Inferior Mesenteric and Hypogastric Artery Reconstruction to Prevent Colonic Ischaemia following Abdominal Aortic Aneurysmectomy

Abstract

In 179 patients receiving prosthetic grafts for abdominal aortic aneurysmectomy, an attempt was made to preserve or restore continuity of at least two vessels, including the patent inferior mesenteric artery (IMA) and bilateral hypogastric arteries (HGAs), so as to prevent colorectal ischaemia. Adjunctive reconstruction of the IMA and/or HGAs was performed in 60 patients; a total of 40 HGAs and 31 IMAs were reconstructed. The hospital mortality rates of patients with elective and ruptured aneurysm repair were 3.9 and 22% respectively. There were no deaths related to colorectal ischaemia. The mean(s.d.) IMA stump blood pressure was 66(18) mmHg and the mean(s.d.) IMA stump pressure index (the ratio of mean peak systolic IMA pressure to mean systolic systemic pressure) was 0.58(0.15). The IMA was revascularized in all patients whose stump pressure was <40 mmHg and whose index was <0.4. Postoperative angiography revealed a 94% patency rate for the IMA and 92% for the HGAs. Colorectal ischaemia did not develop in any patient in whom aneurysmectomy was performed electively or in any who had colonoscopy because of watery diarrhoea after surgery. These results indicate the significance of adjunctive reconstruction of the IMA and HGA during abdominal aortic aneurysmectomy.