Key features of circulation restoration in the inferior mesenteric artery basin after open abdominal aortic and iliac reconstructions

Roman O. Nagibovich, Gennady G. Khubulava, Andrey B. Sazonov, Kirill V. Kitachov, Konstantin Y. Petrov, Alfia M. Gairkhanova, Ruslan A. Ahadov

Medical Military Academy St.Petersburg, St.Petersburg, Russia

Date, time and location: 2018.05.26 13:30, Exhibition area, 1st Floor. Zone – B

Abstract

Objective: Colon ischemia is a devastating complication following aorto-iliac surgery. Severity varies from mucosal to transmural ischemia with a mortality rate that reaches to 100%. The objective of this study was to explore key hemodynamic features of restoration in the inferior mesenteric artery (IMA) basin circulation after open aortoiliac repair.

Methods: Between January 2017 through December 2017, 27 patients with atherosclerotic aneurysmal or occlusive diseases of the abdominal aorta and iliac arteries have been undergoing aortic reconstructions with aorto-bifemoral or iliac bypass. All patients were categorized into two groups. First (n=14), with abdominal aortic aneurysm. Second (n=13), with Leriche syndrome. Intraoperative follow-up consisted of intestinal and colon infrared thermography, ultrasound and manual examination of the main truncus of the IMA.

Results: During the study period 12 (44.4%) patients were presented with abdominal aortic aneurism and 15 (53.6%) with Leriche syndrome. Median age was 64,1 years (range, 42-81 years). There were only three (11,1%) cases of the ischemic colitis in the course of the study and no patients required laparotomy. Five patients (18,5%) underwent the main truncus of the IMA reconstructions after aorto-bifemoral or iliac bypass. We have described hemodynamic variants of the intestinal and colon ischemia and presented intraoperative mesenterial ischemia estimation algorithm.

Conclusions: The combination of three simple methods (infrared thermography, ultrasound and manual examination) may help to understand hemodynamic features in the IMA basin under ischemic conditions. This aproach allow to make the right decision about circulation restoration in the IMA basin.