Incidence, Predictors, and Outcomes of Colonic Ischaemia in Abdominal Aortic Aneurysm Repair

Behrendt, Christian‐Alexander; Rieß, Henrik; Schwaneberg, Thea; Larena‐Avellaneda, Axel; Kölbel, Tilo; Tsilimparis, Nikolaos; Σπανός, Κωνσταντίνος; Debus, Eike Sebastian; Sedrakyan, Art

doi:10.1016/j.ejvs.2018.06.010

Cited by 28 publications

(32 citation statements)

References 33 publications

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“…After elective endovascular AAA repair, the incidence of colonic ischemia was reported to be approximately 0.5% to 1.0%, with increased odds of morbidity and mortality. [29][30][31] Interestingly, to the best of our knowledge, no valid association between bleeding, transfusion, and colonic ischemia after complex aortic repair was reported before this study.…”

Section: Discussionmentioning

confidence: 53%

Predictors of bleeding or anemia requiring transfusion in complex endovascular aortic repair and its impact on outcomes in health insurance claims

Behrendt

Debus

Schwaneberg

et al. 2020

Journal of Vascular Surgery

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Objective: This study aimed to determine predictors and outcomes associated with bleeding or anemia requiring transfusion (BAT) after fenestrated or branched endovascular aneurysm repair (FB-EVAR). Methods: Health insurance claims data of Germany's third largest insurance provider, DAK-Gesundheit, were used to investigate BAT in elective FB-EVAR performed between 2008 and 2017. International Classification of Diseases and German Operations and Procedure Key codes were used. Results: A total of 959 patients (24.8% with BAT) matching the inclusion criteria were identified during the study period. Compared with patients without BAT, patients with BAT were older (74.4 vs 73.0 years; P ¼ .015) and suffered more frequently from congestive heart failure (18.5% vs 9.4%), cardiac arrhythmias (26.9% vs 14.7%), and hereditary or acquired coagulopathy (31.9% vs 6.2%; all P < .001). Coagulopathy (odds ratio [OR], 3.65; 95% confidence interval [CI], 2.29-5.84), female sex (OR, 2.67; 95% CI, 1.78-4.00), and multiple comorbidities (OR, 1.10; 95% CI, 1.07-1.14) were independent predictors of BAT (all P < .001). BAT was associated with higher in-hospital (11.3% vs 2.6%), 30-day (12.2% vs 3.1%), and 90-day (18.5% vs 4.4%) mortality (all P < .001). Furthermore, myocardial infarction (23.9% vs 2.8%) and paraplegia (9.7% vs 0.7%) were more frequent in the BAT group (all P < .001). In multivariable analyses, BAT was associated with worse short-term (OR, 3.19; 95% CI, 1.63-6.33; P ¼ .001) and long-term survival (hazard ratio, 1.62; 95% CI, 1.24-2.11; P < .001). Conclusions: Patients with hereditary or acquired coagulopathy, patients with multiple comorbidities, and women are at higher risk for development of BAT after FB-EVAR. The occurrence of this event was strongly associated with higher major complication rates and worse short-term and long-term survival. This emphasizes a need to further illuminate the value of patient blood management in FB-EVAR.

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Section: Discussionmentioning

confidence: 53%

Predictors of bleeding or anemia requiring transfusion in complex endovascular aortic repair and its impact on outcomes in health insurance claims

Behrendt

Debus

Schwaneberg

et al. 2020

Journal of Vascular Surgery

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“…Therefore, diagnosis of CI after aortic surgery requires a high index of suspicion, especially in patients with rAAA. Current literature suggests that EVAR is associated with lower rates of CI compared to OR [4,5]. For example, Italicized entries mean statistically significant results CI, colonic ischaemia In this study, CI was diagnosed in 20 of 35 within the first four postoperative days.…”

Section: Discussionmentioning

confidence: 60%

“…The online version of this article (https://doi.org/10.1007/s00423-020-01964-2) contains supplementary material, which is available to authorized users. endovascular techniques (EVAR) seemed to be protective after repairs of both ruptured and intact AAA [5]. Williamson et al [4] also reported a reduced incidence of CI after EVAR in their meta-analysis compared to open repair (OR).…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

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

Dovzhanskiy

Bischoff

Wilichowski

et al. 2020

Langenbecks Arch Surg

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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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“…The colonic resection was adapted to the IC extension, leading to a great majority of subtotal or total colectomies. Previous studies reported high mortality rates for IC developed after ruptured AAA repair surgery [15,16,20,26,40], with some differences related to the type of aortic surgery [14,22,40]. Indeed, a recent systematic review and metaanalysis demonstrated that IC occurs more frequently after open repair (2.1-3.6%) than in EVAR (0.5-1%) in the elective setting [22].…”

Section: Discussionmentioning

confidence: 99%

Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience

et al. 2020

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Background: Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. Additionally, we compared postoperative outcomes of patients undergoing emergent colectomy due to aortic surgery-related IC (AS-IC group) vs. other IC etiologies (Other-IC group). Methods: We analyzed records of consecutive patients who underwent emergency open colectomy for IC between 2008 and 2019. Logistic regression analysis was performed to identify clinical and operative parameters associated with postoperative mortality. The AS-IC and Other-IC groups were compared for mortality, morbidity, ICU stay, hospital stay, and survival. Results: During the study period, 94 patients (mean age, 67.4 ± 13.7 years) underwent emergent open colectomy for IC. In the majority of cases, IC involved the entire colon (53.2%) and vasopressor agents were required preoperatively (63.8%) and/or intraoperatively (78.8%). Thirty-four patients underwent surgery due to AS-IC, whereas 60 due to Other-IC causes. In the AS-IC group, 9 patients had undergone endovascular aortic repair and 25 open aortic surgery; 61.8% of patients needed aortic surgery for ruptured abdominal aortic aneurism (AAA). Overall, 66 patients (70.2%) died within 90 days from surgery. The AS-IC and Other-IC groups showed similar operative outcomes and postoperative complication rates. However, the duration of the ICU stay (19 days vs. 11 days; p = 0.003) and of the total hospital stay (22 days vs. 16 days; p = 0.016) was significantly longer for the AS-IC group than for the Other-IC group. The rate of intestinal continuity restoration at 1 year after surgery was higher for the Other-IC group than for the AS-IC group (58.8% vs. 22.2%; p = 0.05). In the multivariate model, preoperative increased lactate levels, a delay between signs/symptoms' onset and surgery > 12 h, and the occurrence of postoperative acute kidney injury were statistically associated with postoperative mortality. Neither IC etiology (aortic surgery vs. other etiology) nor ruptured AAA was associated with postoperative mortality. Conclusion: Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, > 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality.

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Incidence, Predictors, and Outcomes of Colonic Ischaemia in Abdominal Aortic Aneurysm Repair

Cited by 28 publications

References 33 publications

Predictors of bleeding or anemia requiring transfusion in complex endovascular aortic repair and its impact on outcomes in health insurance claims

Predictors of bleeding or anemia requiring transfusion in complex endovascular aortic repair and its impact on outcomes in health insurance claims

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

Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience

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