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Aortoiliac Steal Syndrome

Aortoiliac Steal Syndrome Abstract THE IMPORTANCE of redistribution of blood flow from the mesenteric to the peripheral vascular bed as a causal factor for mesenteric ischemia has not been appreciated. Although necrosis of the gut following aortoiliac reconstructive surgery with or without concomitant sympathectomy is uncommon, symptoms that could be due to intestinal ischemia frequently occur following these reconstructive procedures, but in most cases they are mild and reversible. Because the patient has just undergone an intra-abdominal procedure, symptoms of distention, nausea, and diarrhea are ascribed to the surgery rather than a physiological redistribution of blood flow in the mesenteric and peripheral vascular beds. The sequence and cause of the hemodynamic alterations responsible for the symptomatology and the pathological lesions have remained obscure and frequently impossible to document. In 1963 Young et al31 reviewed the literature and collected 42 cases of severe intestinal ischemia following surgery on the abdominal aorta and its branches References 1. Bernatz, P.E.: Necrosis of the Colon Following Resection for Abdominal Aortic Aneurysms , Arch Surg 81:373, 1960.Crossref 2. Cohn, R., and Kountz, S.: Factors Influencing Control of Arterial Circulation in the Liver of the Dog , Amer J Physiol 205:1260, 1963. 3. Connolly, J.E.; Abrams, H.L.; and Kieraldo, J.H.: Observations on the Diagnosis and Treatment of Obliterative Disease of the Visceral Branches of the Abdominal Aorta , Arch Surg 90:596, 1965.Crossref 4. Corday, E., et al: Mesenteric Vascular Insufficiency: Intestinal Ischemia Induced by Remote Circulatory Disturbances , Amer J Med 33:365, 1962.Crossref 5. DeBakey, M.E., et al: The "Borrowing-Lending" Hemodynamic Phenomenon (Hemometakinesia) and Its Therapeutic Application in Peripheral Vascular Disturbances , Ann Surg 126:850, 1947.Crossref 6. Derrick, J.R.; Pollard, H.S.; and Moore, R.M.: The Pattern of Arteriosclerotic Narrowing of the Celiac and Superior Mesenteric Arteries , Ann Surg 149:684, 1959.Crossref 7. Flotte, CT.: Evaluation of Lumbar Sympathectomy , Amer J Cardiol 4:644, 1959.Crossref 8. Glotzer, D.J., and Shaw, R.: Massive Bowel Infarction , New Eng J Med 260:162, 1959.Crossref 9. Hafner, CD., et al: Gastrointestinal Angina , Ohio Med J 60:946, 1964. 10. Haimovici, H.; Steinman, C.; and Karson, I.H.: Evaluation of Lumbar Sympathectomy , Arch Surg 89:1089, 1964.Crossref 11. Harrison, T.S., et al: Iliofemoral Occlusive Disease Associated With Aneurysms of the Abdominal Aorta , New Eng J Med 271:985, 1964.Crossref 12. Healey, S.J., et al: Reconstructive Operations for Aortoiliac Obliterative Disease , New Eng J Med 271:1386, 1964.Crossref 13. Irving, D.W., and Corday, E.: Effect of the Cardiac Arrhythmias on the Renal and Mesenteric Circulations , Amer J Cardiol 8:32, 1961.Crossref 14. Javid, H., et al: Complications of Abdominal Aortic Grafts , Arch Surg 85:650, 1962.Crossref 15. King, R.D., et al: Evaluation of Lumbar Sympathetic Denervation , Arch Surg 88:36, 1964.Crossref 16. Kountz, S.L.; Eschelman, L.T.; and Cohn, R.: The Effect of Aortoiliac Blood Flow , Amer J Surg 104:316, 1962.Crossref 17. Mandell, R.S.: Abdominal Angina: Report of Case and Review of Literature , New Eng J Med 257:1035, 1957.Crossref 18. Marston, A.: Patterns of Intestinal Ischemia , Ann Roy Coll Surg Eng 35:151, 1964. 