Colonic Infarction Following Open and Endovascular Abdominal Aortic Aneurysm Repair in Patients with Dolicosigma-2 Case Reports and Revision of Literature

Abstract

Colonic Infarc- tion Following Open and Endovascular Abdominal Aortic Aneurysm Repair in Patients with Dolicosigma-2 Case Reports and Revision of Literature. J Surg Curr Trend Innov: S1001. Abstract Background: Colonic ischemia is a major adverse event after ab- dominal aortic aneurysm repair, both in open surgical or endovascular procedures, with poor prognosis and high mortality rates. Case Report: We report two different cases of colonic infarction, the first following a standard EVAR procedure and the second following open abdominal aortic aneurysm repair. Both patients had a patent Inferior Mesenteric Artery (IMA), intact patent iliac hypogastric arter ies pre and post-operatively and had in common a dolicosigma as additional anatomical finding. Informed consent for aneurysm repair and publishing of our case studies was obtained for both patients. Discussion: Colon ischemia accompanying aortic surgery may be an intra-operative finding or a postoperative diagnosis and may be due to several causative factors. The impact of IMA exclusion on colonic perfusion has been largely evaluated, as well as the impor- tance in maintaining adequate blood supply with the preservation of at least one hypogastric artery in case of chronic occlusion of the iliac arteries or distal aorta. Laboratory and clinical parameters may heighten suspicion of bowel ischemia, but they don’t have high enough sensitivity and therefore can’t be considered the only diagnostic modality. Colonoscopy still remains the gold standard for doc- umenting ischemic bowel after aneurysm repair. Conclusion: Early diagnosis is an essential aspect when colonic ischemia occurs as an adverse event after abdominal aortic surgery. Colonscopy has to be performed as early as possible for a certain diagnosis, while clinical parameters and radiological exams, even useful, sometimes may represent confusing factors that could delay the exact diagnosis. Angio-CT scan may be helpful as well in iden tifying patients with predisposing factors or anatomical variants that can increase the risk of colon ischemia.