Does Reimplantation of Inferior Mesenteric Artery Have a Role in Preventing Colonic Ischemia Developing After Surgery of Abdominal Aortic Aneurysm?

Abstract

Introduction: Ischemia of sigmoid colon following surgery of abdominal aortic aneurysm is a rare and a devastating complication. Either ligation or embolisation of inferior mesenteric artery (IMA) or internal iliac artery can be accounted for this. However abundance of collateral flow to the sigmoid colon usually prevents ischemia. Materials and Methods: Seventy five patients that had surgery of infrarenal abdominal aneurysm in Gulhane Military Medical Academy and Private Medicana Hospital between years1991-2010 were followed postoperatively. Group I consists of 31 patients operated and having not IMA reimplantation between 1991 and 1999. Group II consists of 44 patients operated and reimplantated IMA between 1999 and 2010. Results: Early mortality was seen in group I as one death due to peritonitis developed following bowel perforation at 18th hours. Early mortality was not seen in group II. Late mortality was only a death due to myocardial infarction at 18th month in goup II. As a result of comparison, significant improvement in bowel sounds, bowel motility, hospitalization duration and also time to mobilization in group II. Conclusion: Whereas the ligation of chronically occluded IMA far away from aneurysm can result in obliteration of collaterals of superior mesenteric arteries, the abundance of collateral flow to the sigmoid colon usually prevents ischemia. In the conclusion we recommend the reimplantation of IMA to prevent ischemia of colon.