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Open Access 01-11-2020 | Abdominal Aortic Aneurysm | Original Article

Outcome analysis and risk factors for postoperative colonic ischaemia after aortic surgery

Authors: Dmitriy I. Dovzhanskiy, Moritz S. Bischoff, Christopher D. Wilichowski, Fabian Rengier, Anna Klempka, Dittmar Böckler

Published in: Langenbeck's Archives of Surgery | Issue 7/2020

Abstract

Purpose

Colonic ischaemia (CI) represents a serious complication after aortic surgery. This study aimed to analyse risk factors and outcome of patients suffering from postoperative CI.

Methods

Data of 1404 patients who underwent aortic surgery were retrospectively analysed regarding CI occurrence. Co-morbidities, procedural parameters, colon blood supply, procedure-related morbidity and mortality as well as survival during follow-up (FU) were compared with patients without CI using matched-pair analysis (1:3).

Results

Thirty-five patients (2.4%) with CI were identified. Cardiovascular, pulmonary and renal comorbidity were more common in CI patients. Operation time was longer (283 ± 22 vs. 188 ± 7 min, p < 0.0001) and blood loss was higher (2174 ± 396 vs. 1319 ± 108 ml, p = 0.0049) in the CI group. Patients with ruptured abdominal aortic aneurysm (AAA) showed a higher rate of CI compared to patients with intact AAA (5.4 vs. 1.9%, p = 0.0177). CI was predominantly diagnosed by endoscopy (26/35), generally within the first 4 postoperative days (20/35). Twenty-eight patients underwent surgery, all finalised with stoma creation. Postoperative bilateral occlusion and/or relevant stenosis of hypogastric arteries were more frequent in CI patients (57.8 vs. 20.8%, p = 0.0273). In-hospital mortality was increased in the CI group (26.7 vs. 2.9%, p < 0.0001). Survival was significantly reduced in CI patients (median: 28.2 months vs. 104.1 months, p < 0.0001).

Conclusion

CI after aortic surgery is associated with considerable perioperative sequelae and reduced survival. Especially in patients at risk, such as those with rAAA, complicated intraoperative course, severe cardiovascular morbidity and/or perioperative deterioration of the hypogastric perfusion, vigilant postoperative multimodal monitoring is required in order to initiate diagnosis and treatment.

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Title: Outcome analysis and risk factors for postoperative colonic ischaemia after aortic surgery
Authors: Dmitriy I. Dovzhanskiy
Moritz S. Bischoff
Christopher D. Wilichowski
Fabian Rengier
Anna Klempka
Dittmar Böckler
Publication date: 01-11-2020
Publisher: Springer Berlin Heidelberg
Keywords: Abdominal Aortic Aneurysm
Abdominal Aortic Aneurysm
Published in: Langenbeck's Archives of Surgery / Issue 7/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01964-2

At a glance: The STEP trials

Springer Medicine

Outcome analysis and risk factors for postoperative colonic ischaemia after aortic surgery

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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