19. McKain, J., and Shumacker, H.B., Jr.: Ischemia of the Left Colon Associated With Abdominal Aortic Aneurysms and Their Treatment , Arch Surg 76:355, 1958.Crossref 20. Ming, S.C., and Levitan, R.: Acute Hemorrhagic Necrosis of the Gastrointestinal Tract , New Eng J Med 263:59, 1960.Crossref 21. Morris, G.C., and DeBakey, M.E.: Abdominal Angina: Diagnosis and Surgical Treatment , JAMA 176:89, 1961.Crossref 22. Pace, W.G.: Bowel Complications of Surgery of the Abdominal Aorta , Amer J Gastroent 38:529, 1962. 23. Palumbo, L.T., and Lulu, D.L.: Lumbar Sympathectomy in Peripheral Vascular Diseases , Arch Surg 86:512, 1963.Crossref 24. Penner, A., and Bernheim, A.I.: Acute Postoperative Enterocolitis , Arch Path 27:966, 1939. 25. Reivich, M., et al: Reversal of Blood Flow Through the Vertebral Artery and Its Effect on Cerebral Circulation , New Eng J Med 265:878, 1961.Crossref 26. Sapirstein, L.A., et al: A Constant Infusion Technique for the Determination of Cardiac Output , Amer J Physiol 177:134, 1954. 27. Shaw, R.S.: Vascular Lesions of the Gastrointestinal Tract , Surg Clin N Amer 39:1253, 1959. 28. Shaw, R.S.: Intestinal Symptoms After Aorta Surgery , New Eng J Med 266:196, 1962.Crossref 29. Smith, R.F., and Sziliagyi, D.E.: Ischemia of the Colon as a Complication in the Surgery of the Abdominal Aorta , Arch Surg 80:806, 1960.Crossref 30. Tolstedt, G.E.; Jesseph, J.E.; and Bell, J.W.: Late Intestinal Complications of Abdominal Aortic Homografts , Surg Gynec Obstet 116:42, 1963. 31. Young, J.R., et al: Complications of Abdominal Aortic Surgery , Arch Surg 86:51, 1963.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1966 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1966.01320220046007
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Abstract

Abstract THE IMPORTANCE of redistribution of blood flow from the mesenteric to the peripheral vascular bed as a causal factor for mesenteric ischemia has not been appreciated. Although necrosis of the gut following aortoiliac reconstructive surgery with or without concomitant sympathectomy is uncommon, symptoms that could be due to intestinal ischemia frequently occur following these reconstructive procedures, but in most cases they are mild and reversible. Because the patient has just undergone an intra-abdominal procedure, symptoms of distention, nausea, and diarrhea are ascribed to the surgery rather than a physiological redistribution of blood flow in the mesenteric and peripheral vascular beds. The sequence and cause of the hemodynamic alterations responsible for the symptomatology and the pathological lesions have remained obscure and frequently impossible to document. In 1963 Young et al31 reviewed the literature and collected 42 cases of severe intestinal ischemia following surgery on the abdominal aorta and its branches References 1. Bernatz, P.E.: Necrosis of the Colon Following Resection for Abdominal Aortic Aneurysms , Arch Surg 81:373, 1960.Crossref 2. Cohn, R., and Kountz, S.: Factors Influencing Control of Arterial Circulation in the Liver of the Dog , Amer J Physiol 205:1260, 1963. 