LAUSR

OBJECTIVES The role of inferior mesenteric artery reimplantation (IMAR) during open aortic reconstruction is debated. We assessed outcomes following IMAR for aortic aneurysmal disease to help shed light on this question. METHODS Single-center retrospective review was done of all IMARs performed during open aortic surgery over a 10-year period between 2000 and 2009. Primary outcome was patency, while secondary outcomes included colonic ischemia and overall survival. Analysis was performed using Cox models and Kaplan-Meier estimates. RESULTS Of 840 elective abdominal aortic aneurysmal reconstructions performed during this period, 70 underwent IMAR. Indications for IMAR included intraoperative colonic ischemia (n = 24), poor back bleeding (n = 52), large IMA (n = 5), internal iliac disease (n = 5), and prior colon surgery (n = 1). Follow up imaging studies were available in 35 of 70 patients (computed tomography in 30 [86%] and duplex in 5 [14%]). Patency was confirmed in 32 of 35 patients (91%) over a median follow-up of 98 months. Both losses in patency were at 4 months and did not require an operation. One patient underwent left colon resection on postoperative day 9 due to ischemia (patency could not be confirmed). No statistically significant predictor of patency was noted. Incidence of colonic ischemia was 1.4% in patients undergoing IMAR. Overall mortality was 51% in patients undergoing IMAR over the median follow-up period. Overall 10-year survival was 30% in patients undergoing IMAR for aortic aneurysmal disease. Nature of aneurysm (juxtarenal or higher [JRAAA]) was associated with mortality, with a hazard ratio (HR) of 1.8 (p = 0.08) approaching significance. Ten-year survival was worse if IMAR was performed for intraoperative colonic ischemia (26% vs 34%) or in JRAAA (19.0% vs 38%; p = 0.03). Age per year at time of repair was the only statistically significant predictor of survival (P < .001). CONCLUSIONS Inferior mesenteric artery reimplantation for abdominal aortic aneurysmal disease remains necessary for select patients. Reimplantation is associated with excellent long term patency and low risk of colonic ischemia.