Reliability of Selective Surveillance Colonoscopy in the Early Diagnosis of Colonic Ischemia After Successful Ruptured Abdominal Aortic Aneurysm Repair

Megalopoulos, Angelos; Vasiliadis, Konstantinos; Tsalis, Konstantinos; Kapetanos, Dimitrios; Bitzani, Militsa; Tsachalis, T.; Batziou, Eleni; Botsios, Dimitrios

doi:10.1177/1538574407306797

Cited by 14 publications

(19 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Dadian et al identified intra-operative hypotension of <70mmHg as associated with IC [19] . Three studies identified that massive transfusion was associated with increased rates of IC [19,20,15] . All of these were retrospective singlecentre observational studies.…”

Section: Pre-operative Factorsmentioning

confidence: 99%

“…The odds ratio of developing IC if hypotension lasted for 30 minutes or more ranged from 1.26-30 [16,18,15] . Dadian et al identified intra-operative hypotension of <70mmHg as associated with IC [19] .…”

Section: Pre-operative Factorsmentioning

confidence: 99%

“…The reported rates of ischaemic colitis after elective surgery ranged from 0% to 4.6% [11,12] versus 5% to 20.5% [13,14] after emergency surgery. Six studies looked in more depth at emergency presentations and found those who had ruptured aneurysm demonstrated a higher rate of IC compared to those who had not ruptured (3.2 to 6.4 times more likely in ruptures) [9,13,15,10,16,17] . The studies reporting this are retrospective cohort studies.…”

Section: Pre-operative Factorsmentioning

confidence: 99%

See 2 more Smart Citations

Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis

Lee

Daniels

Drake

et al. 2016

Int J Colorectal Dis

View full text Add to dashboard Cite

Article:Lee, M.J. orcid.org/0000-0001-9971-1635, Daniels, S.L., Drake, T.M. et al.(1 more author) (2016) Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis. International Journal of Colorectal Disease, 31 (7). pp. 1273 -1281 . ISSN 0179-1958 https://doi.org/10.1007/s00384-016-2606-6 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request.

show abstract

Section: Pre-operative Factorsmentioning

confidence: 99%

Section: Pre-operative Factorsmentioning

confidence: 99%

Section: Pre-operative Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis

Lee

Daniels

Drake

et al. 2016

Int J Colorectal Dis

View full text Add to dashboard Cite

show abstract

“…9 Therefore, other authors have recommended sigmoidoscopy in patients with specific risk factors. 7,12 It remains unclear whether sigmoidoscopy has actually improved, or possibly worsened the clinical outcome of patients in the present study. Performing sigmoidoscopy carries the risk of delaying the time to bowel resection, and possible worsening of CI.…”

Section: Discussionmentioning

confidence: 72%

The Value of Sigmoidoscopy to Detect Colonic Ischaemia After Ruptured Abdominal Aortic Aneurysm Repair

Jalalzadeh

Schaik

Duin

et al. 2019

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

WHAT THIS PAPER ADDS This study determined the value of sigmoidoscopy to detect colonic ischaemia (CI) after repair of ruptured abdominal aortic aneurysm (RAAA). It demonstrates that sigmoidoscopy is mainly valuable in patients with a moderate clinical suspicion of CI. The probability of identifying a patient with transmural ischaemia increases from approximately 22% to 73% when moderate to severe CI is detected at sigmoidoscopy. Moreover, sigmoidoscopy is effective in ruling out the presence of CI. Objectives: Diagnosing colonic ischaemia (CI) after ruptured abdominal aortic aneurysm (RAAA) repair is challenging. This study determined the diagnostic value of sigmoidoscopy in patients suspected of CI after RAAA repair. Methods: This was a retrospective multicentre cohort study. Patients who underwent RAAA repair in three hospitals in Amsterdam, the Netherlands, between 2004 and 2011 (AJAX cohort) were included. Sigmoidoscopies were carried out based on clinical judgment. Endoscopy results were classified as "no ischaemia," "mild CI," or "moderate to severe CI." The surgical diagnosis was classified as "transmural" or "no transmural" CI. The value of sigmoidoscopy was assessed with calculation of positive and negative predictive values (PPV, NPV) with 95% CI for transmural CI. Logistic regression analysis was used to express the association of risk factors with CI as adjusted OR. Results: Transmural CI was diagnosed in 23 of 351 patients (6.6%). Thirteen of sixteen patients (81%) who underwent direct laparotomy for high suspicion of CI indeed had transmural CI. Forty-six patients (13%) underwent sigmoidoscopy. The prevalence of transmural CI was 22% (10/46; 95% CI 12e36%) in these patients. The PPV for transmural CI of "moderate to severe CI" on sigmoidoscopy was 73% (8/11; 95% CI 43e 90%). The PPV of "mild CI" on sigmoidoscopy was 11% (2/19; 95% CI 2.9e31%). The NPV of "no ischaemia" on sigmoidoscopy was 100% (95% CI 78e100%). Cardiac comorbidity (OR 3.1, 95% CI 1.19e7.97), low first haemoglobin (OR 0.6, 95% CI 0.47e0.87), and high vasopressor administration (OR 9.4, 95% CI 1.99e44.46) were independently associated with CI. Conclusions: Sigmoidoscopy increases the likelihood of correctly identifying the presence or absence of transmural CI, especially in patients with a moderate clinical suspicion for CI after RAAA repair.

