INTESTINAL ISCHEMIA FOLLOWING SURGERY FOR AORTOILIAC DISEASE - A REVIEW OF 502 CONSECUTIVE AORTIC RECONSTRUCTIONS

A 7-year experience with 502 patients undergoing abdominal aortic reco nstruction was reviewed to determine the incidence of intestinal ische mia and the clinical, anatomic and technical factors associated with t his complication of aortic surgery. The other complications during the 30-day postoperative period were also collected. A total of 7(1.4%) p atients had intestinal infarction. Of these, colon necrosis occurred i n 4, and 3 patients had necrosis in the superior mesenteric artery (SM A) territory. The occurrence of intestinal infarction after operation for ruptured aneurysm was 3.9% (4 patients) and for intact aneurysm 1. 3% (3 patients), respectively. None of the 174 patients operated on fo r aortoiliac occlusive disease developed intestinal infarction. The de velopment of colon necrosis after operation for ruptured aneurysm was mostly in relation to shock and diminished tissue perfusion. Suprarena l aortic clamping with subsequent SMA embolization, prolonged aortic c lamping time, and a sporadic thrombosis of the SMA were responsible fo r small bowel necrosis. In 4 of 7 patients (57%) intestinal infarction led to death. An overall 30-day mortality was 18% (91 patients). Four per cent of these deaths were due to intestinal infarction.