The Results of Simultaneous Bilateral Internal Iliac Artery and Inferior Mesecteric Artery Ligation during Open Abdominal Aortic Aneurysm Surgery

PURPOSE: Bilateral internal iliac artery (IIA) ligation with inferior mesenteric artery (IMA) ligation has been performed during open abdominal aortic aneurysm surgery and endovascular aneurismal repair (EVAR). We reviewed both the acute and long term effects of bilateral IIA ligation with IMA ligation. METHODS: A retrospective cross sectional review was performed on 315 patients who underwent open aneurysmal repair and EVAR between 1997 and 2008. Both IIAs of all the patients' were patent before aortic reconstruction. The patency of the IIAs and the presence of bowel ischemia was evaluated by the medical records on the operative findings, the sigmoidoscopy and the computed tomography. Telephone interviews were performed to assess buttock claudication. RESULTS: The mean age was 68.4 years and 259 patients were male. Unruptured aneurysm was found in 233 patients, ruptured aneurysm was found in 72 patients and impending rupture was found in 10 patients. Unilateral ligation of the IIA was required in 78 patients (24.8%), and bilateral ligation was performed in 43 patients (13.7%). Sigmoid colon ischemia occurred in 8 patients (2.5%), and the IIA was patent in 7 patients. Buttock claudication occurred in 10 out of 178 patients who were contactable on telephone, and the IIA was patent in 8 of these 10 patients. Bowel ischemia and buttock claudication were not significantly associated with the patency of the IIA (P>0.05). CONCLUSION: Bilateral IIA ligation with IMA ligation was able to be performed without significantly increasing the incidence of bowel ischemia and buttock claudication. Performing endovascular aneurysmal repair may be considered when bilateral graft extension to the external iliac artery is required.

Surgical Treatment for Cerebrovascular Disease in Takayasu's Arteritis

PURPOSE: Takayasu's arteritis is a chronic disease characterized by nonspecific inflammation of the aorta and its branches, and cerebral ischemia has been considered to be the most life-threatening complication of this disorder. METHOD: We performed a retrospective review of 13 patients who underwent 16 procedures between 1996 and 2006 secondary to cerebrovascular symptoms in Takayasu's arteritis (median follow-up=52.5 months). RESULT: Study subjects included 10 females and 3 males, with a median age of 36.5 years. Procedures included 7 bypasses (2 aorto-bicarotid artery, 1 axillo-axillary artery, 2 subclavian-common carotid artery, 1 common carotid-internal carotid artery, and 1 axillo-vertebral artery), 4 carotid endarterectomies (CEA), and 5 stents (4 common carotid artery [1 for the treatment of re-stenosis of CEA] and 1 vertebral artery). All patients were relieved of their cerebral ischemic symptoms and remained stroke-free during the follow-up period. Re-stenosis was seen in two cases of stenting. Occlusion or stenosis of arterial reconstruction occurred more frequently in patients who had elevated erythrocyte sedimentation rates (ESR) preoperatively (P<0.05). CONCLUSION: Surgical treatment was effective in stroke prevention and elimination of cerebrovascular symptoms. The patency of the reconstruction was related to the progression of the disease as indicated by elevated ESR and [18F]fluorodeoxyglucose positron emission tomography, which are useful tools for evaluating disease activity.