Endovascular Treatment of the Celiac Trunk for Ischemic Colitis in Two Cases Following Cardiac Surgery

Yoshiki Watanabe	Hiroshi Takano	Kei Horiguchi
Masao Yoshitatsu	Kei Torikai	Seiichi Kawamoto
Miho Yamakawa and Yusuke Iwasaki

（Department of Cardiovascular Surgery, Department of Diagnostic Imaging, and Department of Cardiac Internal Medicine, Osaka General Medical Center, Osaka, Japan）

Ischemic colitis following cardiac surgery is a rare but critical complication. We report two cases of ischemic colitis following cardiac surgery successfully treated with stenting of the stenotic celiac trunk. Case 1 was a 65-year-old man who developed perioperative myocardial infarction during off-pump coronary artery bypass grafting. He experienced abdominal pain and bloody stool on postoperative day 19. Severe ischemic changes in the sigmoid colon and descending colon were seen on colonoscopy, and CT scan revealed significant stenosis of the celiac trunk and occlusion of the inferior mesenteric artery and bilateral internal iliac arteries. Revascularization of the celiac trunk via stenting resulted in dramatic improvement in colonic ischemic changes. Case 2 was a 60-year-old woman who underwent a restoration procedure for a left ventricular aneurysm. She experienced gradual onset of postprandial pain beginning 9 days after surgery and massive bloody stool on postoperative day 33. Imaging revealed severe ischemic changes in the descending colon on colonoscopy and stenoses of the celiac trunk, superior mesenteric artery, inferior mesenteric artery, and bilateral common iliac arteries on CT angiogram. Stenting was performed to the celiac trunk on postoperative day 52. Her abdominal pain and bloody stool were completely resolved after treatment. Prior to the introduction of endovascular treatment of mesenteric ischemia in 1980, the standard treatment had been open surgical repair. Since then, endovascular repair has become widely accepted. In our experience, endovascular treatment of the mesenteric vessels may be an effective and less invasive approach to treating mesenteric ischemia in unstable patients after cardiac surgery.

 

Jpn. J. Cardiovasc. Surg. 43:218-223（2014）

Keywords：ischemic colitis;endovascular therapy;stenting;cardiac surgery;complications