[Intestinal ischemia after abdominal aorta surgery. A dreaded complication surveyed by a combination of different methods].
The article consists of a review of findings in previously published reports on intestinal ischaemia after abdominal aortic surgery. In a combined cohort and case-control study of 2,824 patients from the Swedish vascular registry, the incidence of intestinal ischaemia was 2.8%. The independent risk factors identified were preoperative shock, emergency surgery, renal insufficiency, advanced age, operation at a regional hospital, aortabifemoral grafting, ligation of one or both internal iliac arteries, bleeding > 10 litres, and operating and cross-clamping time. Cardinal symptoms were unreliable predictors. Sigmoidoscopy was potentially diagnostic in 95 per cent of cases. In a clinical study of 34 patients, sigmoid colon pHi was highly predictive of ischaemic colitis and other life-threatening complications. In a por-cine model of ischaemic colitis, blood flow in the superior mesenteric artery, colonic pHi and histological mucosal damage were unaffected by dobutamine.
Björck
M
M
Kirurgkliniken, Norrlands Universitetssjukhus, Umeå. martin@bjorck.pp.se
Bergqvist
D
D
Troëng
T
T
Haglund
U
U
Hedberg
B
B
D000368:Aged; D000818:Animals; D001012:Aorta, Abdominal / Q000601:surgery*; D016022:Case-Control Studies; D015331:Cohort Studies; D003106:Colon / Q000098:blood supply* / Q000473:pathology; D006801:Humans; D015994:Incidence; D007413:Intestinal Mucosa / Q000098:blood supply / Q000187:drug effects / Q000473:pathology; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D008954:Models, Biological; D011183:Postoperative Complications / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology*; D012039:Regional Blood Flow / Q000187:drug effects; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology