Research Article| Volume 93, ISSUE 1, P102-106, January 1983

Prevention of intestinal ischemia following abdominal aortic reconstruction

  • Calvin B. Ernst
    Reprint requests: Calvin Ernst, M.D., Section of Surgical Sciences, Baltimore City Hospitals, 4940 Eastern Ave., Baltimore, MD 21224.
    From the Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md., USA
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      Prevention of ischemic bowel complications following abdominal aortic reconstruction requires identification of the patient at high risk for developing the complication; on precise, gentle, meticulous operative technique; on knowledge of bowel blood supply; on determining when the IMA must be reconstructed or when it can be safely ligated; and on methods of preserving or preventing damage to bowel blood supply.
      Patients at greatest risk for developing bowel ischemia following aortic reconstruction include those with a history of visceral angina, those with a patent IMA (40% to 52%), those being treated for ruptured aneurysm, those whose postreconstructive IMA stump mean blood pressures are less than 40 torr, those in whom Doppler flow signals cease following division or occlusion of the IMA, and those who have SMA occlusive disease and arteriographic documentation of IMA to SMA flow in the MMA (Table II). Patients at least risk include those in whom the IMA is already occluded (48% to 60%), those whose postreconstructive IMA stump pressures are more than 40 torr, those in
      IIRisk prediction for bowel ischemia after aortic reconstruction
      Patients at greatest risk
      Symptoms of visceral ischemia
      Aortic aneurysm (ruptured)
      Patent IMA
      Zero operative Doppler flow
      IMA stump pressure <40 torr
      IMA to SMA MMA flow
      Patients at least risk
      Thrombosed IMA
      Operative Doppler flow present
      IMA stump pressure >40 torr
      SMA to IMA MMA flow
      Reconstruction for occlusive disease
      whom Doppler flow signals persist after IMA occlusion, those who have flow in the MMA from the SMA to the IMA (provided this vessel is not injured), and those undergoing aortic reconstruction for aortoiliac occlusive disease.
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