Preservation Of Inferior Mesenteric Artery Research Articles

Comprehensive management of challenging recurrent aortoiliac and lower extremity occlusive disease with simultaneous modified-covered endovascular reconstruction of the aortic bifurcation, inferior mesenteric artery snorkel, and lower extremity bypass.

Despite recent advancements in endovascular technology and proven durability of open surgeries, managing extensive aortoiliac occlusive disease (AIOD) with concurrent severe lower extremity (LE) arterial occlusion remains a formidable challenge. This paper introduces a comprehensive approach to addressing recurrent AIOD and LE occlusive diseases by employing modified-CERAB, inferior mesenteric artery (IMA) snorkel, and LE bypass in a challenging case. A 56-year-old male patient presented with subacute bilateral lower extremity rest pain with dry gangrene in the left great toe and a complex medical history. His history included a hostile abdomen stemming from past ischemic bowel episodes and multiple bowel resections through laparotomies. Furthermore, the patient had a persistent left ventricular thrombus (LVT), stage-2 chronic kidney disease (CKD), diabetes, and was currently experiencing bilateral LE rest pain and dry gangrene in the left great toe, accompanied by severe dermatitis in both LEs. He successfully underwent modified-CERAB with a concurrent snorkel technique for IMA preservation, along with an LE bypass to resolve bilateral LE critical ischemia. This comprehensive management approach, combining simultaneous modified-CERAB, IMA snorkel, and LE bypass, provides an effective alternative for addressing complex AIOD and LE occlusive disease patients with hostile abdomen.

Inferior Mesenteric Artery Preservation in Aorto-Iliac Recanalisation: Wise or Excessive?

Inferior Mesenteric Artery Preservation in Aorto-Iliac Recanalisation: Wise or Excessive?

Long-term functional outcome after tubular laparoscopic sigmoid resection for diverticular disease

PurposeSigmoid resection for diverticular disease is a frequent surgical procedure in the Western world. However, long-term bowel function after sigmoid resection has been poorly described in the literature. This study aims to assess the long-term bowel function after tubular sigmoid resection with preservation of inferior mesenteric artery (IMA) for diverticular disease.MethodsWe retrospectively identified patients who underwent sigmoid resection for diverticular disease between 2002 and 2012 at a tertiary referral center in northern Germany. Using well-validated questionnaires, bowel function was assessed for fecal urgency, incontinence, and obstructed defecation. The presence of bowel dysfunction was compared to baseline characteristics and perioperative outcome.ResultsTwo hundred and thirty-eight patients with a mean age of 59.2 ± 10 years responded to our survey. The follow-up was conducted 117 ± 32 months after surgery. At follow-up, 44 patients (18.5%) had minor LARS (LARS 21–29) and 35 (15.1%) major LARS (LARS ≥ 30–42), 35 patients had moderate-severe incontinence (CCIS ≥ 7), and 2 patients (1%) had overt obstipation (CCOS ≥ 15). The multivariate analysis showed that female gender was the only prognostic factor for long-term incontinence (CCIS ≥ 7), and ASA score was the only preoperative prognostic factor for the presence of major LARS at follow-up.ConclusionSigmoid resection for diverticular disease can be associated with long-term bowel dysfunction, even with tubular dissection and preservation of IMA. These findings suggest intercolonic mechanisms of developing symptoms of bowel dysfunction after disruption of the colorectal continuity that are so far summarized as “sigmoidectomy syndrome.”

Clinical impact of inferior mesenteric vein preservation during left hemicolectomy with low ligation of the inferior mesenteric artery for distal transverse and descending colon cancers: A comparative study based on computed tomography.

PurposePresence of a long remnant sigmoid colon after left hemicolectomy with inferior mesenteric vein (IMV) ligation for distal transverse and descending colon cancers may be a risk factor for venous ischemia. This study aimed to evaluate the clinical impact of IMV preservation in patients who underwent left hemicolectomy with inferior mesenteric artery (IMA) preservation.MethodsWe included 155 patients who underwent left hemicolectomy with IMA preservation for distal transverse and descending colon cancers from 2003 to 2020. Technical success of IMV preservation was determined by assessing pre- and post-operative patency of the IMV on computed tomography (CT) by an abdominal radiologist. Intestinal complications comprising ulceration, stricture, venous engorgement, and colitis in remnant colon were compared between the IMV preservation and ligation groups.ResultsIMV was preserved in 22 (14.2%) and ligated in 133 (85.8%) patients. Surgical time, postoperative recovery outcomes, and number of harvested lymph nodes were similar in both groups. The technical success of IMV preservation was 81.8%. Intestinal complications were less common in the preservation group than in the IMV ligation group (4.5% vs. 23.3%, P=0.048). The complications in the IMV ligation group were anastomotic ulcer (n=2), anastomotic stricture (n=4), venous engorgement of the remnant distal colon (n=4), and colitis in the distal colon (n=21).ConclusionsIMV preservation may be beneficial after left hemicolectomy with IMA preservation for distal transverse and descending colon cancers. We suggest that IMV preservation might be considered when long remnant sigmoid colon is expected during left hemicolectomy with low ligation of IMA.

