The Value of Sigmoidoscopy to Detect Colonic Ischaemia After Ruptured Abdominal Aortic Aneurysm Repair

Abstract

Objectives: Carotid stenosis patients are at risk of vascular events despite antiplatelet therapy. Data on prescribed antiplatelet regimens have not been comprehensively collated from trials to guide optimal therapy in this population.Methods: This review was conducted in line with the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Medline, Ovid, Embase, Web of Science, and Google Scholar from 1988 to 2018 were searched using the search terms "carotid stenosis", "asymptomatic", "symptomatic", "antiplatelet", and "anti-platelet" to identify randomised trials in patients with asymptomatic or symptomatic extracranial moderateesevere carotid stenosis on any form of antiplatelet therapy in which vascular events and pre specified composite outcome events were reported.Results: Twenty-five studies were judged eligible for inclusion. Data from one randomised controlled trial showed no significant difference in benefit with aspirin versus placebo in asymptomatic carotid stenosis, but it is still reasonable to recommend aspirin (81e325 mg daily) for prevention of vascular events in these patients. Low to medium dose aspirin (81e325 mg daily) is superior to higher doses (>650 mg daily) at preventing recurrent vascular events in patients undergoing endarterectomy. Data from endovascular treatment (EVT) trials support peri-procedural treatment of asymptomatic and symptomatic patients with 81e325 mg of aspirin daily. The use of peri-procedural aspirineclopidogrel in patients undergoing EVT is based on one pilot trial, but appears safe. Short-term aspirinedipyridamole or aspirineclopidogrel treatments are equally effective at reducing micro-embolic signals on transcranial Doppler ultrasound in patients with $50% symptomatic carotid stenosis. There is insufficient evidence to recommend routine aspirineclopidogrel combination therapy to reduce the risk of recurrent clinical ischaemic events in patients with symptomatic moderateesevere carotid stenosis.Conclusions: This comprehensive review outlines an evidence based approach to antiplatelet therapy in carotid stenosis patients. Future trials should randomise such patients to receive different antiplatelet regimens to assess their efficacy and safety and to optimise peri-procedural and long-term preventive treatment in this patient cohort.

The specialty of surgical critical care: A white paper from the American Association for the Surgery of Trauma Critical Care Committee

“…Understanding the perioperative risk factors, early recognition of ischemia, and knowledge of the differences in intervention required for mucosal and transmural ischemia are critical to enhance patient outcome. 44,45 Similar advantages have been noted in the critical care of postoperative head and neck surgery patients, 46 pancreaticoduodenectomy patients, 47 and vascular surgery patients, 48 where understanding of anatomy, postoperative physiology, and postoperative complications provide optimal patient outcomes. In a single center study, admission of patients with necrotizing soft tissue infections to an ACS service was associated with a significant reduction in time to surgical source control compared with those admitted to a non-ACS service, 49 often because of more rapid, accurate diagnosis on the ACS service.…”

“…For example, postoperative ischemic colitis following abdominal aortic aneurysm repair is a rare but lethal condition associated with a fourfold higher risk of adjusted in-hospital mortality. Understanding the perioperative risk factors, early recognition of ischemia, and knowledge of the differences in intervention required for mucosal and transmural ischemia are critical to enhance patient outcome 44,45 . Similar advantages have been noted in the critical care of postoperative head and neck surgery patients, 46 pancreaticoduodenectomy patients, 47 and vascular surgery patients, 48 where understanding of anatomy, postoperative physiology, and postoperative complications provide optimal patient outcomes.…”

Value of Routine Flexible Sigmoidoscopy and Potential Predictive Factors for Colonic Ischemia after Open Ruptured Abdominal Aortic Aneurysm Repair

“…Jalalzadeh H et al published that cardiac comorbidity, low first hemoglobin, and high vasopressor administration were independently associated with CI [19].…”

Sigmoidoscopy an Effective Tool for Identifying Colonic Ischaemia After Ruptured AAA

“…The study by Jalalzadeh et al 1 investigated the effectiveness of sigmoidoscopy for identifying colonic ischaemia (CI) in patients who suffered ruptured abdominal aortic aneurysms (RAAAs) in the Dutch Dream Trial.…”