Intraoperative assessment of the left colon blood supply after elective abdominal aortic aneurysm repair

Abstract

The retrospective analysis of the data of 197 patients who had undergone elective abdominal aortic aneurysm (AAA) repair showed that almost half of them (43.1 %) had impaired passability of the inferior mesenteric artery (IMA), 19.3 % – of the internal iliac artery (IIA) and both arteries were affected in 8.3 % of the patients. IMA after elective AAA repair was ligated in 130 patients, 65 patients had it implanted into prosthesis and 2 patients underwent stenting of the aorta. The operation resulted in preserved antegrade and retrograde blood flow in the IIA in a quarter (25.4 %) and a third (32.1 %) of the patients, respectively. In the early postoperative period ischemic colitis was found in 8 patients (4.1 %), and more than a third of them (37.5 %) developed infarction in the left side of the colon with a lethal outcome. To objectify the intraoperative assessment of the blood supply in the left colon after elective AAA repair the methods of direct manometry and ultrasonography were used in 41 and 40 patients, respectively, and both methods were applied in 21 patients. The level of statistical significance and the positive values of the coefficients of correlation between the values of the peak systolic velocity and the indices of pressure intraoperative ultrasonography as a reliable and noninvasive method for assessing perfusion in the left side of the colon after electively AAA repair.