Ischemic colitis after endovascular aortoiliac aneurysm repair: a 10-year retrospective study.
OBJECTIVE
To examine the incidence, cause, and outcomes of ischemic colitis after endovascular stent graft repair of aortoiliac aneurysms (EVAR).


METHODS
Medical record review.


METHODS
University teaching hospital.


METHODS
Eight hundred nine patients treated during 10 years were included in the study. Preoperative data regarding the size of the aneurysm, hypogastric coil embolization, and inferior mesenteric artery patency were evaluated by means of computed tomographic scans and aortograms. Ischemic colitis was diagnosed by lower endoscopy or pathology reports.


METHODS
Ischemic colitis after EVAR.


RESULTS
Eleven patients (1.4%) developed ischemic colitis. Seven patients' episode occurred less than 30 days from repair (early), whereas 4 occurred 30 days or more from repair (late). Ten of 11 patients had preoperative inferior mesenteric artery occlusion. Microembolization was seen histologically in 2 patients in the early group, both of whom died. A significant increase in ischemic colitis was seen in patients undergoing preoperative unilateral hypogastric coil embolization (P = .02). Three of the patients with late ischemic colitis had comorbidities other than the EVAR to explain the ischemia.


CONCLUSIONS
The incidence of ischemic colitis is decreased in patients undergoing EVAR vs open repair. The cause of the ischemia is multifactorial and seems to differ between patients in the early and late groups. Microembolization tends to produce severe ischemic colitis and is usually fatal. There should be a low threshold for performing endoscopy in any patient thought to have ischemic colitis after EVAR.
Department of Surgery, Mount Sinai School of Medicine, 5 E 98th St, New York, NY 10029, USA.
Aaron
A
Miller
Michael
M
Marotta
Irini
I
Scordi-Bello
Yolanda
Y
Tammaro
Michael
M
Marin
Celia
C
Divino
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000473:pathology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D015331:Cohort Studies; D017091:Colitis, Ischemic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014654:Vascular Patency