Risk Factors and Outcomes for Colonic Ischemia after Abdominal Aortic Aneurism Repair

Abstract

Abstract Background Colonic ischemia is a major adverse event after abdominal aortic aneurysm (AAA) repair. incidence of clinically significant colonic ischemia is in the range of 1 to 3% after elective surgery and 10% in case of rupture. When routine postoperative colonoscopy is performed, the incidence is higher. Aim of the Work It aims to review the clinical spectrum of mesenteric ischemia (CI) following abdominal aortic aneurysm (AAA) repair and to assess the incidence, overall mortality, and associated factors of occurrence. Patients and Methods This is a retrospective study which was done to assess the risk factors and outcomes of mesenteric ischemia after Abdominal Aortic Aneurism repair. This study was performed using Ain Shams University database from February 2018 to February 2021. Patients were identified who had undergone open and endovascular AAA repair using Hospitals general files. The variables of the study were chosen from the list of the original variables within the database for AAA repair including patients underwent AAA repair and had documentation of the presence or absence of postoperative IC in their medical records. Results The results of this study provide supporting evidence that repair for a ruptured AAA, open repair and need for blood transfusion, were the most important predictors of postoperative ischemic colitis. Other factors included patient factors such as age, gender, diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease and, as well as operative factors, such as long duration of surgury, excessive blood loss and ischemia time. Further, using the common femoral artery as the site of distal anastomosis during open repair and interruption of the hypogastric artery, because of ligation/occlusion during open repair were also predictors of postoperative ischemic colitis. In addition, postoperative ischemic colitis increase the duration of ICU stay and 30-day mortality was much worse in these parients. Conclusion This study reveals that although colonic ischemia following AAA repair is rare, their outcome is very poor. The cause of postoperative ischemic colitis is multifactorial. open repair and rupture of the aneurism before surgury proved to be an important predictors. Other risk factors included age, gender, hypertension, coronary artery disease, chronic kidney disease and factors indicative of more operative stress, including longer operative time, and extensive blood loss.