Inferior Mesenteric Artery Revascularizatıon during Abdominal Aortic Surgery

Abstract

Introduction: The incidence of ischemic colitis development after elective abdominal aorta surgery is 2%. However, it may rise to 32% in ruptured aneurysm operations. Inferior mesenteric artery (IMA) revascularization reduces the incidence of ischemic colitis. Materials and Methods: Our study included 87 patients who underwent abdominal aorta aneurysm surgery. IMA revascularization was applied in 32 patients. Four techniques are used for IMA revascularization. Carrel button technique is used in seven patients; direct IMA anastomosis to the main body of aortic graft is performed in 15 patients. IMA anastomosis is performed to the left limb of aortic graft in seven patients. IMA is extended by Dacron graft in six patients and saphenous vein is used for extension only one patient. Results: Colonic mucosal ischemia was observed in two patients with IMA revascularization, whereas in five patients without IMA revascularization. The clinical picture of ischemic colitis was evident in two patients without IMA revascularization. Average gaseous and stool output time after surgery were significantly earlier in patients with IMA revascularization. The average gaseous output time is 17 h with IMA revascularization, whereas 28 h in patients without IMA revascularization after surgery (P = 0.001). The average stool output time is 38 h after surgery in IMA revascularization but 55 h patients without IMA revascularization (P = 0.001). Conclusion: IMA revascularization is a considerably effective procedure for the prevention of ischemic colitis. Despite the low incidence, ischemic colitis carries high morbidity and mortality risk. IMA revascularization should be considered in the presence of the risk of the development of ischemic colitis.

Keywords

• abdominal aorta aneurysm
• inferior mesenteric artery revascularization
• ischemic colitis