Intraoperative assessment of colonic ischemia during aortic reconstruction

Ischemic colitis is a devastating complication of aortic reconstruction. Its diagnosis is often delayed or overlooked, resulting in significant patient morbidity and mortality. To avoid this complication, the vascular surgeon must be aware of the preoperative, intraoperative, and postoperative risk factors. The vascular surgeon must be knowledgeable of the vascular anatomy and protective of the many vascular collaterals that may protect the colon when blood flow is reduced. Reviewed are the many intraoperative techniques to assess the adequacy of colonic perfusion during aortic reconstruction. Introduced is a new technique of assessing colonic perfusion: inferior mesenteric vein blood gas sampling. This technnique is compared to laser Doppler flowmetry and photoplethysmography in patients undergoing aortic reconstruction.