Preservation of the pelvic circulation during infrarenal aortic surgery |
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| Affiliation: | 1. Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass;2. Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands;3. Department of Vascular and Endovascular Surgery, University of Washington Medical Center, Seattle, Wash;4. Department of Vascular Surgery, Maine Medical Center, Portland, Me;5. Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla;1. Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Sri Lanka (Drs Rathnayaka and Rajapakse);2. Faculty of Medicine, University of Peradeniya, Sri Lanka (Drs Kularatne and Ranasinghe);3. Medical Unit, Provincial General Hospital, Ratnapura, Sri Lanka (Drs Ranathunga and Kumarasinghe); and the Intensive Care Unit, Provincial General Hospital, Ratnapura, Sri Lanka (Dr Rathnayaka);1. Division of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland;2. Pulmonary Hypertension Program, University Hospitals of Geneva, Geneva, Switzerland;3. Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France;4. University Paris Diderot, Sorbonne Paris Cité, Paris, France;5. INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France;6. Cardiology Division, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland;1. Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Rd., Nanjing 210006, China;2. Clinical Research Collaboration, Siemens China Shanghai Branch, Shanghai, China |
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| Abstract: | Paraplegia, ischemia of the colon, and gluteal necrosis are uncommon but devastating sequelae of surgery of the infrarenal aorta. These complications are ischemic in nature, secondary to the following technical maneuvers, individually or in combination: bilateral occlusion of the hypogastric arteries; division of a patent inferior mesenteric artery; or proximal end-to-end aortic to common femoral artery bypass grafting accompanied by stenosis of the external iliac arteries. The etiology of paraplegia after infrarenal aortic surgery is of particular interest since it now appears that it is more likely due to interruption of flow to lumbosacral branches of the hypogastric arteries supplying the conus of the spinal cord and/or to division of a low-lying ‘conus medullaris artery’ rather than to occlusion of the higher-lying great radicularis artery of Adamkiewicz. Knowledge of the pelvic circulation to the colon, buttocks, and terminal spinal cord allows the surgeon prophylactically to avoid or reconstruct critical branches during operations on the infrarenal aorta. While rare, severe complications cannot be completely eliminated; hopefully their incidence can be reduced by an understanding of their etiology. |
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