Covered endovascular reconstruction of the aortic bifurcation associated to a snorkel technique for inferior mesenteric artery preservation

Aortic distal occlusion has been usually treated by open surgery. A persisting patent and overdeveloped inferior mesenteric artery (IMA) suggests a significant participation in the bowel circulation. Coverage of the inferior mesenteric artery (IMA) origin could compromise the bowel circulation. Covered endovascular reconstruction of the aortic bifurcation (CERAB) is a proven and guideline-suggested alternative for revascularization of the distal aortic occlusion. CERAB associated to a snorkel to the IMA aims to reduce the risk of bowel ischemia keeping and percutaneous and minimal invasive approach.

The Dilemma of the Level of the Inferior Mesenteric Artery Ligation in the Treatment of Diverticular Disease: A Systematic Review of the Literature.

Background and aim: Although sigmoidectomy is a well-standardized procedure for diverticular disease, there are still unclear areas related to the varying morphology and vascular supply of the sigmoid colon. The level of vascular ligation could affect the functional outcomes of patients operated on for diverticular disease. The aim of this review is to primarily evaluate sexual, urinary and defecatory function outcomes, as well as postoperative results, in patients who underwent surgery for diverticular disease, with or without inferior mesenteric artery (IMA) preservation. Materials and methods: The MEDLINE/PubMed, WOS and Scopus databases were interrogated. Comparative studies including patients who underwent sigmoidectomy for diverticular diseases were considered. Bowel function, genitourinary function, anastomotic leak, operation time, conversion to open surgery, anastomotic bleeding, bowel obstruction were the main items of interest. Results: Twelve studies were included in the review, three randomized and nine comparative studies. Bowel and genitourinary function are not differently affected by the level of vascular ligation. The site of ligation of IMA did not influence the rate of functional complications, anastomotic leak and bleeding. Of note, the preservation of IMA is associated with a higher conversion rate and longer operative time. Conclusions: Despite the heterogeneity of patient groups, and although the findings should be interpreted with caution, functional and clinical outcomes after sigmoidectomy for diverticular disease do not seem to be affected by the level of vascular ligation as long as the IMA is ligated far from its origin.

Risk of anastomotic bleeding after left colectomy with preservation of inferior mesenteric artery for diverticular disease: preliminary results.

The inferior mesenteric artery (IMA) preservation in elective laparoscopic left colectomy for diverticular disease may reduce the risk of anastomotic leakage. However, an increased risk of bleeding is assumed. The aim of this study was to investigate the risk of colorectal anastomosis bleeding when IMA is resected or preserved during left colectomy. A retrospective study of a prospectively collected database was performed. All patients who underwent elective left colectomy, from December 2018 to September 2020 were included. Patients' data and clinical information were collected and analyzed. Patients were categorized in two groups: IMA resected (IMA-R) and IMA preserving (IMA-P) left colectomy. Perioperative outcomes between the two groups were compared. Sixty-three consecutive patients who underwent left colectomy over a period of three years were enrolled: 42 in IMA-R group and 22 in the IMA-P group. There were no significant differences in demographic and intraoperative characteristics between the two groups, except for patients' age and primary disease. Six patients (9.37%) developed anastomotic bleeding during recovery, more frequently in the IMA-P than IMA-R group, although the difference is not statistically significative (13.6% and 7.3%; P=0.406). All bleedings were self-limited and only one needed red blood cells transfusion. Using the bioabsorbable staple line reinforcement (BSLR) has proved to be advantageous in preventing anastomotic bleeding in the IMA-P group. IMA preserving left colectomy seems to be associated with a higher risk of mostly self-limited anastomotic bleeding during recovery. BSLR seems to be effective in this group of patients.

