nach oben

International Journal of Colorectal Disease

Erschienen in:

01.06.2016 | Review

Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis

verfasst von: Matthew J. Lee, Sarah L. Daniels, Thomas M. Drake, Ian J. Adam

Erschienen in: International Journal of Colorectal Disease | Ausgabe 7/2016

Einloggen, um Zugang zu erhalten

Abstract

Background

Ischaemic colitis is an infrequent but serious complication following repair of abdominal aortic aneurysm (AAA), with high mortality rates. This systematic review set out to identify risk factors for the development of ischaemic colitis after AAA surgery.

Methods

A systematic search of the MEDLINE, EMBASE and CINAHL databases was performed. This search was limited to studies published in the English language after 1990. Abstracts were screened by two authors. Eligible studies were obtained as full text for further examination. Data was extracted by two authors, and any disputes were resolved via consensus. Extracted data was pooled using Mantel-Haenszel random effects models. Bias was assessed using two Cochrane-approved tools. Effect sizes are expressed as relative risk ratios alongside the 95 % confidence interval. Statistical significance was defined at the level of p < 0.05.

Results

From 388 studies identified in the initial search, 33 articles were included in the final synthesis and analysis. Risk factors were grouped into patient (female gender, disease severity) and operative factors (peri-procedural hypotension, operative modality). The risk of ischaemic colitis was significantly higher when undergoing emergency repair versus elective (risk ratio (RR) 7.36, 3.08 to 17.58, p < 0.001). Endovascular repair reduced the likelihood of ischaemic colitis (RR 0.22, 0.12 to 0.39, p < 0.001).

Discussion

The quality of published evidence on this subject is poor with many retrospective datasets and inconsistent reporting across studies. Despite this, emergency presentation and open repair should prompt close monitoring for the development of IC.

Waton S, Johal A, Groene I, Cromwell D, Mitchell D, Loftus I (2013) Outcomes after elective repair of infra-renal abdominal aortic aneurysm. Royal College of Surgeons of England, London

Mitchell D, Hindley H, Naylor R, Wyatt M, Loftus I (2012) Outcomes after elective repair of infra-renal abdominal aortic aneurysm. Vascular Society of Great Britain and Ireland, London

Sinha S, Ata Ozdemir B, Khalid U, Karthikesalingam A, Poloniecki JD, Thompson MM, Holt PJ (2014) Failure-to-rescue and interprovider comparisons after elective abdominal aortic aneurysm repair. Br J Surg 101(12):1541–1550. doi:10.1002/bjs.9633 CrossRefPubMed

Steele SR (2007) Ischemic colitis complicating major vascular surgery. Surg Clin North Am 87(5):1099–1114. doi:10.1016/j.suc.2007.07.007, ix CrossRefPubMed

Fitridge RA, Boult M, Mackillop C, De Loryn T, Barnes M, Cowled P, Thompson MM, Holt PJ, Karthikesalingam A, Sayers RD, Choke E, Boyle JR, Forbes TL, Novick TV (2015) International trends in patient selection for elective endovascular aneurysm repair: sicker patients with safer anatomy leading to improved 1-year survival. Ann Vasc Surg 29(2):197–205. doi:10.1016/j.avsg.2014.09.015 CrossRefPubMed

Sterne J, Higgins J, Reeves B (2014) A Cochrane Risk Of Bias Assessment Tool: for Non-Randomized Studies of Interventions (ACROBAT-NRSI). http://www.riskofbias.info Accessed 08/12/2015

Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods G, Cochrane Statistical Methods G (2011) The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 343:d5928. doi:10.1136/bmj.d5928 CrossRefPubMedPubMedCentral

Senekowitsch C, Assadian A, Assadian O, Hartleb H, Ptakovsky H, Hagmuller GW (2006) Replanting the inferior mesentery artery during infrarenal aortic aneurysm repair: influence on postoperative colon ischemia. J Vasc Surg 43(4):689–694. doi:10.1016/j.jvs.2005.12.016 CrossRefPubMed

Geraghty PJ, Sanchez LA, Rubin BG, Choi ET, Flye MW, Curci JA, Thompson RW, Sicard GA (2004) Overt ischemic colitis after endovascular repair of aortoiliac aneurysms. J Vasc Surg 40(3):413–418. doi:10.1016/j.jvs.2004.05.022 CrossRefPubMed

10.

