Ischemic Colitis Following Repair Of Abdominal Aortic Aneurysm: Predicting Outcomes And Management Is Possible
Ariela L. Zenilman, MD1, Shuo Huang, MD1, Afshin Parsikia2, Amit Shah, MD2, Aksim Rivera, MD2, John Denesopolis, MD2.
1Montefiore Medical Center, Bronx, NY, USA, 2Jacobi Medical Center, Bronx, NY, USA.
OBJECTIVES: Factors for development of ischemic colitis (IC) have been identified to predict its development following repair of abdominal aortic aneurysms (AAA). We sought to identify risk factors for the development of ischemic colitis following AAA repair that will aid in predicting its manifestation and management.
METHODS: We queried the National Surgical Quality Improvement Project (NSQIP) dataset for patients undergoing AAA repair over a 3-year period. We further identified patients who developed IC to analyze baseline characteristics, as well as intraoperative variables. Further assessment regarding management approach was performed to compare operative vs. non-operative. Multivariate analysis model was used to analyze characteristics of interest and logistic regression was used for significant predictors of outcome.
RESULTS: Of the 9,038 patients, 218 (2.4%) developed IC. IC patients had a higher percentage of ventilator dependence, blood transfusions preoperatively, history of COPD, and emergent aneurysm repair (p<0.0001). Acute renal failure was associated with IC, but need for dialysis was not. There was no association with patient age. Longer operative times, larger aneurysm diameters, ligation of the inferior mesenteric artery, renal and visceral revascularization were all associated with IC development (p<0.0001). ). On multivariate analysis, emergent intervention, COPD, renal stent, and ASA class>3 were the significant predictors in development of IC [Table 1]. When further stratified by treatment course (medical vs surgical management of IC), although not significant, there was a higher percentage of surgical treatment in those who were older and on chronic steroids. Preoperative characteristics and operative details were comparable in the 2 treatment arms. CONCLUSIONS: While incidence is low in this cohort, predictive tools for the development of ischemic colitis following AAA repair can be developed. Pre-operative characteristics, as well as operative technique can be used for identification and stratification of patients at risk. Although treatment modalities of IC remains difficult to predict as it is multifactorial, with further studies, the prediction of the development and management of IC in this high risk population will assist in preoperative optimization and improve outcomes.
| Factor | Odds ratio | 95% CI | P value |
| Age 66-75 | 1.282 | 0.952-1.728 | 0.102 |
| Ventilator dependent-preop | 0.944 | 0.430-2.073 | 0.887 |
| Emergency procedure | 2.000 | 1.276-3.136 | 0.003 |
| COPD history | 1.820 | 1.289-2.570 | 0.001 |
| Renal failure, pre-op | 3.483 | 1.108-10.947 | 0.033 |
| Blood transfusion, pre-op | 1.567 | 0.951-2.582 | 0.078 |
| Management of IMA ligation | 0.896 | 0.509-1.579 | 0.705 |
| Renal stent | 3.368 | 1.879-6.038 | <0.001 |
| ASA class>3 | 1.815 | 1.280-2.213 | 0.001 |
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