Colon ischemia following abdominal aortic aneurysm repair in the era of endovascular abdominal aortic repair.
OBJECTIVE
To review, in the era of endovascular abdominal aortic repair (EVAR), the clinical spectrum of colonic ischemia (CI) following abdominal aortic aneurysm (AAA) repair and to assess the rate, overall mortality, and associated factors of occurrence.


METHODS
Between 1995 and 2005, 1174 patients with infrarenal AAA were treated either by open surgery (n = 682) or by EVAR (n = 492). Preoperative risk factors, clinical presentation, intraoperative data, and early postoperative outcomes were prospectively assessed. Overt colonic ischemia as proven by colonoscopy and/or by operation was considered as a validating event and was correlated to collected variables.


RESULTS
CI occurred in 34 patients (2.9%). Eighteen out of 34 (53%) patients died within 1 month. At 2 years, the survival rate was 35% in the CI group vs 86% in the non-CI group. Associated factors of occurrence of CI were: type of operation (open group = 27/682 [4%] vs EVAR = 7/492 [1.4%] [P = .01]), aneurysm rupture (11/88 [12.5%] vs 23/1086 [2.1%], P < .001), preoperative renal insufficiency (4/30 [13.3%] vs 29/1133 [3.1%], P = .01), preoperative respiratory insufficiency (8/157 [7%] vs 23/1005 [2%], P = .01), duration of operation (<2 hours [518] = 1.7%, between 2 to 4 hours [558] 2.9%, more than 4 hours [66] 13.6%, P = .001). Mean blood loss was greater in patients with CI (CI = 2000 ml [650-3350] than in those without CI = 1000 ml [500-1800] P = .008). Logistic regression analysis showed that rupture (OR 6.03 [interval of confidence (IC) 95% 2.68-13.5] P = .0001), duration of operation (OR 5.73 [IC 95% 2.06-15.9] P = .001) and creatinin > 200 mol/l (OR 4.67 [IC 95% 1.39-15.7] P = .028) were independent factors of CI. The mortality due to colonic ischemia was not statistically different between open surgery 14/27 (52%) and EVAR 4/7 (57%).


CONCLUSIONS
CI remains a serious complication following AAA repair. In the univariate analysis, EVAR was associated with a lower rate of colonic ischemia. However, the logistic regression analysis showed that only rupture, long duration of operation, and prior renal disease were independently associated with CI. Within the two treatment modalities, the mortality rate remained identical.
Becquemin
Jean-Pierre
JP
University of Paris, XII, Hospital Henri Mondor, Creteil, Paris. jpbecquemin@hotmail.com <jpbecquemin@hotmail.com>
Majewski
Marek
M
Fermani
Nicoletta
N
Marzelle
Jean
J
Desgrandes
Pascal
P
Allaire
Eric
E
Roudot-Thoraval
Françoise
F
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000150:complications; D016063:Blood Loss, Surgical; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D003082:Colectomy; D003106:Colon / Q000098:blood supply*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D016015:Logistic Models; D008171:Lung Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome