Outcomes of and predictors for bowel ischemia after AAA repair: a study of 7312 patients

One discussion this week included AAA repair. The article cited here was provided by the chief resident.

Reference: Ultee KH, et al. Incidence of and risk factors for bowel ischemia after abdominal aortic aneurysm repair. Journal of Vascular Surgery. 2016 Nov;64(5):1384-1391. doi: 10.1016/j.jvs.2016.05.045.

Summary: Bowel ischemia is a rare but devastating complication after abdominal aortic aneurysm (AAA) repair. Its rarity has prohibited extensive risk-factor analysis, particularly since the widespread adoption of endovascular AAA repair (EVAR); therefore, this study assessed the incidence of postoperative bowel ischemia after AAA repair in the endovascular era and identified risk factors for its occurrence

METHODS: A total of 7312 patients undergoing intact or ruptured AAA repair in the Vascular Study Group of New England (VSGNE) January 2003 – November 2014 were included. Patients with and without postoperative bowel ischemia were compared and stratified by indication (intact and ruptured) and treatment approach (open repair and EVAR). Criteria for diagnosis were endoscopic or clinical evidence of ischemia, including bloody stools, in patients who died before diagnostic procedures were performed. Independent predictors of postoperative bowel ischemia were established using multivariable logistic regression analysis.

RESULTS: Postoperative outcomes (p.1389):

AAA repair

RESULTS: Predictors of bowel ischemia after AAA repair (p.1390):

AAA predictors

CONCLUSIONS: The authors state that “these date should be considered during operative planning in an effort to adequately assess patient risk for bowel ischemia and undertake efforts to reduce it” (p.1391).

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