[HSF] Any One Had This Complication?

[Edward Bender]

I haven't had that complication, but I think I have avoided it in the past.
A few years back I did a CABG on a man in his 60's who had severe
aorto-iliac occlusive disease.  The cardiologists in my institution have a
habit of shooting the LIMA in patients referred for CABG (billable?).  The
patient had a massively huge LIMA.  I have seen a few patients in whom lower
extremity blood flow (and probably colon blood flow) was dependent on
collaterals from the IMA's to the inferior epigastrics.  I therefore did not
use a LIMA in that patient.

Ed Bender, MD


On 4/27/08 7:49 AM, "Hgrmd at aol.com" <Hgrmd at aol.com> wrote:

> Dear Members,
>   Last Friday was a tough day at the office.  First I did a  mitral,
> tricuspid, Cox-maze, CABG x1 on a 72 yo lady.  I then did an AVR,  MVR
> (heavily 
> calcified posterior annulus), tricuspid, CABG x 4, Cox-maze on a 78  yo man.
> His 
> past history was notable for the fact that he had an  aorto-enteric fistula
> (previous AAA repair) requiring excision of the graft and  a right
> axillary-bifemoral bypass.  Intraop, I noticed that the LIMA had  unusually
> brisk flow.  
> About 4 hours postop, he had a bright red  stool.  NG aspirate nonbloody.  By
> yesterday afternoon, he had begun  to develop abdominal tenderness.  He had a
> lap 
> in the early evening.   There was a dead colon requiring resection.  The small
> bowel reportedly  looked ischemic, but viable.  He's much better this
> morning, though he's  now developed ATN.  His heart is working great.  It'll
> be a 
> struggle,  but I'm cautiously optimistic he'll make it.  Anybody seen this
> scenario?
>  
> Hal
> 
> 
> 
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