After Abdominal Aortic Aneurysm Research Articles

Secondary aortoenteric fistula: a narrative review of the view of the surgeon

Aortoenteric fistula (AEF) is defined as the abnormal communication between the aorta and the gastrointestinal tract. AEFs are divided into primary and secondary usually after abdominal aortic aneurysm (AAA) recovery and are a rare but quite dangerous cause of gastrointestinal bleeding that the general surgeon may face during his/her career. Secondary AEF was first described in 1953 to a 44-year-old woman 3 months after an AAA operation. This review presents the role of the surgeon in the management of secondary aortoenteric fistulas. AEFs are a rare but fatal gastrointestinal bleeding cause that the general surgeon may be asked to manage. Diagnosis requires the combination of strong clinical suspicion and the presence of a history of AAA surgery. Although a vascular surgery case, general surgeons play a role in choosing the technique of restoring the intestinal tract, which seems to be significantly related to subsequent morbidity and mortality.

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

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.

Analysis of Repair Type and Hypogastric Artery Antegrade Perfusion and Erectile Function following Repair of Abdominal Aortic Aneurysms

Published reports suggest that exclusion of antegrade hypogastric artery flow may have deleterious effects on erectile function after abdominal aortic aneurysm (AAA) repair. Off-label and open surgical hybrid procedures and, more recently, purpose-built branched devices have been developed to maintain antegrade pelvic perfusion in patients undergoing endovascular repair. Maintaining antegrade perfusion may reduce a spectrum of risks, including buttock claudication, colorectal ischemia, and spinal cord ischemia when patients undergo subsequent thoracic aortic procedures, as well as erectile dysfunction (ED). This project specifically focuses on erectile function, and analyzes baseline associations and relationships of hypogastric artery exclusion on changes in erectile function following aneurysm repair. Male patients in the Veterans Affairs Open Versus Endovascular Repair (CSP#498; OVER) Trial had erectile function assessed preoperatively and postoperatively by administration of the International Index of Erectile Function-5 questionnaire. Bayesian mixed-effects regression models were created with the outcome variable (erectile function) treated as a latent variable. Primary effects of differences in erectile function between groups with and without preservation of bilateral antegrade hypogastric flow were compared. 876 men (442 randomized to endovascular repair) were enrolled in the trial and included in the analysis comparing treatment assignment. There is significant ED in elderly men with aortic aneurysm at baseline. Over 5years of follow-up, there is modest decrease in erectile function and the endovascular group has improved function compared to open repair (0.082; 95% credible interval (CI) 0.008 and 0.155). A fifth of patients did not have bilateral preservation of antegrade hypogastric artery perfusion, with no difference in erectile function by univariate analysis. A more detailed regression analysis was applied--and after adjustment for baseline score, age, beta blocker use, diabetes, activity level, ejection fraction, preoperative ankle-brachial indices and time--preservation of both antegrade hypogastric arteries' perfusion showed transient improvement in survey scores compared to occlusion of at least 1 hypogastric artery at 6months and 12months after treatment, although this was not sustained at 60months (score change: 0.046; 95% CI: -0.123, 0.215). Retesting this model in the cohort with complete data as a sensitivity analysis did not meaningfully change the conclusions. In this large prospective aneurysm treatment trial with systematic measurement of erectile function with a validated instrument, endovascular repair is associated with improved erectile function. Preservation of antegrade hypogastric flow with any repair is associated with early improved erectile function; however, it is not a sustained benefit. There is limited benefit of maintaining bilateral hypogastric artery perfusion for this specific indication in unselected men undergoing AAA repair.

Thirty-day mortality in females after elective and urgent abdominal aortic aneurysm repair.

