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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2003 June;22(2):159-63


lingua: Inglese

Experi­men­tal sur­gery in infra­ren­al aorta and sig­moid ische­mia

Katsenis K., Kotsis T., Pafiti A., Doufas A., Dimakakos P.

Vas­cu­lar Depart­ment, 2nd Sur­gi­cal Clin­ic, ­School of Med­i­cine Athens Uni­ver­sity, Are­taeion Hos­pi­tal, Ath­ens, ­Greece


Aim. Colon ische­mia is a rare but seri­ous com­pli­ca­tion in sur­gery of the infra­ren­al aorta, due to liga­tion of the infe­ri­or mes­en­ter­ic ­artery and the ische­mia-reper­fu­sion syn­drome. In order to inves­ti­gate the ­degree of intes­ti­nal dam­age, we ­employed experi­men­tal sur­gery in pigs, apply­ing the usual pro­to­col for elec­tive ­repair of the infra­ren­al aorta (AAA or Y graft).
Meth­ods. Three ­groups of pigs were oper­at­ed on. In Group A (n=4, 21-25 kg, mean 22.6) a sham oper­a­tion was per­formed. In Group B (n=6, 21-26 kg, mean 24) the infra­ren­al aorta was cross-­clamped along with the inter­nal and exter­nal iliac arter­ies and a lon­gi­tu­di­nal inci­sion was per­formed in the aorta, while in Group C (n=5, 20-27 kg, mean 23.8) a ­Pruitt-Inaha­ra shunt was used to allow flow from the infra­ren­al aorta ­towards the iliac arter­ies and the infe­ri­or mes­en­ter­ic ­artery dur­ing cross-clamp­ing. The dura­tion of cross-clamp­ing was two hours (Group B and C). In all ­groups we eval­u­at­ed sig­moid his­tol­o­gy after reper­fu­sion under light micros­co­py.
­Results. The path­o­log­ic exam­ina­tion of the sig­moid ­revealed ­increased post­is­chem­ic inju­ries in Group B, while the pro­tec­tive ­effect of the shunt was obvi­ous in Group C. The tis­sue sam­ples of Group B pre­sent­ed hyper­emia, sub­mu­co­sal edema, dil­a­ta­tion of the lymph ves­sels and ­severe inflam­ma­to­ry infil­tra­tion of the muco­sa, mus­cu­lar­is pro­pria and sero­sa, with cells show­ing acute and chron­ic inflam­ma­to­ry respons­es. In Group C all spec­i­mens pre­sent­ed hyper­em­ic ves­sels and a ­slight inflam­ma­to­ry reac­tion of muco­sa. In con­clu­sion, Group B, pre­sent­ed the most ­severe inflam­ma­to­ry chang­es, involv­ing all ­layers, while in Group C con­ges­tion and ­slight inflam­ma­to­ry reac­tions of the muco­sa were ­observed. In Group A, no sig­nif­i­cant chang­es in nor­mal his­tol­o­gy were ­observed.
Con­clu­sion. The impor­tance of these find­ings is evi­dent, ­because in the clin­i­cal sit­u­a­tion ­patients have var­i­able ­degrees of arter­i­op­a­thy, thus even short peri­ods of ische­mia might prove dis­as­trous and this could occur in ­repair of the infar­en­al aorta as well as in other cases of inev­i­ta­ble risk, such as in sur­gery of the tho­ra­co-abdom­i­nal aorta

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