Spinal Cord Ischemia Prevention Through Hypogastric and Inferior Mesenteric Artery Preservation During Complex Endovascular Aortic Procedures

Endovascular procedures have been widely accepted as safe treatment in patients with thoracoabdominal aortic aneurysms (TAAAs). Spinal cord ischemia (SCI) is the most dreaded complication. Its incidence is estimated in 3.9% of patients undergoing thoracoabominal procedures. As reported in American and European guidelines, spinal fluid drainage, mean arterial pressure above 100 mm Hg, hemoglobin above 10 g/dL, transcutaneous oxygen measurement above 95%, staged procedures, and collateral networks preservation are recognized as possible preventive strategies.

Totally intracorporeal colorectal anastomosis after segmental sigmoid resection with inferior mesenteric artery preservation for deep infiltrating endometriosis.

Totally intracorporeal colorectal anastomosis after segmental sigmoid resection with inferior mesenteric artery preservation for deep infiltrating endometriosis.

Risk of anastomotic bleeding after left colectomy with preservation of inferior mesenteric artery for diverticular disease: preliminary results

Background The inferior mesenteric artery (IMA) preservation in elective laparoscopic left colectomy for diverticular disease may reduce the risk of anastomotic leakage. However, an increased risk of bleeding is assumed. The purpose of this study is to investigate the risk of colorectal anastomosis bleeding, when IMA is resected or preserved during left colectomy. Methods A retrospective review of a prospectively collected database was performed. All patients who underwent elective left colectomy, from December 2018 to September 2020, were included. Patients' data and clinical information were collected and analyzed. Patients were categorized in two group: IMA resected (IMAR) and IMA preserving (IMA-P) left colectomy. Perioperative outcomes between the two groups were compared. Results Sixty-three consecutive patients who underwent left colectomy over a period of three years were enrolled: 42 in IMA-R group and 22 in the IMA-P group. There were no significant differences in demographic and intraoperative characteristics between the two groups, except for patients' age and primary disease. Six patients (9.37%) developed anastomotic bleeding during recovery, more frequently in the IMA-P than IMA-R group, although the difference is not statistically significative (13.6% and 7.3%; p=0.406). All bleedings were self-limited and only one needed red blood cells transfusion. Using the bioabsorbable staple line reinforcement (BSLR) has proved to be advantageous in preventing anastomotic bleeding in the IMA-P group. Conclusions IMA preserving left colectomy seems to be associated with a higher risk of mostly selflimited anastomotic bleeding during recovery. BSLR seems to be effective in this group of patients.

Total laparoscopic left hemicolectomy with preservation of inferior mesenteric artery and vein combined with natural orifice specimen extraction

Introduction: For left side colon cancer surgery, the roots of the inferior mesenteric artery and vein (IMA/IMV) are generally cut to perform the D3 lymph node dissection. In these cases, the extended resection of the colon would be required owing to the poor blood supply of the colon. In order to reduce the risk of distal bowel ischaemia and anastomosis leakage and preserve more normal sigmoid colon function, we aimed to introduce an innovative method to preserve the IMA/IMV and present its efficacy and safety. Materials and Methods: From January to February in 2019, two advanced colonic splenic flexure cancer (CSFC) patients received total laparoscopic left hemicolectomy with preservation of IMA/IMV combined with natural orifice specimen extraction surgery. The surgery followed the D3 lymph node dissection principle. Results: Two patients underwent a total laparoscopic surgery and no cases were converted to open or laparoscopic-assisted surgery. The mean time of operation was 148 min and mean blood loss was 50 ml. The harvested lymph nodes were 17 and 39 respective and the length of normal bowel both proximal and distal to the tumor more than 10 cm. The mean time of post-operative hospitalisation was 6 days. There were no cases of intra-or post-operative morbidity, or of bleeding owing to vessel injury. Conclusion: It is an efficient and safe technique to treat CSFC in a setting of surgeons experienced in laparoscopic colorectal surgery.

Functional and Short-term Outcomes in Elective Laparoscopic Colectomy for Symptomatic Diverticular Disease With Either Low Ligation or Inferior Mesenteric Artery Preservation: A Randomized Trial.