Female sex is a risk factor of post-operative mortality and morbidity after abdominal aortic aneurysm (AAA) repair. The aim of this systematic review is to assess the sex-specific early mortality following both elective and urgent AAA repair. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Observational studies (2000-2022), of the English medical literature, focusing on early mortality after AAA repair in females under elective or urgent setting were eligible. A systematic search of MEDLINE, EMBASE and CENTRAL databases, was conducted (November 30th, 2022). The risk of bias was assessed using the Newcastle-Ottawa Scale. Primary outcome was 30-day mortality in relevant strata. A proportional metanalysis was used to assess the estimates. Seventeen retrospective studies and 83,738 females were included. Thereof 68.7% underwent elective repair while the remaining were managed urgently. Endovascular repair (EVAR) was applied in 37.3% of patients (15.4% urgent) vs. 62.7% with OSR (23.5% urgent). In the total cohort, the perioperative mortality was estimated at 11% (OR, 95% CI: 5-17%, P<0.01, I2 99.92%) while 3% (OR, 95% CI: 0.02-0.03, P<0.01, I2 93.42%) deceased after elective repair (2% OR, 95% CI 0.01-0.02, P<0.01, I2 83.08%, after EVAR and 5% (OR, 95% CI: 0.05-0.06, P<0.01, I2 77.36%, after OSR) and 36% (OR, 95% CI: 0.28-0.44, P<0.01, I2 99.51%) after urgent repair (25% OR, 95% CI: 0.16-0.34, P<0.01, I2 98.45%, after EVAR and 40% (OR, 95% CI: 0.34-0.46, P<0.01, I2 95.96%, after OSR). AAA repair in females appears to be associated with considerable postoperative mortality. Despite the rapid development of innovative techniques and intensive care of severely ill patients, perioperative mortality after ruptured AAA remains devastatingly high.

Effect of socioeconomic status on patients undergoing elective abdominal aortic aneurysm repair in a publicly funded health care system.

The association between socioeconomic status (SES) and outcomes after abdominal aortic aneurysm (AAA) repair in publicly funded health care systems is poorly described. The purpose of this study was to determine the effect of SES on postoperative outcomes in patients who underwent AAA repair in Nova Scotia, Canada. We performed a retrospective analysis of all elective AAA repairs in Nova Scotia between November 2005 and March 2015 using administrative data sources. We compared postoperative 30-day outcomes and long-term survival across socio-economic quintiles, defined as the Pampalon Material Deprivation Index (MDI) and Social Deprivation Index (SDI). We also compared the relation between baseline characteristics, MDI quintile, SDI quintile and 30-day mortality. We used multivariable logistic regression and survival analysis to calculate adjusted 30-day mortality and long-term survival, respectively. A total of 1913 patients underwent AAA repair during the study period. The overall 30-day mortality rate was 2.6% (50 patients). Thirty-day outcomes including death (p = 0.8), stroke (p = 0.7), myocardial infarction (p = 0.06), length of stay (p = 0.3) and discharge disposition other than home (p = 0.8) were similar across MDI quintiles. Similarly, there was no statistically significant association between SDI quintile and postoperative outcomes. Multivariable analysis showed that age greater than 70 years (odds ratio [OR] 3.06, 95% confidence interval [CI] 1.55-6.06) and open repair (OR 3.22, 95% CI 1.59-6.52) but not MDI quintile (p = NS) or SDI quintile (p = NS) were associated with increased 30-day mortality. There was no effect of MDI or SDI quintile on long-term survival on univariable or multivariable analysis. Socioeconomic status does not appear to affect short- or long-term mortality after AAA repair in a publicly funded health care system. Further research is needed to address any existing gaps in screening and referral before repair.

The Association Between Body Mass Index and Death Following Elective Endovascular and Open Repair of Abdominal Aortic Aneurysms in the Vascular Quality Initiative

