Ureteric complications and left retroperitoneal abdominal aortic surgery
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Abstract Background Open surgery for abdominal aortic aneurysms in the UK is usually performed via a midline transperitoneal incision. However, the left retroperitoneal (RP) approach may be beneficial for juxtarenal abdominal aortic aneurysms and certain physiological reasons. One potential disadvantage is that the left kidney usually requires mobilization anteromedially risking injury to the renal tract and possibly the ureter. Methods In this retrospective study, the time of onset, clinical presentation and treatment of left renal tract complications are scrutinized and discussed. Reasons for open aortic surgery as opposed to endovascular repair being undertaken were documented. Also, the aortic cross‐clamp positions and type of reconstruction were examined. Results A total of 208 patients underwent RP aortic surgery for aneurysmal disease. The aortic cross‐clamp positions were infrarenal in 115 (55%), suprarenal in 78 (38%) and supra‐superior mesenteric artery or supracoeliac in 15 (7%). Two percent (4/208) sustained ureteric complications and all occurred in the upper third of the left ureter. The time of onset of symptoms ranged from 2 to 14 days post‐operatively with a median of 3.5. Clinical signs were non‐specific including pyrexia, tachycardia and flank pain. Conclusion Ureteric complications following left RP aortic surgery is uncommon and usually occurs in the upper third of the renal tract. Trauma appears to be the most common cause, although ureteric ischaemia can occur but presents later particularly in those with comorbidities.Keywords:
Inferior mesenteric artery
Abdominal aorta
A 67-year-old male patient required surgical management of an abdominal aortic aneurysm. Contrast-enhanced computed tomography showed a saccular infrarenal abdominal aortic aneurysm and occlusion of the origins of the celiac artery, superior mesenteric artery, and inferior mesenteric artery. Aortography revealed large amounts of blood flow from capillaries around the abdominal aorta to the inferior mesenteric artery and retrograde blood flow to a meandering mesenteric artery through the superior rectal artery. Considering the risk of bowel ischemia, we performed endovascular aneurysm repair with mesenteric artery bypass. The operation was successful, and his postoperative course was uneventful. This procedure could be useful and less invasive.
Inferior mesenteric artery
Celiac artery
Mesenteric arteries
Aortography
Abdominal aorta
Mesenteric Ischemia
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Inferior mesenteric artery
Lumbar arteries
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Inferior mesenteric artery
Celiac artery
Mesenteric arteries
Aortography
Abdominal aorta
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Inferior mesenteric artery
Lumbar arteries
Computed Tomography Angiography
Celiac artery
Mesenteric arteries
Abdominal aorta
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Inferior mesenteric artery
Mesenteric Ischemia
Celiac artery
Collateral circulation
Mesenteric arteries
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Chronic mesenteric ischemia (CMI) is a challenging problem, with revascularization the mainstay of treatment. Management of CMI is especially challenging in the patient with superior mesenteric artery (SMA) and celiac artery (CA) occlusions.We report a case series of four patients with chronic mesenteric ischemia who were not candidates for CA or SMA revascularization who were successfully treated with inferior mesenteric artery (IMA) angioplasty and stent placement to improve collateral circulation and palliate symptoms.To our knowledge, this is the largest case series to date reporting the use of an IMA stent to improve collateral circulation in patients with CMI.
Inferior mesenteric artery
Collateral circulation
Celiac artery
Mesenteric Ischemia
Mesenteric arteries
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Inferior mesenteric artery
Mesenteric arteries
Celiac artery
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A 42-year-old man had intestinal ischemia 7 weeks after endovascular abdominal aortic aneurysm repair due to sacrifice of the inferior mesenteric artery, which had compensated for the intestinal blood supply because of the total occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery (CA). He was diagnosed in the active phase of Takayasu arteritis, and an emergency endovascular treatment was performed. After the SMA failed to be recanalized, a stent was successfully placed into the CA; this choice was made based on the preexisting collaterals between them. The symptoms were relieved shortly after the operation. The Kirk arcade, the Barkow arcade, and the enlarged pancreaticoduodenal arcade were visualized on the follow-up computed tomography angiography. Based on this case, a short review of celiomesenteric and intermesenteric collateral circulations is presented.
Inferior mesenteric artery
Celiac artery
Mesenteric Ischemia
Computed Tomography Angiography
Collateral circulation
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A Case of the Inferior Mesenteric Artery Arising from the Superior Mesenteric Artery in a Korean Woman Anatomical variations of the inferior mesenteric artery are extremely uncommon, since the inferior mesenteric artery is regularly diverged at the level of the third lumbar vertebra.We found a rare case in which the inferior mesenteric artery arose from the superior mesenteric artery.The findings were made during a routine dissection of the cadaver of an 82-yr-old Korean woman.This is the tenth report on this anomaly, the second female and the first Korean.The superior mesenteric artery normally arising from abdominal aorta sent the inferior mesenteric artery as the second branch.The longitudinal anastomosis vessels between the superior mesenteric artery and inferior mesenteric artery survived to form the common mesenteric artery.This anatomical variation concerning the common mesenteric artery is of clinical importance, performing procedures containing the superior mesenteric artery.
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Mesenteric arteries
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Inferior mesenteric artery
Mesenteric arteries
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