The current treatment of symptomatic diverticular disease is left colectomy/sigmoidectomy with low ligation of the inferior mesenteric artery versus the inferior mesenteric artery preservation. Up to now, there is no strong evidence in favor of one of the 2 strategies. The aim of this study is to compare the bowel-specific quality of life and functional outcomes between these 2. Between June 2015 and February 2019, patients were randomly assigned to inferior mesenteric artery low ligation or inferior mesenteric artery preservation during elective laparoscopic sigmoidectomy for diverticular disease. Gastrointestinal, genitourinary functions and surgical outcomes were compared postoperatively between groups. One-hundred sixty-eight patients were randomized providing 2 homogenous groups. Gastrointestinal and genitourinary functions were not significantly different between groups after 1 and 6 months postoperative. In both groups, the function was restored to the preoperative level 6 months after surgery. There was no statistically significant difference in terms of conversion rate, blood loss, length of surgery, between groups. There was no difference in the overall complication rate and the anastomotic leak rate among groups. Inferior mesenteric artery low ligation or inferior mesenteric artery preservation during elective laparoscopic sigmoidectomy for a diverticular disease can be considered equivalent in affecting the postoperative bowel-related quality of life, genitourinary function, and surgical outcomes.

Sigmoid resection for diverticular disease - to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta-analysis.

In colorectal cancer, ligation of the inferior mesenteric artery (IMA) is a standard surgical approach. In contrast, ligation of the IMA is not mandatory during treatment of diverticular disease. The object of this meta-analysis was to assess if preservation of the IMA reduces the risk of anastomotic leakage. A search was performed up to August 2018 using the following electronic databases: MEDLINE/PubMed, ISI Web of Knowledge and Scopus. The measures of treatment effect utilized risk ratios for dichotomous variables with calculation of the 95% CI. Data analysis was performed using the meta-analysis software Review Manager 5.3. Eight studies met the inclusion criteria and were included in the meta-analysis: two randomized controlled trials (RCTs) and six non-RCTs with 2190 patients (IMA preservation 1353, ligation 837). The rate of anastomotic leakage was higher in the IMA ligation group (6%) than the IMA preservation group (2.4%), but this difference was not statistically significant [risk ratio (RR) 0.59, 95% CI 0.26-1.33, I2 =55%]. The conversion to laparotomy was significantly lower in the IMA ligation group (5.1%) than in the IMA preservation group (9%) (RR 1.74, 95% CI 1.14-2.65, I2 =0%). Regarding the other outcomes (anastomotic bleeding, bowel injury and splenic damage), no significant differences between the two techniques were observed. This meta-analysis failed to demonstrate a statistically significant difference in the anastomotic leakage rate when comparing IMA preservation with IMA ligation. Thus, to date there is insufficient evidence to recommend the IMA-preserving technique as mandatory in resection for left-sided colonic diverticular disease.

Low ligation inferior mesenteric artery versus selective sigmoidal artery ligation in sigmoid colon cancer: a comparative study

Background: Ligation at the root of the inferior mesenteric artery (IMA) or ‘high-tie’ is widely accepted during oncologic resection of sigmoid colon cancer surgery. However, IMA ligation may compromise the anastomotic blood supply and risk injury to autonomic nerve plexus. The preservation of IMA or ‘low-tie’ may lead to increase blood flow and decrease postoperative bowel complications, nevertheless require longer operative time and technical difficulties. This study aims to compare the results between laparoscopic sigmoidectomy with selective sigmoidal artery ligation (group A) and low-ligation IMA (group B).Methods: A 1:2 case-matched comparative study and retrospective review of 27 patients with sigmoid cancer (19 female and 8 male) who underwent laparoscopic sigmoidectomy between January 2012 to December 2015. There were 9 patients in group A and 18 patients in group B. Perioperative results were collected and follow-up was recorded at 6 and 12 months after surgery.Results: There were no difference in the mean operative time {group A 194.44 (+28.77), group B 178.89 (+55.52), p=0.349}, blood loss {group A 94.44 (+52.71), group B 79.44 (+58.15), p=0.51}, and mean numbers of harvested lymph nodes {group A 14.56 (+3.74), group B 17.56 (+7.64), p=0.183}. Three patients in group B experienced a short period of stool frequency (2-4 weeks postoperative) and one with constipation. No leakage, bleeding, or tumor recurrence occurred in both groups during the 1 year follow up.Conclusions: Laparoscopic sigmoidectomy with selective sigmoidal artery ligation and lymph node dissection allows equivalent short-term oncologic results to low-ligation IMA technique.

