Incidence of Colonic Ischemia after Repair of Ruptured Abdominal Aortic Aneurysm with Endograft

Champagne, Brad; Lee, Ed C.; Valerian, Brian T.; Mulhotra, Nitten; Mehta, Manish

doi:10.1016/j.jamcollsurg.2007.01.030

Cited by 50 publications

(25 citation statements)

References 9 publications

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“…1, 9, 10, 22 Furthermore, our results for EVAR are on the lower end of what has previously been reported for EVAR series, with 0.6% vs. 0.5 – 3% for intact, and 6.4% vs. 4 – 23% for ruptured EVAR. 4–8, 11 …”

Section: Discussionmentioning

confidence: 99%

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Incidence of and risk factors for bowel ischemia after abdominal aortic aneurysm repair

Ultee

Zettervall

Soden

et al. 2016

Journal of Vascular Surgery

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Introduction Bowel ischemia is a rare but devastating complication following abdominal aortic aneurysm (AAA) repair. Its rarity has prohibited extensive risk factor analysis, particularly since the widespread adoption of endovascular repair (EVAR). Therefore, the purpose of this study was to assess the incidence of postoperative bowel ischemia following AAA repair in the endovascular era, and identify risk factors for its occurrence. Methods All patients undergoing AAA repair, either intact or ruptured, in the Vascular Study Group of New England between January 2003 and November 2014 were included. We compared patients with postoperative bowel ischemia to those without, and stratified by indication (intact and ruptured) and treatment approach (open repair and EVAR). Criteria for diagnosis were endoscopic or clinical evidence of ischemia, including bloody stools in patients who died before diagnostic procedures were performed. Independent predictors of postoperative bowel ischemia were established using multivariable logistic regression analysis. Results A total of 7312 patients were included, with 6668 intact (67.0% EVAR), and 644 ruptured AAA repairs (31.5% EVAR). The incidence of bowel ischemia following intact repair was 1.6% (open repair: 3.6%, EVAR: 0.6%), and 15.2% following ruptured repair (open repair: 19.3%, EVAR: 6.4%). Ruptured AAA was the most important determinant of postoperative bowel ischemia (OR:6.4, 95%CI:4.5 – 9.0), followed by open repair (OR:2.9, 95%CI:1.8 – 4.7). Additional predictive patient factors were advanced age (OR:1.4 per 10 years, 95%CI:1.1 – 1.7), female gender (OR:1.6, 95%CI:1.1 – 2.2), hypertension (OR:1.8, 95%CI:1.1 – 3.0), heart failure (OR:1.8, 95%CI:1.2 – 2.8), and current smoking (OR:1.5, 95%CI:1.1 – 2.1). Other risk factors included unilateral interruption of the hypogastric artery (OR:1.7, 95%CI:1.0 – 2.8), prolonged operative time (OR:1.2 per 60 min. increase, 95%CI:1.1 – 1.3), blood loss >1L (OR:2.0, 95%CI:1.3 – 3.0), and a distal anastomosis to the femoral artery (OR:1.7, 95%CI:1.1 – 2.7). Bowel ischemia patients had a significantly higher perioperative mortality after both intact (open repair: 20.5% vs. 1.9%, P<.001; EVAR: 34.6% vs. 0.9%, P<.001), as well ruptured AAA repair (open repair: 48.2% vs. 25.6%, P<.001; EVAR: 30.8% vs. 21.1%, P<.001). Conclusion This study underlines that although bowel ischemia following AAA repair is rare, the associated outcomes are very poor. The cause of postoperative bowel ischemia is multifactorial in nature, and can be attributed to patient factors, as well as operative characteristics. These data should be considered during pre-operative risk assessment, and optimization of both patient and procedure in an effort to reduce the risk of postoperative bowel ischemia.

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Section: Discussionmentioning

confidence: 99%

“…2, 9 Furthermore, the incidence of bowel ischemia is substantially higher in patients undergoing repair of a ruptured AAA, with similar increases in resulting mortality. 1, 9–11 …”

Section: Introductionmentioning

confidence: 99%

Incidence of and risk factors for bowel ischemia after abdominal aortic aneurysm repair

Ultee

Zettervall

Soden

et al. 2016

Journal of Vascular Surgery

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“…ABES = angioplasty and balloon-expandable stent placement; CA = celiac artery; COPD = chronic obstructive pulmonary disease; IMA = inferior mesenteric artery; LSCI = left-side colon ischemia; RSCI = right-side colon ischemia; SMA = superior mesenteric artery. 2 A pathogenic role of large artery hypoperfusion is manifested when colon ischemia occurs after the IMA is sacrificed during surgery for abdominal aortic aneurysm 19,20 or colon resection, 21 as in case 4 (Table 2), eliminating a critical source of collateral supply to the distribution of a diseased SMA. Therapy of visceral artery occlusion is effective.…”

Section: Original Research and Contributionsmentioning

confidence: 99%

Right-Side Colon Ischemia: Clinical Features, Large Visceral Artery Occlusion, and Long-Term Follow-Up

Longstreth

Hye²

2015

TPJ

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“…Assessment of tissue perfusion such as intestinal wall appears to be a unique and advantageous feature of HEMS which allows a longer duration for imaging. Champagne et al reported the incidence of ischemic colitis following surgery for ruptured AAA as 42% [27]. Shock status in the preoperative period is the most important predictor of ischemic colitis [28].…”

Section: Application To Aaa Surgerymentioning

confidence: 99%

Intraoperative Indocyanine Green Imaging Technique in Cardiovascular Surgery

Yamamoto¹,

Orihashi²,

Sato³

2013

Artery Bypass

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Incidence of Colonic Ischemia after Repair of Ruptured Abdominal Aortic Aneurysm with Endograft

Cited by 50 publications

References 9 publications

Incidence of and risk factors for bowel ischemia after abdominal aortic aneurysm repair

Incidence of and risk factors for bowel ischemia after abdominal aortic aneurysm repair

Right-Side Colon Ischemia: Clinical Features, Large Visceral Artery Occlusion, and Long-Term Follow-Up

Intraoperative Indocyanine Green Imaging Technique in Cardiovascular Surgery

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