Nonocclusive Mesenteric Ischemia After Aorto-Iliac Reconstruction of a Ruptured Abdominal Aortic Aneurysm: Report of a Case

Tsushimi, Takaaki; Furukawa, Shouichi; Gohra, Hidenori; Takahashi, Tsuyoshi; Fukuda, Shigetoshi; Oda, Tatsurou

doi:10.1007/s00595-003-2607-2

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…Mitchell et al reported that the risk of intestinal necrosis was infl uenced more by intraoperative hypotension than by the pursuit of the IMA reconstruction. 7 This fi nding, together with the recently reported pathology known as nonobstructive mesenteric ischemia (NOMI), 8 raises concerns of reduced abdominal organ reperfusion pressure and vasospasms in conjunction with long-duration aortic clamping. In a similar case, Neglen et al used pediatric extracorporeal circulation to reperfuse the IMA at a fl ow rate of 650-900 ml/min.…”

Section: Discussionmentioning

confidence: 97%

Repair of an Abdominal Aortic Aneurysm with a Remarkably Dilated Meandering Artery: Report of a Case

et al. 2007

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A 73-year-old man on dialysis for chronic renal dysfunction was referred to our hospital for surgical treatment of an abdominal aortic aneurysm (AAA). Preoperative angiography showed a remarkably developed meandering artery branching from the inferior mesenteric artery (IMA). The superior mesenteric and celiac arteries were occluded at the origin, and all blood flow to the abdominal organs was apparently supplied by collateral circulation from the IMA. Considering the risk of mesenteric ischemia after aortic clamping in conjunction during surgery, we used a perfusion catheter with a 12-F balloon to create a shunt to the IMA from the subclavian artery. The operation was successful and the patient recovered uneventfully. We describe this surgical procedure for its effectiveness in preventing postoperative mesenteric ischemia in a rare case of an AAA with complex branching lesions.

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Section: Discussionmentioning

confidence: 97%

Repair of an Abdominal Aortic Aneurysm with a Remarkably Dilated Meandering Artery: Report of a Case

et al. 2007

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“…It is also possible that the intestinal ischemic episode may occur due to nonobstructive causes in already hospitalized patients or during major aortoiliac reconstructions. 1,3,14 Under these circumstances bacterial translocation, sepsis, and systemic infl ammatory response syndrome occur and a vicious circle of further metabolic acidosis and subsequent circulatory and respiratory failure tend to develop, thus playing a signifi cant role in the reported high mortality rate. [15][16][17] Previous well-designed experimental studies have shown that PFC-O 2 offers a reduction in mortality and protects the intestinal mucosa from ischemia/reperfusion injury.…”

Section: Discussionmentioning

confidence: 99%

Intraluminal Intestinal Administration of Oxygenated Perfluorocarbon Improves Acid–Base and Cardiopulmonary Parameters After Acute Mesenteric Ischemia. An Experimental Study in Rabbits

et al. 2007

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“…Different complications during or after an aortic clamping, in the postoperative follow up of humans [3,8,17], and in porcine models are observed. After abdominal aortic surgery humans showing cases of paraplegia, aortic occlusion with ischemic colitis, ischemic lower limbs, and non occlusive mesenteric ischemia are described [24,25]. There are also single reports about potential paraplegia after aortic cross clamping in pigs [4,13,14,21].…”

Section: Introductionmentioning

confidence: 99%

Pig specific vascular anatomy allows acute infrarenal aortic occlusion without hind limb ischemia and stepwise occlusion without clinical signs

Haacke

Unger

Haidenhein

et al. 2011

Clinical Hemorheology and Microcirculation

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Objective: In a porcine, aortic graft model we found 5 animals to develop and survive unnoticed, complete infrarenal aortic occlusion and 2 pigs with an acute occlusion but rather unspecific clinical symptoms. We investigated the pigs' vascular system to classify the anatomic capabilities to compensate for an acute abdominal aortic occlusion.Design of study: Retrospective analysis of CT scans and clinical data to specify unexpected results in a case series of infrarenal occlusion in a porcine model.Setting: Collaborative study of experimental and clinical departments. Subjects: Fifteen healthy female minipigs. Interventions: All pigs underwent an infrarenal aortic graft intervention. Anesthesia and perioperative management of the animals were preformed along the standard operating procedures of the local Department of Experimental Medicine. All animals received perioperative antibiotics, ASS, and carprofen for postoperative analgesia. Arterial pressure, heart rate, body temperature, and diuresis were monitored during surgery and therapeutic interventions.Main outcome measures: Contrast media based computed tomography (CT) with total body scans were performed at 1, 4, 10, 12 weeks after surgery. Comparable scans of cardiovascular healthy subjects (humans and pigs) and patients with a Leriche's syndrome were analyzed.Results: Neither acute (within the first 12 h after surgery) nor stepwise total aortic occlusion show unmistakable clinical signs. In pigs, the epigastric artery (EGA) -which is in connection with suprarenal lumbal arteries, subclavian and external iliac artery -is highly developed associated to the high number of mammary glands of about 7 on one side. In humans, the ratio of aortic to EGA-diameter is 1 : 0.15. In minipigs we found a ratio of 1 : 0.43 which changed during aortic occlusion resulting in a ratio of 1 : 0.58. Pigs with a slowly developing occlusion demonstrated an enlargement of the ureteric artery of about 210% completing a sufficient collateral system.Conclusion: While in the human Leriche's syndrome months are needed to enlarge the EGAs for a partial collateral support of an infrarenal aortic occlusion the pig's EGA is a naturally sufficient collateral system capable to cover immediately for an acute infrarenal aortic occlusion. Further collateral enlargement even provides a permanent, sufficient hind limb perfusion in pigs. As N. Haacke et al. / Infrarenal aortic occlusion in pigsthe sufficient collateral system probably reduce pressure and shear rates in the infrarenal aortic segment after cross clamping, pigs might have a higher predisposition to produce early thrombosis related graft occlusions tan humans.

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Nonocclusive Mesenteric Ischemia After Aorto-Iliac Reconstruction of a Ruptured Abdominal Aortic Aneurysm: Report of a Case

Cited by 3 publications

References 14 publications

Repair of an Abdominal Aortic Aneurysm with a Remarkably Dilated Meandering Artery: Report of a Case

Repair of an Abdominal Aortic Aneurysm with a Remarkably Dilated Meandering Artery: Report of a Case

Intraluminal Intestinal Administration of Oxygenated Perfluorocarbon Improves Acid–Base and Cardiopulmonary Parameters After Acute Mesenteric Ischemia. An Experimental Study in Rabbits

Pig specific vascular anatomy allows acute infrarenal aortic occlusion without hind limb ischemia and stepwise occlusion without clinical signs

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