Stent Graft Treatment of AAA With Preservation of the Inferior Mesenteric Artery

Coverage of the inferior mesenteric artery is standard in stent graft treatment of an infrarenal abdominal aortic aneurysm (AAA). Complications of colonic ischemia are rare, but risk factors include poor collateral flow from prior colonic surgery or from severe pelvic arterial occlusive disease. Preservation of inferior mesenteric artery (IMA) flow may prevent such complications in patients deemed to be at high risk for intestinal/pelvic ischemic complications. We have performed two unique cases of aortic stent grafting with preservation of IMA flow, comprising one IMA fenestration and one IMA snorkel. Record reviews of these two patients with details on the indications, technical details, and outcomes were recorded. A 53-year-old woman with a recent right hemicolectomy for cecal cancer also an enlarging AAA at 4.5 cm and a right iliac aneurysm of 3.8 cm. Given the recent colonic resection, the need to occlude the right internal iliac artery, and a stenotic left internal iliac artery, her risk for colonic ischemia was thought to be significantly higher than the average. To avoid this, a single fenestration was made with a back table modification of a Zenith graft (Cook Inc, Bloomington, Ind) and a Viabahn stent (W. L. Gore, Flagstaff, Ariz) and was used to fenestrate the IMA. On follow-up, the patient had no complications with no evidence of colonic ischemia and successful treatment of her AAA (Fig 1). The second patient was a 61-year-old man with a history a left iliac stent placed previously for calf claudication who developed severe, progressive hip claudication and impotence. Computed tomography angiography showed 3.5-cm iliac aneurysms and a 3.7-cm distal aortic aneurysm with preocclusive right and totally occluded left internal iliac arteries. There was a 7-mm-diameter inferior mesenteric artery coming off the AAA with severe stenosis at its origin. An Endologix AFX stent graft (Endologix, Irvine, Calif) was used to treat the aortoiliac aneurysmal disease with a long Viabahn snorkel stent placed into the IMA. Both iliac limbs were extended to the externals. Follow-up computed tomography showed complete exclusion of the aortoiliac aneurysms with no endoleak, and the patient had resolution of his hip claudication and impotence (Fig 2). Preservation of IMA flow with modified stent graft techniques is feasible and may reduce complications of colonic and pelvic ischemia in highly selected patients.Fig 1Fenestration technique. CTA, Computed tomography angiography; IMA, inferior mesenteric artery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

TCTAP A-209 Inferior Mesenteric Artery Preservation with Bare Stent in Endovascular Bilateral Iliac Aneurysm Repair Using a Bifurcated Stent Graft with Bilateral Internal Iliac Artery Coil Embolization

Endovascular aneurysm repair (EVAR) has become a first-line therapy for treating abdominal aortic aneurysms (AAAs). The endovascular treatment for common iliac artery aneurysms (CIAAs) must consist of two parts: first, the branching vessels of the internal iliac artery (IIA) are embolized using

Two Cases of Successful Inferior Mesenteric Artery Preservation with Bare Metal Stent in Endovascular Iliac Artery Aneurysm Repair

During endovascular aneurysm repair, interruption of the inferior mesenteric artery (IMA) or internal iliac arteries (IIAs) is thought to be associated with postoperative pelvic ischemic complications, including ischemic colitis. However, preserving the IIA does not guarantee protection against ischemic colitis. We herein report two cases of bilateral common iliac artery aneurysms, which were treated with bifurcated stent grafting with bilateral IIA embolization and simultaneous IMA stent placement to prevent colonic ischemia. This procedure might be effective for both preserving the IMA circulation and preventing ischemic colitis.

Totally double laparoscopic colon resection with intracorporeal anastomosis and transvaginal specimens extraction