3. Connolly, J.E.; Abrams, H.L.; and Kieraldo, J.H.: Observations on the Diagnosis and Treatment of Obliterative Disease of the Visceral Branches of the Abdominal Aorta , Arch Surg 90:596, 1965.Crossref 4. Corday, E., et al: Mesenteric Vascular Insufficiency: Intestinal Ischemia Induced by Remote Circulatory Disturbances , Amer J Med 33:365, 1962.Crossref 5. DeBakey, M.E., et al: The "Borrowing-Lending" Hemodynamic Phenomenon (Hemometakinesia) and Its Therapeutic Application in Peripheral Vascular Disturbances , Ann Surg 126:850, 1947.Crossref 6. Derrick, J.R.; Pollard, H.S.; and Moore, R.M.: The Pattern of Arteriosclerotic Narrowing of the Celiac and Superior Mesenteric Arteries , Ann Surg 149:684, 1959.Crossref 7. Flotte, CT.: Evaluation of Lumbar Sympathectomy , Amer J Cardiol 4:644, 1959.Crossref 8. Glotzer, D.J., and Shaw, R.: Massive Bowel Infarction , New Eng J Med 260:162, 1959.Crossref 9. Hafner, CD., et al: Gastrointestinal Angina , Ohio Med J 60:946, 1964. 10. Haimovici, H.; Steinman, C.; and Karson, I.H.: Evaluation of Lumbar Sympathectomy , Arch Surg 89:1089, 1964.Crossref 11. Harrison, T.S., et al: Iliofemoral Occlusive Disease Associated With Aneurysms of the Abdominal Aorta , New Eng J Med 271:985, 1964.Crossref 12. Healey, S.J., et al: Reconstructive Operations for Aortoiliac Obliterative Disease , New Eng J Med 271:1386, 1964.Crossref 13. Irving, D.W., and Corday, E.: Effect of the Cardiac Arrhythmias on the Renal and Mesenteric Circulations , Amer J Cardiol 8:32, 1961.Crossref 14. Javid, H., et al: Complications of Abdominal Aortic Grafts , Arch Surg 85:650, 1962.Crossref 15. King, R.D., et al: Evaluation of Lumbar Sympathetic Denervation , Arch Surg 88:36, 1964.Crossref 16. Kountz, S.L.; Eschelman, L.T.; and Cohn, R.: The Effect of Aortoiliac Blood Flow , Amer J Surg 104:316, 1962.Crossref 17. Mandell, R.S.: Abdominal Angina: Report of Case and Review of Literature , New Eng J Med 257:1035, 1957.Crossref 18. Marston, A.: Patterns of Intestinal Ischemia , Ann Roy Coll Surg Eng 35:151, 1964. 19. McKain, J., and Shumacker, H.B., Jr.: Ischemia of the Left Colon Associated With Abdominal Aortic Aneurysms and Their Treatment , Arch Surg 76:355, 1958.Crossref 20. Ming, S.C., and Levitan, R.: Acute Hemorrhagic Necrosis of the Gastrointestinal Tract , New Eng J Med 263:59, 1960.Crossref 21. Morris, G.C., and DeBakey, M.E.: Abdominal Angina: Diagnosis and Surgical Treatment , JAMA 176:89, 1961.Crossref 22. Pace, W.G.: Bowel Complications of Surgery of the Abdominal Aorta , Amer J Gastroent 38:529, 1962. 23. Palumbo, L.T., and Lulu, D.L.: Lumbar Sympathectomy in Peripheral Vascular Diseases , Arch Surg 86:512, 1963.Crossref 24. Penner, A., and Bernheim, A.I.: Acute Postoperative Enterocolitis , Arch Path 27:966, 1939. 25. Reivich, M., et al: Reversal of Blood Flow Through the Vertebral Artery and Its Effect on Cerebral Circulation , New Eng J Med 265:878, 1961.Crossref 26. Sapirstein, L.A., et al: A Constant Infusion Technique for the Determination of Cardiac Output , Amer J Physiol 177:134, 1954. 27. Shaw, R.S.: Vascular Lesions of the Gastrointestinal Tract , Surg Clin N Amer 39:1253, 1959. 28. Shaw, R.S.: Intestinal Symptoms After Aorta Surgery , New Eng J Med 266:196, 1962.Crossref 29. Smith, R.F., and Sziliagyi, D.E.: Ischemia of the Colon as a Complication in the Surgery of the Abdominal Aorta , Arch Surg 80:806, 1960.Crossref 30. Tolstedt, G.E.; Jesseph, J.E.; and Bell, J.W.: Late Intestinal Complications of Abdominal Aortic Homografts , Surg Gynec Obstet 116:42, 1963. 31. Young, J.R., et al: Complications of Abdominal Aortic Surgery , Arch Surg 86:51, 1963.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Apr 1, 1966

References