Outcome analysis and risk factors for postoperative colonic ischaemia after aortic surgery
- PDF / 431,549 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 93 Downloads / 195 Views
ORIGINAL ARTICLE
Outcome analysis and risk factors for postoperative colonic ischaemia after aortic surgery Dmitriy I. Dovzhanskiy 1 Dittmar Böckler 1
&
Moritz S. Bischoff 1 & Christopher D. Wilichowski 1 & Fabian Rengier 2 & Anna Klempka 2 &
Received: 15 June 2020 / Accepted: 9 August 2020 # The Author(s) 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. Comorbidities, 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. Keywords Colonic ischaemia . Aortic surgery . Abdominal aorticaneurysm . Ischaemic colitis . Outcome . Risk factors . Vascular surgery . Matched-pair analysis
Introduction Dmitriy I. Dovzhanskiy and Moritz S. Bischoff contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-01964-2) contains supplementary material, which is available to authorized users. * Dittmar Böckler [email protected] 1
Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
2
Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
Aortic pathologies, including abdominal aortic aneurysm (AAA), belong to the most complex part
Data Loading...
