Ann Surg Treat Res.  2019 Aug;97(2):74-82. 10.4174/astr.2019.97.2.74.

Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients

Affiliations
  • 1Department of Surgery, School of Medicine, Pusan National University, Yangsan, Korea. skm1711@pusan.ac.kr
  • 2Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 3Department of Radiology, School of Medicine, Pusan National University, Yangsan, Korea.
  • 4Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea.

Abstract

PURPOSE
Colon perfusion status is one of the most important factors for the determination of postoperative anastomotic complications. Colonic hypoperfusion can be induced by inferior mesenteric artery (IMA) ligation in some patients. This study aimed to evaluate atherosclerotic risk assessment and vascular parameters of CT angiography as predictors of colonic hypoperfusion.
METHODS
This prospective study was conducted at a tertiary referral hospital and included 46 rectosigmoid colon cancer patients undergoing laparoscopic anterior resection between August 2013 to July 2014. Atherosclerotic risk scores were assessed using the Framingham cardiovascular risk score system. The IMA length, branching pattern, atherosclerotic calcification, and intermesenteric artery and mesenteric vascular diameters were evaluated using CT angiography. Mesenteric marginal artery pressures were measured before and after IMA clamping. The mean arterial pressure (MAP) index was calculated by dividing the mesenteric marginal MAP into the systemic MAP to determine the mesenteric hypoperfusion status after IMA clamping. A critically low MAP index was defined as <0.4.
RESULTS
Critically low MAP index (<0.4) was observed in 6 cases (13.0%) after IMA clamping. Atherosclerotic calcification of the IMA and superior mesenteric artery occurred in 11 (23.9%) and 5 patients (10.9%), respectively. Low MAP index was associated with high atherosclerotic risk score and short IMA length, rather than atherosclerotic calcification and other vascular parameters of the major mesenteric arteries. Multivariate analysis indicated that high atherosclerotic risk and short IMA length were independent predictors of critically low MAP index.
CONCLUSION
Atherosclerotic risk assessment and IMA length were useful predictors of the mesenteric hypoperfusion status following IMA ligation during laparoscopic rectosigmoid colon surgery.

Keyword

Arterial pressure; Atherosclerosis; Computed tomography angiography; Inferior mesenteric artery; Hypoperfusion
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