Unknown late complication after reimplantation of the inferior mesenteric artery

Clinically apparent ischemia of the colon is a rare but serious complication of aortic reconstruction. The mortality rate of transmural involvement is between 60 and 100%. The reimplantation of the inferior mesenteric artery (IMA) during aortic surgery may prevent the development of this complication. The indication and efficiency to preserve colon viability of this procedure in the clinical practice is still disputed.

In our presentation we demonstrate an unknown late complication of the reimplantation of the IMA after abdominal aorta aneurysm resection and aortobifemoral bypass. An aneurysm had developed and ruptured four years after the operation. The urgent surgical intervention (suture the site of the reimplantation and ligature of the IMA) was successful and the patient is well one year after the operation. In our practice we do the reimplantation of the IMA, only in those cases when the bleeding from the distal IMA stump is weak, or the viability of the colon is doubtful. In the last six years the rate of the IMA reimplantation during aortic bypasses was 1.4% (146/2), and 12.0% (108/13) when we made aneurysm resection with bypass operation. Colon ischemia has developed altogether in two patients after surgery, none of them had reimplantation of the IMA and both patients died.

In our experience IMA reimplantation can prevent the ischemia after infrarenal aortic surgery. Otherwise the procedure extends the time of the surgery and can be the source of complications. Colonoscopy after operation, in selected cases may be valuable for early recognition of ischemic colitis.