The effect of body mass index (BMI) on post-operative outcomes after abdominal aortic aneurysm (AAA) repair remains poorly defined. The association between BMI and death following elective endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) of AAA in a large national quality registry is investigated. All elective AAA repairs within the Society for Vascular Surgery Vascular Quality Initiative (VQI; 2010 to September 2021) were reviewed (EVAR, n= 53 426; OAR, n= 9 479). All analyses were conducted separately for EVAR and OAR patients. The primary end points were 30 day mortality and five year survival rates. Study cohorts were divided into World Health Organisation BMI categories (C1 < 18.5, C2 18.5 ≤ BMI < 25, C3 25 ≤ BMI < 30, C4, 30 ≤ BMI < 35, C5 35 ≤ BMI < 40, C6 ≥ 40). BMI was examined as both a categorical and continuous variable. Logistic and Cox proportional hazards regression were used for risk adjustment. Among EVAR patients, BMI distribution was C1, 1 216 (2%); C2, 14 687 (28%); C3, 20 516 (38%); C4, 11 352 (21%); C5, 3 947 (7%); C6, 1 708 (3%). Class 1, 2, and 6 BMI patients experienced an increased 30 day mortality rate (C1 2.6%; C2 1.3%; C6 1.4% vs. C3 - 5 0.7%; p < .001) and C1 and C2 had correspondingly inferior long term survival (five years: C1 69 ± 3%; C2 79 ± 1% vs. C3 - 6 86 - 88 ± 2%; log rank p < .001). These survival disparities persisted after risk adjustment for multiple confounders. In the OAR cohort, BMI distribution was C1, 280 (3%); C2, 2 862 (30%); C3, 3 587 (38%); C4, 1 940 (21%); C5, 581 (6%); C6, 229 (2%). Crude 30 day mortality rates were increased for both the lowest and highest BMI patients (C1 12%, C6 7% vs. C2 - 5 3 - 4%; p < .001); these differences also persisted in long term survival (five years: C1 71 ± 6%, C6 82 ± 6% vs. C2 - 6 85 - 88 ± 3%; log rank p < .001). In risk adjusted analysis, both low and high BMI OAR patients had an increased 30 day and long term mortality rate. Within the VQI, both the extreme low (< 18.5) and high (≥ 40) BMI groups experienced an increased 30 day mortality rate after both elective EVAR and OAR. By comparison, while the lowest BMI cohort was significantly associated with decreased long term survival after both procedures, the highest BMI group only experienced reduced long term survival after OAR. Based upon this large real world registry analysis of elective AAA repairs, differential metabolic signatures exist within extreme BMI categories, which may inform peri-operative risk stratification and clinical decision making.

The Importance of the Hypogastric Artery Preservation during Treatment for Aortoiliac Aneurysms: A Prospective Single-Center Study

To determine the importance of the hypogastric artery for the outcomes of survival, endoleaks, reinterventions, buttock claudication (BC), and perioperative mortality rate (PMR) in patients with aortoiliac aneurysms (AIA) receiving endovascular or open surgical (OS) repair. This was a prospective consecutive cohort study of patients with AIA who underwent endovascular treatment or OS repair during the period of 2010-2021. Endovascular repair was performed with use of aortoiliac endoprosthesis associated with internal iliac artery (IIA) coil embolization and/or with iliac branch endoprosthesis (IBE) in order to preserve the IIA. The AIA OS repairs were performed with the artery ligation in order to exclude the IIA, or in some cases, the exclusion of the IIA was performed with an endosuture in the proximal stump of the artery. Three groups were identified in the postprocedural period: group 0 (no hypogastric arteries (HAs) preserved), group 1 (1 hypogastric artery preserved), and group 2 (2 hypogastric arteries preserved). A total of 91 patients were submitted to OS or endovascular surgery. Regarding the HA patency, there were 17 patients in group 0, 45 patients in group 1, and 29 patients in group 2. There were 17 cases of bowel ischemia (BI) (94.1% in group 0, 5.9% in group 1, and no cases in group 2, P<0.001) most of them in group 0, with statistical significance, 12 cases of BC (91.7% in group 0, 8.3% in group 1, and no cases in group 2, P<0.001), most of them in group 0, with statistical significance. The perioperative mortality was 14.3%, 13 patients (9 patients - 52.9% group 0, 3 patients - 6.7% group 1, and 1 patient - 3.4% group 2, P<0.001). The linear regression analysis for survival rates showed that BI [P=0.026 to hazard ratio (HR)=1.69], emergency aortoiliac repair (P<0.001, HR=8.86), and number of HAs (P<0.001, HR=5.46) in postoperative were related to poorer survival rates in both univariate and multivariate analysis. The linear regression analysis showed that the number of HAs (P<0.001, HR=3.61) in postoperative, emergency aortoiliac repair (P=0.002, HR 3.233), and cardiac disease (P=0.048, HR=3.84) were related to BI. In conclusion, the number of HA is crucial for adequate and safe outcomes after abdominal aortic aneurysm (AAA) repair. The main factors related to death were BI, emergency aortoiliac repair, and the number of HAs preserved. Moreover, the main factors related to BI were the number of HAs in postoperative, emergency aortoiliac repair, and cardiac disease.

