanal Doppler device, we have performed rational repair of AAA. Preoperatively we examined angiograms, CT scans, ultrasound images, and duplex scans in recent cases. In addition, a functional evaluation of the SMA was made by transanal Doppler examination of the collateral blood flow in the rectum after aortic clamping. According to these findings, we decided the IMA and the IIA should be preserved or ligated. As the result, all three vessels (both IIAs and IMA) were ligated safely in 14 patients among 46 AAA cases.
An adequate evaluation of the SMA is essential to prevent postoperative ischemic colitis.
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