COLON ISCHEMIA IN ABDOMINAL AORTIC ANEURYSM SURGERY REPAIR

  • Mariana Moutinho CHLN — Hospital Santa Maria
  • Ruy Fernandes Serviço de Cirurgia Vascular HSM-CHLN, Faculdade de Medicina, Universidade de Lisboa, Portugal
  • Luís Silvestre Serviço de Cirurgia Vascular HSM-CHLN, Faculdade de Medicina, Universidade de Lisboa, Portugal
  • Ana Evangelista CHLN — Hospital Santa Maria
  • Gonçalo Sobrinho Serviço de Cirurgia Vascular HSM-CHLN, Faculdade de Medicina, Universidade de Lisboa, Portugal
  • Augusto Ministro Serviço de Cirurgia Vascular HSM-CHLN, Faculdade de Medicina, Universidade de Lisboa, Portugal
  • Luísq Mendes Pedro Serviço de Cirurgia Vascular HSM-CHLN, Faculdade de Medicina, Universidade de Lisboa, Portugal
  • José Fernandes Fernandes Serviço de Cirurgia Vascular HSM-CHLN, Faculdade de Medicina, Universidade de Lisboa, Portugal
Keywords: Mesenteric ischemia, aortic aneurysm, abdominal compartment syndrome

Abstract

Background: Colon ischemia (CI) is an underdiagnosed complication of the abdominal aortic aneurysms (AAA) treatment. Objectives: The aim of this study was to analyze its frequency in patients treated for AAA and to identify predisposing factors for its occurrence to enable early diagnosis and appropriate therapeutic intervention in a timely manner.

Methods: Retrospective study which analyzes all patients’ files with infrarenal, pararenal or justarenal AAA operated in an institution in the period from 1 October 2012 to 1 October. The diagnosis of CI was confirmed by endoscopy and/or surgical intervention. The risk factors and determinants of morbidity and mortality were analyzed in 17.0 SPSS program.

Results: 161 patients underwent surgical treatment in this period, of which 117 for conventional surgery and 44 for endovascular, 119 electively and 42 in rupture. 92% were male with a mean age of 72 years. Eight of these patients had IC, 4.2% elective and 7.1% emergency. In patients with rupture, hypotension on admission was the most important determinant of IC (119 vs 68 mm Hg, p = 0,03), whereas in patients treated electively the most relevant factors were renal dysfunction (Cr 3.9 vs 1.2 mg / dL, p = 0.002 OR 2,04) and prolonged use of amines in the immediate postoperative period (40% vs 8.2%, p = 0.001 OR 22). The overall 30-day mortality was 13%, but in those with IC was 25%.

Conclusions: In our series, ruptured aneurysms, patients with severe hypotension and / or renal insufficiency at the time of admission as well as patients requiring significant intraoperative aminergic and transfusional support were more likely to suffer from IC in postoperative treatment of AAA; although, in this case, this is a less frequent complication compared to other series.

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Published
2017-09-30
Section
Original Article