Reimplantation of the Inferior Mesenteric Artery as Prophylaxis of Colonic Ischemia in the Aorto-iliac Sector

Abstract

The infrarenal abdominal aorta is the most frequent site for degenerative aneurysm formation. Intestinal ischemia constitutes a serious complication of reconstructive surgery of the abdominal aorta, usually involving the left colon, and, rarely, the small bowel or both simultaneously. The objective of this work was to present a 68-year-old male patient who started with lumbar pain, radiating to the right lower limb, and frequent diarrhea, accompanied by pain in the left lumbar fossa. Angiotac showed aneurysm of the aorta and both primitive iliac arteries up to their bifurcation; in addition, significant stenosis was observed in the hypogastric and external iliac arteries. Three aneurysms were confirmed during the trans-operative procedure, the smallest one in the infrarenal aorta encompassing the inferior mesenteric artery. In the iliac arteries the aneurysms measured 8 cm on the left and more than 10 cm on the right, the latter with signs of eminent rupture, rupture of the vessel serosa and weakness of the wall. An aortobifemoral by-pass with vascular prosthesis was performed and the inferior mesenteric artery was reimplanted to the vascular prosthesis in the aortic portion due to the pelvic circulation, in order to prevent ischemia of the left colon. When surgically treating the aortoiliac sector, the status of the mesenteric arteries, both superior and inferior, as well as the hypogastric arteries must be taken into account, especially if the distal anastomosis is in the femoral arteries to avoid ischemia of the colon, which is a fatal complication in such surgery.