Ischemic colitis incidence following abdominal aortic reconstruction: a prospective study

Area of Science:

• Vascular Surgery
• Gastroenterology
• Surgical Complications

Background:

• Previous studies reported 1-2% incidence of left colon ischemia after abdominal aortic reconstruction.
• Existing data primarily based on retrospective analyses of clinically apparent or autopsy findings.

Purpose of the Study:

• To prospectively determine the accurate incidence of left colon ischemia following abdominal aortic reconstruction.
• To evaluate the utility of early postoperative colonoscopy for identifying ischemic complications.

Main Methods:

• Prospective study of 50 patients undergoing abdominal aortic reconstruction (23 for occlusive disease, 27 for aneurysm disease).
• All patients underwent colonoscopy within 4 days of surgery.
• Arteriography was used to assess collateral circulation to the inferior mesenteric artery.

Main Results:

• An overall incidence of 6% for colon ischemia was observed (4.3% in occlusive disease, 7.4% in aneurysm disease).
• Colon ischemia did not occur in patients with documented collateral opacification of the inferior mesenteric artery.
• All patients with ischemia recovered uneventfully; two developed diarrhea post-recognition.

Conclusions:

• The actual incidence of colon ischemia after abdominal aortic reconstruction may be higher than previously estimated.
• Postoperative colonoscopy is a valuable tool for early detection of colon ischemia before clinical symptoms become severe.
• Identifying collateral mesenteric artery supply may predict risk for developing colon ischemia.