Match each postoperative clinical presentation following cardiothoracic or vascular surgery with its corresponding pathophysiological mechanism or definitive diagnosis.
- A 71-year-old man on postoperative day 1 after open infrarenal abdominal aortic aneurysm repair develops fever, left-sided abdominal tenderness, and bloody diarrhea. Flexible sigmoidoscopy reveals scattered mucosal ulcerations in the distal colon.Ischemic colitis secondary to inferior mesenteric artery sacrifice and inadequate collateral flow via the marginal artery of Drummond
- A 65-year-old woman undergoes emergent embolectomy for acute limb ischemia present for 10 hours. Postoperatively, pedal pulses are restored, but she develops excruciating calf pain exacerbated by passive movement, tense edema, and dark brown urine.Compartment syndrome from reperfusion injury, leading to increased fascial compartment pressure, myonecrosis, and myoglobinuria
- A 75-year-old man undergoes surveillance imaging 1 year after endovascular aneurysm repair (EVAR). CT angiography demonstrates an enlarging aneurysm sac with contrast accumulation outside the stent graft but within the sac. There is no evidence of a graft attachment site leak or fabric tear.Type II endoleak due to persistent retrograde flow from patent aortic branch vessels into the excluded aneurysm sac
- A 68-year-old man who underwent open repair of a descending thoracic aortic aneurysm develops new-onset flaccid paraplegia and bilateral loss of pain and temperature sensation below the umbilicus, while joint position and vibration sense remain intact.Anterior cord syndrome resulting from ischemia or disruption of the great radicular artery (artery of Adamkiewicz)
Answer
The correct matches align ischemic colitis with IMA sacrifice, compartment syndrome with reperfusion injury, Type II endoleak with retrograde branch vessel flow, and anterior cord syndrome with disruption of the artery of Adamkiewicz.
Each postoperative scenario provides classic hallmark signs of major vascular surgery complications. Left colon ischemia is a known risk of IMA ligation during AAA repair. Compartment syndrome is a classic reperfusion injury following prolonged acute limb ischemia. Type II endoleaks are the most common cause of sac expansion post-EVAR when the graft itself is intact. Anterior cord syndrome is the dreaded neurological complication of descending thoracic aortic interventions due to spinal cord hypoperfusion.
Step-by-Step Solution
Key Concept
Major postoperative complications in vascular and cardiothoracic surgery, including their distinct clinical presentations and pathophysiological mechanisms.