Comparison Between Several CT-Derived Psoas Muscle Sarcopenia Markers for Predicting Survival After Abdominal Aortic Aneurysm Repair.

Multiple CT-derived measurements of sarcopenia have been described yet their relationship with survival after abdominal aortic aneurysm (AAA) repair has not been properly assessed. We aimed to define and compare the relationship between several psoas CT-derived measurements and the 5-year survival after AAA repair and to evaluate their potential contribution to survival prediction. Preoperative CT area (TPA) and density (MTPD) of the psoas muscle at L3 were measured in 218 consecutive AAA patients electively intervened. Additional measurements were obtained by normalizing TPA by anthropometric data or L3-vertebra surface or by TPAxMTPD multiplication (lean psoas muscle area-LPMA). The association of sarcopenia markers with survival was evaluated with Cox models adjusted by age, sex, type of intervention and the Charlson Comorbidity Index, and their contribution to survival prediction assessed with the C-statistic and the Continuous Net Reclassification Index (c-NRI). Sixty patients (27.5%) died during the first 5years after surgery. There was a statistically significant and linear (spline analysis) relationship of sarcopenia markers with 5-year survival in all multivariate models, except that including LPMA. Despite this association, the inclusion of sarcopenia markers did not improve the C-statistic and moderately increased the c-NRI. None normalized sarcopenia markers performed better than TPA. The majority of CT-derived psoas muscle measurements of sarcopenia showed a significant and independent relationship with survival after elective AAA repair. Despite this association, they did not appear to improve sufficiently our survival prediction ability to become an efficient tool for decision-making.

The Impact of Medicaid Expansion on Outcomes After Abdominal Aortic Aneurysm Repair

The Impact of Medicaid Expansion on Outcomes After Abdominal Aortic Aneurysm Repair

TH4.4 Real-world mid to long term mortality after Abdominal Aortic aneurysm (AAA) repair

Abstract Aim Centralisation of vascular services has decreased 30-day AAA mortality from 7% to 3% across UK, but does it have an effect on their long term survival? Methods Electronic patient records for 264 patients with AAA repair between 2009–2018 submitted to national vascular registry (NVR) from a single centre were analysed. Results 231 of 264 patients (88%) had endovascular aneurysm repair (EVAR) while 19 (12%) had open repair (OR). Male to Female ratio 8:1; Mean age 76.5 years at time of surgery (TOS). 251 elective, 13 were emergency repairs. 192 (72%) of patients have died since surgery- a median survival of 4 years (IQR 2–7) post-surgery. Of these, 171 were male, with a median survival of 4 years (IQR 2–7); 21 were female, with median survival 3 years (IQR 1–5). Cause of death could be ascertained only in 27 &amp; 23 were attributable to non-aortic reasons. Median survival post-surgery in 70–80 years age group (n-89) and 80+ (n-82), was 5 years (2–7) and 3 years (1.25–5), respectively. Cohorts of patients who lived either greater or less than median survival years were aged similarly at TOS; 79.7 and 80.4 years, Mean survival post-EVAR was 4.5 years, while post-OR was 2.3 years. Conclusion With a median and mean survival post surgery of about 4 years, is it time we had mandatory involvement of Geriatric physicians/older person assessment units like POPS (Perioperative medicine for Older People Undergoing Surgery) in patient risk assessment preoperatively especially in those that require costly customised stent grafts.

Disparities in Five-Year Outcomes and Imaging Surveillance After Elective Endovascular Repair of Abdominal Aortic Aneurysm by Sex, Race, and Ethnicity

Disparities in perioperative outcomes after abdominal aortic aneurysm (AAA) repair stratified by sex, race, and ethnicity have been described; however, data on long-term outcomes are limited. Our aim was to identify differences in 5-year outcomes and imaging surveillance after elective endovascular aortic aneurysm repair (EVAR) by sex, race, and ethnicity and to explore the potential mechanisms underlying these differences.

Emphasis on Early Identification of Risk Factors to Curtail High Mortality Involved With Ischemic Colitis (IC) After Abdominal Aortic Aneurysm (AAA) Repair.

