[Transanal Doppler ultrasound for prevention of colonic ischemia following abdominal aortic reconstruction].
Colonic gangrene is a fatal complication following aorto-iliac reconstruction. Preservation of a sufficient blood flow through both the inferior mesenteric artery (IMA) and the internal iliac artery (IIA) is believed to be important in its prevention. The transanal Doppler ultrasound technique is a new method to explore intraoperative pelvic hemodynamic changes. After identifying the artery responsible for rectal perfusion and then estimating the collateral rectal blood supply which was derived from the superior mesenteric artery (SMA) after aortic clamping, the treatment for the IMA and the IIA was determined. Out of 49 cases of abdominal aortic aneurysm (AAA), 43 cases (88%) were considered to be SMA-dominant, with ligation of the IMA and the IIA being feasible. The IMA and bilateral IIAs could be ligated uneventfully in 14 AAA cases. And, in fact, the reconstruction of the IMA was performed in only 2 cases (4%). Among 21 cases of aorto-iliac occlusive disease (AIOD), 8 cases (38%) were found to be SMA-non-dominant, which suggests a greater importance in the preservation of intrapelvic circulation in AIOD than in AAA. Adequate intraoperative monitoring, by the transanal Doppler ultrasound technique, is essential for the successful prevention of postoperative colonic ischemia.
Sakurazawa
K
K
First Department of Surgery, School of Medicine, Tokyo Medical and Dental University, Japan.
D001012:Aorta, Abdominal / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000517:prevention & control*; D008991:Monitoring, Physiologic; D012007:Rectum / Q000098:blood supply* / Q000000981:diagnostic imaging; D014463:Ultrasonography