Mehta M, Byrne WJ, Robinson H, Roddy SP, Paty PS, Kreienberg PB, Feustel P, Darling RC 3rd (2012) Women derive less benefit from elective endovascular aneurysm repair than men. J Vasc Surg 55(4):906–913. doi:10.1016/j.jvs.2011.11.047 CrossRefPubMed

11.

Woo EY, Ullery BW, Carpenter JP, Wang GJ, Fairman RM, Jackson BM (2011) Open abdominal aortic aneurysm repair is feasible and can be done with excellent results in octogenarians. J Vasc Surg 53(2):278–284. doi:10.1016/j.jvs.2010.08.061 CrossRefPubMed

12.

Perry RJ, Martin MJ, Eckert MJ, Sohn VY, Steele SR (2008) Colonic ischemia complicating open vs endovascular abdominal aortic aneurysm repair. J Vasc Surg 48(2):272–277. doi:10.1016/j.jvs.2008.03.040 CrossRefPubMed

13.

Becquemin JP, Majewski M, Fermani N, Marzelle J, Desgrandes P, Allaire E, Roudot-Thoraval F (2008) Colon ischemia following abdominal aortic aneurysm repair in the era of endovascular abdominal aortic repair. J Vasc Surg 47(2):258–263. doi:10.1016/j.jvs.2007.10.001, discussion 263CrossRefPubMed

14.

Megalopoulos A, Vasiliadis K, Tsalis K, Kapetanos D, Bitzani M, Tsachalis T, Batziou E, Botsios D (2008) Reliability of selective surveillance colonoscopy in the early diagnosis of colonic ischemia after successful ruptured abdominal aortic aneurysm repair. Vasc Endovasc Surg 41:509–15CrossRef

15.

Neary P, Hurson C, Briain DO, Brabazon A, Mehigan D, Keaveny TV, Sheehan S (2007) Abdominal aortic aneurysm repair and colonic infarction: a risk factor appraisal. Color Dis 9(2):166–172. doi:10.1111/j.1463-1318.2006.01149.x CrossRef

16.

Menegaux F, Tresallet C, Kieffer E, Bodin L, Thabut D, Rouby J (2006) Aggressive management of nonocclusive ischemic colitis following aortic reconstruction. Arch Surg 141:678–82CrossRefPubMed

17.

Mehta M, Roddy SP, Darling RC 3rd, Oszvath K, Kreienberg PB, Paty PS, Chang BB, Shah DM (2005) Infrarenal abdominal aortic aneurysm repair via endovascular versus open retroperitoneal approach. Ann Vasc Surg 19(3):374–378CrossRefPubMed

18.

Champagne BJ, Darling RC 3rd, Daneshmand M, Kreienberg PB, Lee EC, Mehta M, Roddy SP, Chang BB, Paty PS, Ozsvath KJ, Shah DM (2004) Outcome of aggressive surveillance colonoscopy in ruptured abdominal aortic aneurysm. J Vasc Surg 39(4):792–796. doi:10.1016/j.jvs.2003.12.002 CrossRefPubMed

19.

Hansman MF, Neuzil D, Quigley TM, Hauptmann E, Fotoohi M, Robinson D, Raker EJ (2003) A comparison of 50 initial endoluminal endograft repairs for abdominal aortic aneurysm with 50 concurrent open repairs. Am J Surg 185(5):441–444. doi:10.1016/s0002-9610(03)00053-9 CrossRefPubMed

20.

Alric P, Hinchcliffe R, MacSweeney S, Wenhem P, Whitaker S, Hopkinson B (2002) The zenith aortic stent-graft: a 5-year single-center experience. J Endovasc Ther 9:719–728CrossRefPubMed

21.