Ischemic colitis (IC) is one of the most feared complications after abdominal aortic aneurysm (AAA) repair. Though the complication is seen in only a handful of total repairs, the mortality rates after IC is very high. Due to infrequent presentation, attending doctors may overlook this possibility leading to a delay in diagnosis. Open repair and endovascular aneurysm repair (EVAR) are the two most common methods used for repairing aneurysms and both of these procedures have their implications in the development of IC. While the incidence of IC was greater after open repair, it also harbored more patients with ruptured aneurysms, emergency repairs, and patients in shock. Similarly, a significant proportion of patients having ruptured aneurysms developed IC. Controlling minor variables like acidosis, hypothermia, hypovolemia, and clamp time duration can play a cumulative role in diminishing this hazardous complication. Medical advancements and minimally invasive technologies have improved the quality of care and operation success considerably, but researchers have not identified a statistically significant association in the prevention of postoperative IC. Therefore, early diagnosis and prompt management become crucial in reducing mortality rates. This can be achieved by being aware of impending signs and symptoms especially in patients with risk factors and being proactive in medical management.

A systematic review and meta-analysis on early mortality after abdominal aortic aneurysm repair in females in urgent and elective settings

Objective Females represent a group of patients with higher mortality after abdominal aortic aneurysm (AAA), endovascular (EVAR), or open surgical (OSR), repair. This systematic review aimed to evaluate the 30-day mortality after AAA repair in females, comparing both EVAR and OSR, in elective and urgent settings.

Comparison of the Bifurcated Graft Reconstruction and Aortic Stump Closure in Open Surgical Conversion After Endovascular Aneurysm Repair

The optimal management of the aortic stump in open surgical conversion (OSC) after Abdominal aortic aneurysm (AAA) endovascular aneurysm repair (EVAR) is debated. Therefore, we aimed to compare the efficacies and safety between the bifurcated prosthetic vascular graft in situ stump reconstruction (p-graft ISSR) and aortic stump closure (ASC) in OSC. We analyzed 973 elective AAA patients admitted from January 01, 2001 to December 31, 2020, at the First Affiliated Hospital of Sun Yat-sen University. We conducted a statistical analysis of the clinical characteristics, procedural data, as well as outcomes and technique considerations of aortic stump management in OSC patients. A total of 24 male patients had OSC after EVAR. The rate of stent graft infection was 54.17% before OSC. Eleven patients underwent ASC, and 13 patients were treated with p-graft ISSR. The major complication after OSC was aortic stump bleeding (total incidence was 37.50%) (1 patient with a periaortic hematoma and 8 patients with a stump blowout). The total incidences of stump blowout between the patients with ASC and those with p-graft ISSR were significantly different (45.45% vs. 23.08%, P < 0.05). The total perioperative mortality was 25.00% (6 patients with stump blowouts). The perioperative survival rates between these 2 aortic stump management approaches were 72.72% and 76.92% (ASC vs. p-graft ISSR, P < 0.05). In total, 18 patients were followed up (3-180 months). There were 3 aorta-related deaths during the late follow-up period (including both of the 2 stump-blowout-related deaths just treated with ASC). If the condition of the aorta and peri-aortic tissue are suitable for a prosthetic graft bypass, the p-graft ISSR is highly recommended for OSC patients after EVAR.

A Unique Case of an Expanded Polytetrafluoroethylene Graft Rupture 14 Years after Abdominal Aortic Aneurysm Open Repair Managed with Placement of a Thoracic Endograft.

We report a unique case of expanded polytetrafluoroethylene (ePTFE) tube graft rupture that occurred 14 years after abdominal aortic aneurysm (AAA) repair. Endovascular repair with a thoracic endograft was performed. Postoperatively, an increase in the size of the existing hematoma with active extravasation occurred and was managed with iliolumbar artery embolization. Τo the best of our knowledge, rupture of ePTFE graft used for AAA repair has not been reported in the literature.

Racial and Ethnic Differences in Long-term Outcomes After Elective Endovascular Repair of Abdominal Aortic Aneurysm

Racial and ethnic disparities in perioperative outcomes after abdominal aortic aneurysm (AAA) repair have been described, but differences in long-term outcomes are poorly understood. Our aim was to identify racial/ethnic differences in late aneurysm rupture, reintervention, and survival after elective endovascular AAA repair (EVAR) and to explore potential mechanisms underlying these differences.

