Abstract
PurposeColonic ischaemia (CI) represents a serious complication after aortic surgery. This study aimed to analyse risk factors and outcome of patients suffering from postoperative CI.MethodsData of 1404 patients who underwent aortic surgery were retrospectively analysed regarding CI occurrence. Co-morbidities, procedural parameters, colon blood supply, procedure-related morbidity and mortality as well as survival during follow-up (FU) were compared with patients without CI using matched-pair analysis (1:3).ResultsThirty-five patients (2.4%) with CI were identified. Cardiovascular, pulmonary and renal comorbidity were more common in CI patients. Operation time was longer (283 ± 22 vs. 188 ± 7 min, p < 0.0001) and blood loss was higher (2174 ± 396 vs. 1319 ± 108 ml, p = 0.0049) in the CI group. Patients with ruptured abdominal aortic aneurysm (AAA) showed a higher rate of CI compared to patients with intact AAA (5.4 vs. 1.9%, p = 0.0177). CI was predominantly diagnosed by endoscopy (26/35), generally within the first 4 postoperative days (20/35). Twenty-eight patients underwent surgery, all finalised with stoma creation. Postoperative bilateral occlusion and/or relevant stenosis of hypogastric arteries were more frequent in CI patients (57.8 vs. 20.8%, p = 0.0273). In-hospital mortality was increased in the CI group (26.7 vs. 2.9%, p < 0.0001). Survival was significantly reduced in CI patients (median: 28.2 months vs. 104.1 months, p < 0.0001).ConclusionCI after aortic surgery is associated with considerable perioperative sequelae and reduced survival. Especially in patients at risk, such as those with rAAA, complicated intraoperative course, severe cardiovascular morbidity and/or perioperative deterioration of the hypogastric perfusion, vigilant postoperative multimodal monitoring is required in order to initiate diagnosis and treatment.
Highlights
Aortic pathologies, including abdominal aortic aneurysm (AAA), belong to the most complex part of modern vascular surgery, requiring ongoing development of technological and treatment strategies
This study aimed to analyse the clinical course of Colonic ischaemia (CI) after aortic surgery, and to describe the short- and long-term results for these patients compared with patients without CI
The diagnoses leading to aortic surgery were intact AAA (n = 25), ruptured AAA (n = 8) and proximal anastomotic aneurysm after previous open repair (OR) (n = 2)
Summary
Aortic pathologies, including abdominal aortic aneurysm (AAA), belong to the most complex part of modern vascular surgery, requiring ongoing development of technological and treatment strategies. The majority of publications addressing CI during the last decade have focussed on the pathogenesis or early diagnosis of CI, whereas its impact on the surgical short- and long-term outcomes has been less well described [2,3,4]. A recent analysis of insurance data revealed a worsening of in-hospital outcomes and long-term survival in patients with CI, where. The medical and surgical features of the postoperative period and changes in colonic blood supply in patients with and without CI are less well-known. This study aimed to analyse the clinical course of CI after aortic surgery, and to describe the short- and long-term results for these patients compared with patients without CI
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