P-019 - RISK FACTORS AND OUTCOMES FOR COLONIC ISCHEMIA AFTER ABDOMINAL AORTIC ANEURISM REPAIR: A SINGLE CENTER EXPERIENCE

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Rizk M. (faculty of medicine, Ain shams university ~ cairo ~ Egypt) , Youssef T. (faculty of medicine, Ain shams university ~ cairo ~ Egypt) , Mahmoud A. (faculty of medicine, Ain shams university ~ cairo ~ Egypt) , Meshref M. (faculty of medicine, Ain shams university ~ cairo ~ Egypt)
Introduction:
Ischemic colitis represents one of the serious causes responsible for morbidity and mortality related to abdominal aortic aneurysm repair in this single center study we reviewed our experience with such complication.
Methods:
This were a retrospective study that was performed on the data available for patients who underwent repair of an abdominal aortic aneurysm either on elective or emergency basis between February 2018 till February 2021. We excluded patients with history of previous bowel ischemia, and mortality within the first 24 hours postoperative. The intraoperative course was analyzed, and several implicating factors were recorded. Postoperatively, patients who were clinically suspicious of having bowel ischemia underwent diagnostic coloscopy, and the results of the coloscopy were classified according to Nikolic et al.,(1) into four stages. Any further interventions were recorded along with the hospital stay.
Results:
This study included 52 patients with a mean age of 59.83 ± 7.06 (45 -72) years, there was 15.4% females versus 84.6% males. 5.8% had an EVAR, while 94.2% underwent open repair. 98.07% were operated upon on elective basis, while 1.93% patient had a ruptured aneurysm. The incidence of postoperative ischemic colitis was 7.69% with a high 30-day mortality rate of 75%, with a mean time of presentation of 4.75 ± 1.48 days. 75% of patients who presented with colonic ischemia underwent colectomy for the gangrenous bowel, while 25% were managed conservatively. A lot of factors were considered as risk factors for development of postoperative colonic ischemia including diabetes mellitus, hypertension, COPD, and chronic kidney disease as patient factors. Also, duration of surgery, blood loss, blood transfusion, proximal clamp time application, and bilateral coverage of hypogastric arteries were considered as intraoperative factors. Patients undergoing open repair showed more incidence of bowel ischemia compared to those undergoing EVAR, as well as those presenting with a ruptured aneurysm.
Conclusion:
Although, the occurrence of bowel ischemia is not that common, but it is a very morbid condition and leads to increased mortality. Patients who were considered at risk should be closely monitored; we should also consider performing routine postoperative coloscopy for those high-risk groups.
References:
(1) Nikolic AL, Keck HO. Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management. AZN J Surg 2018; 88: 278-83.
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