Effect of Chronic Kidney Disease on Perioperative Mortality and Morbidity After Complex Abdominal Aortic Aneurysm Repair

Preoperative chronic kidney disease (CKD) is associated with worse outcomes after abdominal aortic aneurysm (AAA) repair. However, between complex open and endovascular AAA repair, the effect of CKD on perioperative mortality and morbidity has not yet been defined. We compared the outcomes between strata of CKD severity after complex open and endovascular AAA repair (EVAR).

Effect of Preoperative Aspirin, Beta-Blocker, and Statin Usage on Perioperative and One-Year Mortality of Abdominal Aortic Aneurysm Repair

Improved perioperative management and surgical techniques have significantly reduced morbidity and mortality after abdominal aortic aneurysm (AAA) repair in recent years. However, guidelines remain unclear regarding the role of preoperative medical management in long-term outcomes. Aspirin, statins, and beta-blockers have individually shown promising Results, but data assessing the efficacy and combinative effect remain limited. In our study, we evaluated the association between the preoperative use of these pharmacotherapeutic agents and the postoperative and long-term outcomes of AAA repair in the Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network.

Effect of Statins on Total Mortality in Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-analysis

The aim was to summarise the evidence from published epidemiological studies investigating the efficacy of statin therapy on long term survival in patients after abdominal aortic aneurysm (AAA) repair.

Nationwide Study to Predict Colonic Ischemia after Abdominal Aortic Aneurysm Repair in The Netherlands

Colonic ischemia remains a severe complication after abdominal aortic aneurysm (AAA) repair and is associated with a high mortality. With open repair being one of the main risk factors of colonic ischemia, deciding between endovascular or open aneurysm repair should be based on tailor-made medicine. This study aims to identify high-risk patients of colonic ischemia, a risk that can be taken into account while deciding on AAA treatment strategy. A nationwide population-based cohort study of 9,433 patients who underwent an AAA operation between 2014 and 2016 was conducted. Potential risk factors were determined by reviewing prior studies and univariate analysis. With logistic regression analysis, independent predictors of intestinal ischemia were established. These variables were used to form a prediction model. Intestinal ischemia occurred in 267 patients (2.8%). Occurrence of intestinal ischemia was seen significantly more in open repair versus endovascular aneurysm repair (7.6% vs. 0.9%; P<0.001). This difference remained significant after stratification by urgency of the procedure, in both intact open (4.2% vs. 0.4%; P<0.001) and ruptured open repair (15.0% vs. 6.2%); P<0.001). Rupture of the AAA was the most important predictor of developing intestinal ischemia (odds ratio [OR], 5.9, 95% confidence interval [CI] 4.4-8.0), followed by having a suprarenal AAA (OR 3.4; CI 1.1-10.6). Associated procedural factors were open repair (OR 2.8; 95% CI 1.9-4.2), blood loss >1L (OR 3.6; 95% CI 1.7-7.5), and prolonged operating time (OR 2.0; 95% CI 1.4-2.8). Patient characteristics included having peripheral arterial disease (OR 2.4; 95% CI 1.3-4.4), female gender (OR 1.7; 95% CI 1.2-2.4), renal insufficiency (OR 1.7; 1.3-2.2), and pulmonary history (OR 1.6; 95% CI 1.2-2.2). Age <68 years proved to be a protective factor (OR 0.5; 95% CI 0.4-0.8). Associated mortality was higher in patients with intestinal ischemia versus patients without (50.6% vs. 5.1%, P<0.001). Each predictor was given a score between 1 and 4. Patients with a score of ≥10 proved to be at high risk. A prediction model with an excellent AUC=0.873 (95% CI 0.855-0.892) could be formed. One of the main risk factors is open repair. Several other risk factors can contribute to developing colonic ischemia after AAA repair. The proposed prediction model can be used to identify patients at high risk for developing colonic ischemia. With the current trend in AAA repair leaning toward open repair for better long-term results, our prediction model allows a better informed decision can be made in AAA treatment strategy.