eMedicine Specialties > General Surgery > Abdomen

Abdominal Angina: Follow-up

Author: Carol EH Scott-Conner, MD, PhD, Professor, Department of Surgery, University of Iowa College of Medicine
Coauthor(s): Beth Ballinger, MD, Assistant Professor, Department of Surgery, Section of Vascular Surgery, University of Iowa College of Medicine
Contributor Information and Disclosures

Updated: Sep 6, 2007

Follow-up

Further Inpatient Care

  • Intraoperative considerations
    • Cardiac monitoring with transesophageal echo or invasive monitoring may be needed.
    • Intraoperative duplex ultrasound examination of the reconstruction is important.
  • Postoperative care and complications
    • Most patients require monitoring in an intensive care unit. Postoperative ileus is common.
    • In addition to the usual cardiac problems traditionally associated with major vascular repairs, major postoperative complications include bleeding and coagulopathy, pulmonary insufficiency, and hepatic and renal failure.
    • In multiple studies, a picture similar to multiorgan dysfunction occurs in a small but significant minority of patients. Reperfusion injury has been hypothesized to trigger this cascade of events. Immediate pronounced hepatocellular dysfunction has been noted as an early event in some of these cases.
    • In one series, coronary artery disease and chronic renal insufficiency prior to surgery were associated with postoperative complications.

Further Outpatient Care

  • Both duplex ultrasonography and magnetic resonance imaging have been used for follow-up, but, because the proper management of an asymptomatic occlusion of a reconstruction is unknown, this generally is not recommended.

Complications

Prognosis

  • Currently, more than 700 cases in the literature describe good early clinical results after surgical revascularization, and this treatment remains the criterion standard.
    • Reocclusion is more prevalent in males than in females (in contrast to the female predominance noted at initial presentation).
    • Several series have demonstrated that 86-96% of patients remain asymptomatic at 5 and 10 years, with similar graft patency rates.

Patient Education

  • Patients should be counseled to stop smoking.

Miscellaneous

Medicolegal Pitfalls

  • Because most of these patients have generalized vascular disease, failure to perform a cardiovascular evaluation before surgery could be a medicolegal pitfall.
 


More on Abdominal Angina

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Multimedia: Abdominal Angina
References
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Further Reading

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Keywords

intestinal angina, chronic mesenteric ischemia, abdominal angina, postprandial abdominal angina, occlusive mesenteric vascular disease, postprandial pain, symptomatic occlusive mesenteric ischemia, central abdominal pain

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Contributor Information and Disclosures

Author

Carol EH Scott-Conner, MD, PhD, Professor, Department of Surgery, University of Iowa College of Medicine
Carol EH Scott-Conner, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Gastroenterology, American College of Surgeons, American Medical Association, American Society for Gastrointestinal Endoscopy, Association for Academic Surgery, Association for Surgical Education, Association of VA Surgeons, Iowa Medical Society, Sigma Xi, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Critical Care Medicine, Society of Surgical Oncology, Society of University Surgeons, and Southeastern Surgical Congress
Disclosure: Nothing to disclose.

Coauthor(s)

Beth Ballinger, MD, Assistant Professor, Department of Surgery, Section of Vascular Surgery, University of Iowa College of Medicine
Beth Ballinger, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Medical Association, Iowa Medical Society, and Minnesota Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Marc D Basson, MD, PhD, Chief of Surgery, John D Dingell VA Medical Center; Professor, Department of Surgery, Wayne State University School of Medicine
Marc D Basson, MD, PhD is a member of the following medical societies: American College of Surgeons and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David L Morris, MD, PhD, Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other; AMGEN Consulting fee Consulting

 
 
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