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The Journal of Cardiovascular Surgery 2022 February;63(1):52-9

DOI: 10.23736/S0021-9509.21.11861-0


language: English

Influence of perioperative risk factors on the development of transmural colonic ischemia after open repair of ruptured abdominal aortic aneurysm

Nikola ILIC 1, 2, Petar ZLATANOVIC 2 , Igor KONCAR 1, 2, Marko DRAGAS 1, 2, Perica MUTAVDZIC 2, Ranko TRAILOVIC 2, Ksenija STEVANOVIC 1, 2, Lazar DAVIDOVIC 1, 2

1 School of Medicine, University of Belgrade, Belgrade, Serbia; 2 Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia

BACKGROUND: Development of colonic ischemia (CI) after ruptured abdominal aortic aneurysm (RAAA) treatment is a lethal complication with perioperative mortality reported to be high as 50%. Therefore, the main goal of this study was to identify pre-, intra- and postoperative risk factors associated with CI in patients undergoing open repair (OR) due to RAAA, that might help to select patients who are more prone to develop CI.
METHODS: This was a single-center prospective cohort study on patients with RAAA undergoing OR between January 1st 2018 and July 1st 2019, at the Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia. During this period 89 patients were treated due to RAAA and all were included in the study. The primary endpoint was grade III CI, or transmural necrosis, diagnosed by laparotomy.
RESULTS: Out of 89 patients operated due to RAAA, CI was diagnosed in 14 (15.73%). During the operation, patients with CI had a longer duration of hypotension (42.86±35.82 vs. 24.13±23.48, P=0.021) and more common significant hypotension (54.54% vs. 14.66%, P=0.024). In the postoperative course, patients with CI had more common signs of abdominal compartment syndrome (71.42% vs. 25.33%, P=0.001) and higher mortality rate (78.57% vs 29.33%, P=0.001). The univariate regression model showed that one of the most significant factors that were associated with CI were age higher than 75 years, significant hypotension lasting more than one hour, organ lesion, development of abdominal compartment syndrome and higher potassium values on third and fourth quartile.
CONCLUSIONS: Grade III colon ischemia (transmural) remains the important cause of mortality after ruptured abdominal aortic aneurysm repair. We identified pre- and intraoperative and postoperative risk factors that could improve the selection of patients for primary open abdomen treatment or early exploratory laparotomy in order to prevent or timely diagnose colon ischemia.

KEY WORDS: Aortic aneurysm, abdominal; Ischemia; Postoperative complications

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