Dadian N, Ohki T, Veith FJ, Edelman M, Mehta M, Lipsitz EC, Suggs WD, Wain RA (2001) Overt colon ischemia after endovascular aneurysm repair: the importance of microembolization as an etiology. J Vasc Surg 34(6):986–996. doi:10.1067/mva.2001.119241 CrossRefPubMed

22.

Bjorck M, Lindberg F, Broman G, Bergqvist D (2000) pHi monitoring of the sigmoid colon after aortoiliac surgery. A five-year prospective study. Eur J Vasc Endovasc Surg 20(3):273–280. doi:10.1053/ejvs.2000.1148 CrossRefPubMed

23.

Moore W, Kashyap V, Vescera C, Quinones-Baldrich W (1999) Abdominal aortic aneurysm: a 6-year comparison of endovascular versus transabdominal repair. Ann Surg 230(3):298–308CrossRefPubMedPubMedCentral

24.

Jarvinen O, Laurikka J, Salaenius J, Lepantalo M (1999) Mesenteric infarction after aortoiliac surgery on the basis of 1752 operations from the National Vascular Registry. World J Surg 23:243–247CrossRefPubMed

25.

Bjorck M, Troeng T, Bergqvist D (1997) Risk factors for intestinal ischaemia after aortoiliac surgery: a combined cohort and case–control study of 2824 operations. Eur J Vasc Endovasc Surg 13:531–539CrossRefPubMed

26.

Jarvinen O, Laurikka J, Sisto T, Tarkka M (1996) Intestinal ischemia following surgery for aorto-iliac disease. Vasa 25(2):148–155PubMed

27.

Prinnsen M, Verhoeven E, Buth J, Cuypers P, van Sambeek M, Balm R, Buskens E, Grobbee D, Blankenstejn J (2004) A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351:1607–1618CrossRef

28.

Maldonado TS, Rockman CB, Riles E, Douglas D, Adelman MA, Jacobowitz GR, Gagne PJ, Nalbandian MN, Cayne NS, Lamparello PJ, Salzberg SS, Riles TS (2004) Ischemic complications after endovascular abdominal aortic aneurysm repair. J Vasc Surg 40(4):703–709. doi:10.1016/j.jvs.2004.07.032 CrossRefPubMed

29.

Karch LA, Hodgson KJ, Mattos MA, Bohannon WT, Ramsey DE, McLafferty RB (2000) Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg 32(4):676–683. doi:10.1067/mva.2000.109750 CrossRefPubMed

30.

Cao P, Verzini F, Parlani G, Romano L, De Rango P, Pagliuca V, Iacono G (2004) Clinical effect of abdominal aortic aneurysm endografting: 7-year concurrent comparison with open repair. J Vasc Surg 40(5):841–848. doi:10.1016/j.jvs.2004.08.040 CrossRefPubMed

31.

Björck M, Bergqvist D, Troëng T (1996) Incidence and clinical presentation of bowel ischaemia after aortoiliac surgery--2930 operations from a population-based registry in Sweden. Eur J Vasc Endovasc Surg12(2):139–44

32.

Longo W, Lee T, Barnett M, Vernava A, Wade T, Petersen G, Jacobs D, Virgo K, Johnson F (1996) Ischemic colitis complicating abdominal aortic aneurysm surgery in the U.S. Veteran. J Surg Res 60:351–354CrossRefPubMed

33.

Cohen JD, Singer P, Grunberg G, Grozovski E, Sulkes J, Zelikovski A (1998) Outcome after elective infrarenal aortic aneurysm surgery. World J Surg 22(3):278–82

34.

Chen JC, Hildebrand HD, Salvian AJ, Taylor DC, Strandberg S, Myckatyn TM, Hsiang YN (1996) Predictors of death in nonruptured and ruptured abdominal aortic aneurysms. J Vasc Surg 24(4):614–20

35.

