Inferior mesenteric artery replantation does not decrease the risk of ischemic colitis after open infrarenal...

Area of Science:

• Vascular Surgery
• Gastrointestinal Surgery
• Surgical Outcomes Research

Background:

• Ischemic colitis is a significant complication following open abdominal aortic aneurysm (AAA) repair, occurring in 1-6% of elective cases and up to 60% of ruptured cases.
• Inferior mesenteric artery (IMA) replantation is sometimes performed to prevent ischemic colitis, but evidence supporting its efficacy is lacking.

Purpose of the Study:

• To investigate whether IMA replantation reduces the incidence of ischemic colitis after open AAA repair.
• To evaluate the impact of IMA replantation on overall patient outcomes following AAA repair.

Main Methods:

• A multicenter analysis of patients undergoing open infrarenal AAA repair (2012-2015) from the American College of Surgeons National Surgical Quality Improvement Program Targeted AAA Database.
• Exclusion of emergency cases, patients with chronically occluded IMAs, ruptured aneurysms with hypotension, and those requiring visceral revascularization.
• Comparison of 30-day outcomes (mortality, morbidity, perioperative events) between patients who underwent IMA replantation (IMA-R) and those who had IMA ligation, using multivariable logistic regression.

Main Results:

• Of 672 eligible patients, 35 underwent IMA-R and 637 underwent IMA ligation. No significant preoperative comorbidity differences were observed.
• IMA-R was associated with longer operative times (319.7 vs 242.4 minutes; P < .001).
• Patients undergoing IMA-R experienced higher rates of return to the operating room (20.0% vs 7.2%; P = .006), wound complications (17.1% vs 3.0%; P = .001), and ischemic colitis (8.6% vs 2.4%; P = .027). Multivariable analysis identified IMA-R as a predictor for ischemic colitis and wound complications.

Conclusions:

• IMA replantation does not appear to protect against ischemic colitis after open AAA repair.
• The clinical utility and role of IMA replantation in open AAA repair require further investigation.