show abstract

“…Some endovascular series have shown higher rates [110] due to an inability to evacuate retroperitoneal haematoma. Risk factors include hypotension, hypothermia, acidosis, aggressive fluid ⁄ blood product resuscitation, anaemia [1,111,112] and the need for an aortic occlusion balloon [110]. Some authors recommend postoperative monitoring of intra-abdominal pressure via bladder pressure [1,113,114] or even surveillance colonoscopy in patients at increased risk [111,115].…”

Section: Postoperative Managementmentioning

confidence: 99%

Anaesthesia for vascular emergencies

Ellard¹,

Djaiani

2012

Anaesthesia

View full text Add to dashboard Cite

SummaryPatients presenting with vascular emergencies including acute aortic syndrome, ruptured thoracic or abdominal aortic aneurysms, thoracic aortic trauma and acute lower limb ischaemia have a high risk of peri-operative morbidity and mortality. Although anatomical suitability is not universal, endovascular surgery may improve mortality and the results of ongoing randomised controlled trials are awaited. Permissive hypotension pre-operatively should be the standard of care with the systolic blood pressure kept to 50-100 mmHg as long as consciousness is maintained. The benefit of local anaesthesia over general anaesthesia is not definitive and this decision should be tailored for a given patient and circumstance. Cerebrospinal fluid drainage for prevention of paraplegia is often impractical in the emergency setting and is not backed by strong evidence; however, it should be considered postoperatively if symptoms develop. We discuss the pertinent anaesthetic issues when a patient presents with a vascular emergency and the impact that endovascular repair has on anaesthetic management. In-hospital mortality after open repair of ruptured abdominal aortic aneurysm (rAAA) approaches 40-50% with total mortality, including pre-hospital deaths, closer to 80% [1][2][3]. Traumatic thoracic aortic injury is often immediately fatal with a 30-40% mortality in those who arrive alive to hospital and an overall mortality of 90% [4]. Thirty-day mortality rates are > 50% following ruptured thoracic aneurysm [5], 13% for acute type B dissection [6] and > 25% following embolectomy for acute limb ischaemia [7,8].We define a 'vascular emergency', for the purpose of this review, as an acute condition requiring intervention within hours, involving the descending aorta and its main lower limb branches. Specific pathologies meeting these criteria include acute aortic syndrome, ruptured thoracic and abdominal aneurysms, traumatic injuries of the thoracic aorta and acute lower limb ischaemia. Pathology involving the ascending aorta or aortic arch that is generally managed by cardiac surgeons is excluded.This review aims to discuss the optimal anaesthetic management to minimise morbidity and mortality and the impact of a move towards endovascular repair. An English language electronic search using Medline and Embase databases identified relevant scientific literature from the last 10 years and was supplemented with a manual search of reference lists from reviewed articles. Overview of vascular emergenciesAcute aortic syndrome Acute aortic syndrome consists of three interrelated conditions: penetrating atherosclerotic ulcer; intramural haematoma; and aortic dissection. Penetrating athero-

show abstract

Reliability of Selective Surveillance Colonoscopy in the Early Diagnosis of Colonic Ischemia After Successful Ruptured Abdominal Aortic Aneurysm Repair

Abstract: Our study showed that CI is a frequent complication after successful rAAA repair and could reliably be early diagnosed if surveillance colonoscopy was offered selectively in patients with more than three PRFs.

Cited by 14 publications

References 15 publications

Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis

Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis

The Value of Sigmoidoscopy to Detect Colonic Ischaemia After Ruptured Abdominal Aortic Aneurysm Repair

Anaesthesia for vascular emergencies

Contact Info

Product

Resources

About