Coppi G, Silingardi R, Gennai S, Saitta G, Ciardullo AV (2006) A single-center experience in open and endovascular treatment of hemodynamically unstable and stable patients with ruptured abdominal aortic aneurysms. J Vasc Surg 44(6):1140–1147. doi:10.1016/j.jvs.2006.08.070 CrossRefPubMed

36.

Schoder M, Zaunbauer L, Holzenbein T, Fleischmann D, Cejna M, Kretschmer, Thurnher S, Lammer J (2001) Internal iliac artery embolization before endovascular repair of abdominal aortic aneurysms: frequency, efficacy, and clinical results. Am J Roentgenol 177:599–605CrossRef

37.

Wolpert L, Dittrich K, Hallisey M, Almendinger P, Gallagher J, Heydt K, Lowe R, Windels M, Drezner A (2001) Hypogastric artery embolization in endovascular abdominal aortic aneurysm repair. J Vasc Surg 33:1193–1198CrossRefPubMed

38.

Farooq M, Freischlag J, Seabrook G, Moon M, Aprahamina C, Towne J (1996) Effect of the duration of symptoms, transport time, and length of emergency room stay on morbidity and mortality in patients with ruptured abdominal aortic aneurysms. Surgery 119(1):9–14CrossRefPubMed

39.

Van Damme H, Creemers E, Limet R (2000) Ischaemic colitis following aortoiliac. Acta Chir Belg 100(1):21–27PubMed

40.

Levison J, Halpern V, Kline R, Faust G, Cohen J (1999) Perioperative predictors of colonic ischemia after ruptured abdominal aortic aneurysm. J Vasc Surg 29:40–47CrossRefPubMed

41.

Welch M, Baguneid M, McMahon R, Dodd P, Fulford P, Griffiths G, Walker M (1998) Histological study of colonic ischaemia after aortic surgery. Br J Surg 85:1095–1098CrossRefPubMed

42.

Toya N, Baba T, Kanaoka Y, Ohki T (2014) Embolic complications after endovascular repair of abdominal aortic aneurysms. Surg Today 44:1893–1899CrossRefPubMed

43.

Mehta M, Veith FJ, Ohki T, Cynamon J, Goldstein K, Suggs WD, Wain RA, Chang D, Freidman S, Scher L, Lipsitz E (2001) Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients: a relatively innocuous procedure. J Vasc Surg 33:s27–32CrossRefPubMed

44.

Roberts K, Revell M, Youssef H, Bradbury AW, Adam DJ (2006) Hypotensive resuscitation in patients with ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 31(4):339–344. doi:10.1016/j.ejvs.2005.11.003 CrossRefPubMed

45.

Powell JT, Hinchliffe RJ, Thompson MM, Sweeting MJ, Ashleigh R, Bell R, Gomes M, Greenhalgh RM, Grieve RJ, Heatley F, Thompson SG, Ulug P (2014) Observations from the IMPROVE trial concerning the clinical care of patients with ruptured abdominal aortic aneurysm. Br J Surg 101(3):216–224. doi:10.1002/bjs.9410, discussion 224CrossRefPubMed

Titel: Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis
verfasst von: Matthew J. Lee
Sarah L. Daniels
Thomas M. Drake
Ian J. Adam
Publikationsdatum: 01.06.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: International Journal of Colorectal Disease / Ausgabe 7/2016
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-016-2606-6

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Background

Methods

Results

Discussion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2016

Induction of GLUT4 by inhibiting IFN-γ: a winning move to halt type 2 diabetes?

Wound infection following stoma reversal: a prospective comparative study between primary closure and partial closure with intervening silver dressings

Non-healing perianal ulcer in an immunocompetent patient as the presenting sign of a systemic disease

Comparison of endoscopic incision and endoscopic balloon dilation for the treatment of refractory colorectal anastomotic strictures

Letter to the editor: stercoral perforation of the sigmoid colon possibly associated with anticholinergic drugs or opiates: a case series

Clinical severity of fecal incontinence after anorectal surgery and its relationship with endoanal ultrasound features

Update Chirurgie