| Popis: |
The advent of endovascular abdominal aortic aneurysm repair (EVAR) has led to a decrease in postoperative morbidity, shorter hospital stays, and quicker recovery time following abdominal aortic aneurysms repair. Nevertheless, EVAR continues to be burdened with similar ischemic complications as seen with open aortic surgery, and occurs in 3–10 % of patients. Signs and symptoms of pelvic ischemia (PI) include buttock and thigh claudication (BC and TC), impotence, perineal necrosis, rectal necrosis, colonic necrosis, and distal spinal cord or lumbar plexus ischemic neuropathy. Some of the mechanisms that may contribute to PI include interruption of hypogastric arterial circulation and atheroembolization. Several case reports and small retrospective studies have found that preservation of direct internal iliac artery (IIA) perfusion is important in preventing PI complications. The incidence of colonic ischemia after EVAR is 1.5 %, though multiple large series have reported no cases of ischemic colitis. Preserving direct blood flow to the IIAs is likely the key in preventing this complication, particularly in the presence of a patent inferior mesenteric artery. |
