Overt colon ischemia after endovascular aneurysm repair: The importance of microembolization as an etiology Nishan Dadian, MD, Takao Ohki, MD, Frank.

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Presentation transcript:

Overt colon ischemia after endovascular aneurysm repair: The importance of microembolization as an etiology Nishan Dadian, MD, Takao Ohki, MD, Frank J. Veith, MD*, Morris Edelman, MD, Manish Mehta, MD, Evan C. Lipsitz, MD, William D. Suggs, MD, Reese A. Wain, MD Journal of Vascular Surgery Volume 34, Issue 6, Pages 986-996 (December 2001) DOI: 10.1067/mva.2001.119241 Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 A, Preoperative CT scan demonstrating presence of extensive mural thrombus in the proximal neck. B, Aneurysm sac measuring 7 cm. Note the presence of defibrillator. Journal of Vascular Surgery 2001 34, 986-996DOI: (10.1067/mva.2001.119241) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Preoperative arteriogram demonstrating a proximal para-anastomotic aneurysm (P ) in a patient having undergone previous aneurysm repair with a bifurcated graft (G ) (patient 5, Table I). A femorofemoral crossover graft had been performed for occlusion of the right limb of the previous bifurcating graft. Inset, Lateral views revealing mural thrombus within the proximal neck. Journal of Vascular Surgery 2001 34, 986-996DOI: (10.1067/mva.2001.119241) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 A, Completion arteriogram demonstrates exclusion of the aneurysm with Montefiore Endovascular Grafting System, with no sign of an endoleak. B, Delayed views (3 sec) of the same arteriogram reveals stagnation of clearance of contrast in the renal arteries, suggesting distal renal arterial microembolization. Journal of Vascular Surgery 2001 34, 986-996DOI: (10.1067/mva.2001.119241) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 Photomicrograph (×100) of the colon of the patient shown in Figs 1-3 (patient 5, Table I) demonstrates cholesterol crystals (C ) in arteriolar lumens. Note the ischemic necrosis of the colonic mucosa (N ) overlying the embolized arterioles. Journal of Vascular Surgery 2001 34, 986-996DOI: (10.1067/mva.2001.119241) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 5 Radiographic imaging of a 77-year-old man undergoing EVAR. A, Preoperative arteriogram reveals AAA with favorable anatomy. B, The right HA was coil embolized at the time of arteriography (4 weeks before EVAR). C, CT scan shows presence of mural thrombus in the right common iliac artery, which was not obvious on arteriogram. D, Completion arteriogram demonstrating successful aneurysm exclusion, with the right limb of the stent graft overlying the previously coil-embolized right HA. Note the patency of the left HA. Journal of Vascular Surgery 2001 34, 986-996DOI: (10.1067/mva.2001.119241) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 6 A, Preoperative arteriogram demonstrating a patent IMA (arrow ) 19 years after right hemicolectomy. Collateral mesenteric vessels are not present. B, Completion arteriogram after aorto-right common iliac EVAR demonstrating complete exclusion of the AAA without signs of an endoleak. Also, internal iliac arteries were preserved bilaterally. F, Femorofemoral bypass graft; O, occluder device. Journal of Vascular Surgery 2001 34, 986-996DOI: (10.1067/mva.2001.119241) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions