20 - Freie Mitteilung
15. Mai 2019, 13:30 - 15:00, Sopra Grande, 4. OG
Colonic ischemia after endovascular aortic repair
A. Sommerau, S. Hofer, K. Pavotbawan, M. Furrer, Presenter: A. Sommerau (Chur)
Colonic ischemia (CI) after endovascular aortic repair (EVAR) in abdominal aortic aneurysm is a rare but severe complication. Several risk factors have been described, but their significance is unclear. Our aim was to analyse patient characteristics, presentation and outcome of CI after EVAR in our institution.
From June 2008 until December 2018 we performed 232 EVAR in patients with elective or ruptured abdominal aneurysm. We reviewed all patients regarding postoperative colon ischemia. Different predictors such as comorbidities, hypogastric (HA) and visceral artery patency, previous colon surgery, surgery time, severe intraoperative hypotension and blood loss were analysed in the patients with CI. The van Walraven comorbidity score (vWcs) was used for measuring patients individual risk.
Two patients (0.9%) out of 232 developed a severe CI. None had previous colon surgery. In both patients one HA was occluded, the vWcs was high and surgery time was long with over 380 minutes. Additionally to the occluded HA, the first patient showed a stenosis of the superior mesenteric artery. During the procedure he had a relevant blood loss resulting from perforating the left common illiac artery. The blood pressure during this period did not fall below 80 mmHg. Additionally, a thrombosis in the remaining open left HA occurred. CI was diagnosed on day five and the patient died one day after hemicolectomy. The second patient had an additional aneurysm of the right HA. EVAR and an iliac branch stentgraft implantation on the right side were performed without any complications. Preservation of the right HA was achieved. On day two CI was diagnosed and treated by hemicolectomy, but the outcome was fatal because of a severe sepsis. Astonishingly, the postoperative CT scan of both patients showed an endoleak type II caused by a lumbal artery and the open inferior mesenteric artery. Microembolisms could not be detected in the histologic assessment of the removed left colon.
Predictability of CI after EVAR is challenging. The relevance of patency of HA and main visceral arteries remains unclear and may increase in combination with additional predictors. In patients showing several predictors as high vWcs, long operating times and HA occlusion, the threshold to rule out CI should be low to prevent late diagnosis and fatal outcome.