Carlos H. Timaran1, Gustavo S. Oderich2, Mark A. Farber3, William Quinones-Baldrich4, Peter Gloviczki2, Guillermo Escobar5, Roy K. Greenberg6, James Black7, Sharif Ellozy8, Edward Woo9, Michael Singh10, Mark Fillinger11, Jason Lee12, Hasan H. Dosluoglu13
1University of Texas Southwestern Medical Center, Dallas, TX; 2Mayo Clinic, Rochester, MN; 3University of North Carolina, Chapel Hill, NC; 4University of California, Los Angeles, CA; 5University of Michigan, Ann Arbor, MI; 6The Cleveland Clinic, Cleveland, OH; 7Johns Hopkins Medical Center, Baltimore, MD; 8Mount Sinai School of Medicine, New York, NY; 9University of Pennsylvania Medical Center, Philadelphia, PA; 10University of Rochester Medical Center, Rochester, NY; 11Dartmouth-Hitchcock Medical Center, Lebanon, NH; 12Stanford University Medical Center, Stanford, CA; 13State University of New York, Buffalo, NY.
OBJECTIVES: The purpose of this study was to describe the frequency, predictors and outcomes of ischemic colitis after abdominal debranching combined with aortic stent grafts (ADSG) used to treat pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs).
METHODS: We reviewed clinical data of 208 patients treated by ADSG in 13 North American academic centers between 1999-2010. Ischemic colitis was identified by colonoscopy and/or operative findings. End-points included need for colon resection, morbidity and mortality. Predictive factors for ischemic colitis were identified using univariate and multivariate logistic regression analysis.
RESULTS: One-hundred eighteen male and 90 female patients (mean age, 72±10 years) were treated for 45 PRA and 163 TAAAs. ADSG required reconstruction of 468 vessels (2.8/ patient) done in a single stage in 92 patients (44%). Ischemic colitis occurred in 13 patients (6%) and transmural necrosis requiring colon resection in 4 (2%). Thirty-day mortality was 14% for the entire cohort, and was significantly higher among patients with ischemic colitis (46%[6/13] vs. 12%[24/195]; p<0.05), including those who required colon resection (50%;). By univariate analysis, age, Society for Vascular Surgery (SVS) comorbidity score, chronic kidney disease, symptomatic or ruptured aneurysm and single-stage operation were associated with significantly higher rates (p<0.05) of ischemic colitis. Independent predictors for ischemic colitis included age (OR 1.12, 95%CI 1.02-1.24), SVS comorbidity score (OR 1.02; 95%CI 1.00-1.04) and single-stage operation (OR 1.3, 95%CI 1.25-1.37) (p<0.01). Patient survival at 1-year was significantly decreased among patients who had ischemic colitis compared to those who did not have this complication (51% vs. 79%, p<0.003).
CONCLUSIONS: Ischemic colitis after ADSG is a devastating complication that carries high mortality (44%) and occurs more frequently in patients with advanced age, significant medical comorbidities and in those undergoing a single-stage operation.
AUTHOR DISCLOSURES: J. Black, Nothing to disclose; H. H. Dosluoglu, Nothing to disclose; S. Ellozy, Nothing to disclose; G. Escobar, Nothing to disclose; M. A. Farber, Nothing to disclose; M. Fillinger, Nothing to disclose; P. Gloviczki, Nothing to disclose; R. K. Greenberg, Cook Inc., Consulting fees or other remuneration (payment); J. Lee, Nothing to disclose; G. S. Oderich, Nothing to disclose; W. Quinones-Baldrich, Nothing to disclose; M. Singh, Nothing to disclose; C. H. Timaran, W.L. Gore & Assoc., Consulting fees or other remuneration (payment); E. Woo, Nothing to disclose.
Posted April 2012