Perikardektomie und akute infektiose Perikarditis. [Intestinal ischemia following replacement of the infrarenal aorta and aorto-iliac bifurcation]

Détails

ID Serval
serval:BIB_C67C12C9B827
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Perikardektomie und akute infektiose Perikarditis. [Intestinal ischemia following replacement of the infrarenal aorta and aorto-iliac bifurcation]
Périodique
Helvetica Chirurgica Acta
Auteur(s)
Redaelli  C. A., Carrel  T., von Segesser  L. K., Turina  M.
ISSN
0018-0181
Statut éditorial
Publié
Date de publication
01/1992
Volume
58
Numéro
4
Pages
589-94
Notes
English Abstract
Journal Article --- Old month value: Jan
Résumé
Intestinal ischemia following abdominal aortic surgery is a rare but dreaded complication and is associated with a high postoperative morbidity and mortality. Based on a review of the literature the incidence was noted between 2% to 10% of patients undergoing reconstruction of the abdominal aorta. From January 1980 to March 1991, 1017 patients were operated on the abdominal aorta or aorto-iliac bifurcation; the diagnosis was either abdominal aortic aneurysm (AAA) or chronic occlusive disease (COD). There were 819 patients with AAA (80.5%, mean age 67.9 years), and 198 patients with COD (19.5%, mean age 62.2 years). In 134 cases (122 for AAA, 12 for COD) the inferior mesenteric artery (IMA) was reimplantated into the graft. The incidence of postoperative intestinal ischemia after AAA repair was 2.8% (23/819 patients) after AAA repair and 0.5% (1/198 patient) with COD. 66% of the patients who have developed intestinal ischemia were operated emergently. However 2/134 (1.5%) patients presented intestinal ischemia despite reimplantation of IMA. Early explorative laparotomy or early postoperative colonoscopy could demonstrate ischemia in the majority of cases, whereas diagnosis of intestinal ischemia was confirmed at autopsy in 2 patients. In our experience with more than 1000 patients operated on the infrarenal aorta during a 10-year period suggests that a postoperative intestinal ischemia is caused mainly by a misbalance of the blood supply of the left hemicolon and rectosigmoid and may be prevent by reimplantation of IMA. Our actual policy consider reimplantation in presence of patent and large IMA with weak backflow, especially in patients with previous colonic disease or by missing collaterals at preoperative angiogram.
Mots-clé
Aged Aorta, Abdominal/*surgery Aortic Aneurysm/*surgery Aortic Rupture/*surgery Arterial Occlusive Diseases/*surgery Female Humans Iliac Artery/*surgery Intestines/*blood supply Ischemia/*surgery Male Mesenteric Vascular Occlusion/surgery Middle Aged Postoperative Complications/*surgery Reoperation
Pubmed
Web of science
Création de la notice
14/02/2008 14:19
Dernière modification de la notice
20/08/2019 15:41
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