ROLE OF DIRECT REVASCULARIZATION OF THE INTERNAL ILIAC ARTERY DURING AORTOILIAC SURGERY

The purpose of this retrospective study was to determine the indicatio ns and efficacy of direct revascularization of the internal iliac arte ries during aortoiliac reconstruction in the prevention of postoperati ve colonic and pelvic ischemia. This study included 540 patients who u nderwent aortoiliac reconstruction between January 1987 and December 1 996 for nonruptured abdominal aortic aneurysm in 341 cases (63%) and o cclusive aortoiliac disease in 199 cases (37%). Mean age was 67.4 year s. A tubular aortic prosthetic graft was used in 36 patients and a bif urcated prosthetic graft in the remaining 504 patients. Direct revascu larization of the internal iliac artery was performed 102 times in 85 patients (72 with aortic aneurysms and 13 with occlusive aortoiliac di sease). The indication for direct revascularization was absence of ade quate retrograde flow in 54 cases (53%), absence of anterograde flow i n 19 cases (19%), and aneurysmal involvement of the origin of one inte rnal iliac artery in 29 cases (28%). Concomitant revascularization of the inferior mesenteric artery was performed in 14 cases (2.5%). Twent y-two patients (4.1%) died during the immediate postoperative period a nd two (0.4%) presented nonfatal colonic ischemia. Fatal pelvic ischem ia occurred in one patient following treatment of an aortoiliac aneury sm with retrograde revascularization of the internal iliac artery. Pos toperative rest pain due to buttock ischemia was observed in three pat ients (0.6%) in whom direct revascularization of the internal iliac ar tery was not performed. In the subgroup of patients who underwent dire ct revascularization of the internal iliac artery, there were 3 deaths (3.5%), 13 nonfatal complications (15.3%), and no colonic ischemia. I n this series direct revascularization of the internal iliac artery wa s performed in a high proportion of cases (15.7%) and did not increase the postoperative morbidity/mortality rate. The incidence of postoper ative colonic and pelvic ischemia was low (0.6%). Direct revasculariza tion of the internal iliac artery in selected patients appears to be e ffective in the prevention of postoperative pelvic and colonic ischemi a.