Preservation of pelvic perfusion with iliac branch devices does not decrease ischemic colitis compared with...

Area of Science:

• Vascular Surgery
• Gastroenterology

Background:

• Ischemic colitis is a rare but serious complication following endovascular repair of abdominal aortic aneurysms.
• The incidence of ischemic colitis increases with hypogastric artery embolization (HAE) during EVAR.
• Iliac branch devices (IBDs) are used to preserve pelvic perfusion, but their impact on ischemic colitis is unclear.

Purpose of the Study:

• To investigate whether preserving pelvic perfusion with IBDs reduces the incidence of ischemic colitis after EVAR.
• To compare outcomes of standard EVAR, EVAR with HAE, and EVAR with IBDs.

Main Methods:

• Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database (2012-2017).
• Inclusion of patients undergoing EVAR for infrarenal abdominal aortic aneurysms, stratified into average-risk and high-risk groups.
• Examination of 30-day outcomes including ischemic colitis, mortality, and organ dysfunction, comparing standard EVAR, EVAR-HAE, and EVAR-IBD.

Main Results:

• No significant difference in ischemic colitis incidence was observed between EVAR, EVAR-HAE, and EVAR-IBD across all risk groups.
• In average-risk patients, EVAR-HAE was associated with significantly higher mortality compared to standard EVAR.
• EVAR-IBD did not demonstrate superiority over EVAR-HAE in reducing 30-day mortality, major organ dysfunction, or ischemic colitis in the average-risk cohort.

Conclusions:

• HAE does not appear to increase the risk of ischemic colitis.
• IBDs do not decrease the incidence of ischemic colitis following EVAR.
• While HAE is linked to higher mortality in average-risk patients, IBDs do not significantly improve mortality compared to HAE.