Ischemia of the Left Colon Associated with Abdominal Aortic Aneurysms and Their Treatment

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Abstract
Since the advent of resectional therapy for abdominal aneurysms,1,2 it has become evident that the inferior mesenteric artery can generally be divided close to the aorta with impunity. This fact was anticipated in many of the earlier reports of extirpation of aneurysms.2-8 The hindgut derivatives usually remain viable under these circumstances because of the adequacy of collateral blood flow through the middle colic artery via the marginal artery of Drummond9 and by a similar, but less effective and constant, flow through the middle hemorrhoidal arteries from below. This latter avenue of collateral blood supply presupposes that one hypogastric artery remains open. When the hypogastrics are occluded or must be sacrificed, such flow depends upon collateral channels through the inferior hemorrhoidal artery. The dimension of time may also play an ill-defined, and possibly not too important, role in the establishment of collateral circulation by these channels. Since many

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