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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2010 June;17(2):59-63
Colonic ischemia after endovascular abdominal aortic aneurysm repair
Adovasio R., Settembre N., Nikolakopoulos K., Ukovich L., Biasion C., Zamolo F., Ziani B.
Department of Vascular Surgery, University of Trieste, Trieste, Italy
Aim. The purpose of this study was to evaluate the causes of colonic ischemia (CI) and to analyse the occurrence, incidence, management and outcome of patients suffering from this complication after endovascular abdominal aortic aneurysm repair.
Methods. Between January 2000 and October 2008, 492 patients were treated for infrarenal aortic aneurysm: 255 (52%) out of them underwent endovascular repair, 6 (2.4%) had an emergent endovascular treatment for ruptured aneurysm and 237 (48%) underwent open repair; within this last group, 84 (35.5%) had an emergent treatment.
Results. In the endovascular aneurysm repair (EVAR) group colonic ischemia occurred in six patients (2.4%) during the postoperative period. Four out of the six patients had left colon resection with left colostomy, while two recovered after total parenteral nutrition and multiple intestinal dilatations. Mortality rate in our series was 1/3 (33.3%). According to these results, we supposed that colonic ischemia was due to microembolization in three cases (50%) and in the remaining three we attributed this complication to the intraoperative occlusion of one or both hypogastric arteries with insufficient collateral circulation.
Conclusion. The role of the occlusion of internal iliac arteries during EVAR is still not clear. Possible prevention of CI is based on careful manipulation of endovascular devices. The hypogastric artery exclusion, when necessary, should be staged previously and should be avoided when abundant clot is present in the aneurysm neck.