Dear Editor: Laparoscopic colorectal resection is equivalent to open resection in terms of oncologic outcomes, with superior perioperative results. Usually, an abdominal incision is required for anastomosis and specimen extraction. Recently, natural orifice specimen extraction (NOSE) and intracorporeal anastomosis have been proposed to improve the quality of laparoscopic colon resections. Transvaginal and transanal specimen extraction have been reported in association with right and left colic intracorporeal anastomosis and these two technical innovations may maximize the advantages of laparoscopic surgery. We present a case of double colon resection with intracorporeal anastomosis and transvaginal specimens extraction. A 73-year-old female obese patient was admitted for rectal bleeding and hypochromic microcytic anemia. Past medical history was significant for hypertension, COPD, myocardial infarction, treated with double stenting 4 years before, and sigmoid diverticular disease with several episodes of diverticulitis in the last 6 years. Her BMI was 36 kg/m. She denied any change in bowel habits, neither constipation nor diarrhea. She underwent colonoscopy revealing a gradually narrowing stenosis of the sigmoid with intact mucosa. Multiple biopsies were negative for cancer and confirmed the inflammatory disease. Due to the stenosing lesion, the procedure was incomplete and a virtual colonoscopy was performed. A right-colon mass, highly suspected for cancer but apparently not involving the lymph nodes, was found. Metastatic disease was excluded with contrast-enhanced total body CT scan. Preoperative carcinoembryonic antigen (CEA) level was normal (<5 ng/ml). Because of the patient’s general conditions and to reduce the risks related to anesthesia, we decided to treat both lesions at the same surgical time. In the aim to minimize complications and according to the patient willingness, we choose a minimally invasive approach with totally laparoscopic right colectomy and sigmoidectomy. Her low-dose aspirin therapy was stopped 7 days before surgery and therapeutic-dose of lowmolecular-weight heparin was administered. Mechanical bowel preparation was avoided, a single enema was given the night before. Broad-spectrum intravenous antibiotics were administered 30 min before the skin incision and postoperatively for 24 h. The patient underwent general endotracheal anesthesia and was positioned in the lithotomic position; nasogastric tube and urinary catheter were placed. The surgeon stood at the left side of the patient for the right colectomy and on the right for the sigmoidectomy. A medial to lateral right colectomy followed by a side to side ileocolic anastomosis with linear stapler was first performed. Subsequently, a sigmoidectomy with inferior mesenteric artery preservation and side to end colorectal anastomosis, using a circular stapler, was carried out. A colotomy was made just proximal to the transection site. The anvil was introduced inside the abdomen through one of the trocar incisions, and inserted in the proximal colon through the colotomy. The proximal colon was closed with a linear stapler, and an end to side anastomosis was established using a transrectal circular stapler. A 12-mm trocar was inserted through the posterior fornix under laparoscopic vision. The culdotomy F. Stipa :V. Giaccaglia : E. Santini : L. Tammaro Department of Surgery, San Giovanni Hospital, Rome, Italy

Usefulness of inferior mesenteric artery preservation in retroperitoneal lymph node dissection

— In stage II and III non-seminomatous germ-cell testis tumor, retroperitoneal lymph node dissection is generally advised, often associated with systemic chemotherapy. Most Authors report ligature and section of the inferior mesenteric artery without any complication. We reviewed some papers by Valdoni and co-workers about preservation and peeling of the afore-mentioned artery in colo-rectal radical surgery; such procedure is technically feasible and oncologically reliable and ensures good perfusion of the descending colon, especially in the case of vascular anomalies (accessory left colic flexure artery, mono- or bilateral absence of middle rectal artery). In fact those patients subjected to retroperitoneal lymph node dissection may request colonic resection in the future; therefore preservation of the inferior mesenteric artery may represent an example of surgical foresight.

Laser Doppler flowmetry in evaluation of colonic blood flow during aortic reconstruction

Intraoperative laser Doppler flowmetry (LDF) was used to measure blood perfusion in terminal ileum and sigmoid colon in eight patients operated on for aorto-iliac occlusive disease (AIO) and eight patients for abdominal aortic aneurysm (AAA). The aim of the study was to evaluate the influence of clamping the inferior mesenteric artery (IMA) on intestinal perfusion. LDF-measured sigmoid colon flow was also compared with the postoperative clinical course, to define a limit below which risk of ischaemic colitis is high and revascularisation should be considered. Neither clamping of the IMA nor aortic reconstruction affected perfusion in the terminal ileum in any group. Sigmoid colon perfusion in the AAA-group showed a slight, not significant reduction after reconstruction (P = 0.09). AIO patients showed significant flow reduction in the sigmoid colon when the IMA was clamped (P less than 0.05), returning to the initial value after aortic reconstruction with end-to-side proximal anastomosis and preservation of IMA. AAA patients, operated with end-to-end proximal anastomosis and ligation of IMA, had significantly lower sigmoid colon perfusion after aortic reconstruction than AIO patients (P less than 0.05). Thirteen patients had sigmoid colon flux values greater than 5 RFU (Relative Flux Units) after reconstruction, and had no complications. Three aneurysm patients had flux values less than 3.3 RFU, and developed symptoms of ischaemic colitis. We conclude that LDF can be easily applied to the evaluation of colonic blood flow during aortic surgery. Flux values less than 4 RFU may indicate a risk of ischaemic colitis, and justify revascularisation of the colon.