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International Angiology 2003 June;22(2):159-63


language: English

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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