Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
J Surg Res. 2021 Feb;258:246-253. doi: 10.1016/j.jss.2020.07.053. Epub 2020 Oct 7.
The objective of the study was to examine the effect of hypogastric revascularization maneuvers on the rate of postoperative ischemic colitis among patients undergoing endovascular aortoiliac aneurysm repair.
Using the 2011-2018 Endovascular Aneurysm Repair Procedure-Targeted American College of Surgeons National Surgical Quality Improvement Program Participant Use Files, we analyzed patients undergoing elective endovascular infrarenal aortoiliac aneurysm repairs. Using multivariable modeling techniques, a cohort of patients at high risk for postoperative ischemic colitis was identified. The outcomes of this group were then compared using Pearson's chi-square testing in accordance with whether or not they underwent hypogastric revascularization.
Of 4753 patients undergoing endovascular aortoiliac aneurysm repair in the National Surgical Quality Improvement Program cohort, 1161 had concomitant hypogastric revascularization procedures. High-risk predictors of ischemic colitis included chronic obstructive pulmonary disease and concurrent renal artery or external iliac artery stenting. There was not a significant association between pelvic revascularization and postoperative ischemic colitis [1.0% with versus 0.5% without pelvic revascularization; adjusted odds ratio of ischemic colitis with revascularization 2.07 (0.96, 4.46); P = 0.06] after adjustment for patient- and procedure-related factors. In a subgroup analysis of patients with a distal aneurysm extent beyond the common iliac artery, the incidence of ischemic colitis was significantly lower in patients without pelvic revascularization (0.1% versus 1.6%, P = 0.004).
Our analysis of patients undergoing elective endovascular repair of infrarenal aortoiliac aneurysmal disease did not find a reduced incidence of postoperative ischemic colitis in patients who received a concomitant pelvic revascularization procedure, suggesting instead that such procedural adjuncts may actually increase risk for this complication.
本研究旨在探讨血管内腹主动脉瘤修复术后缺血性结肠炎的发生率与血管下腹膜后再血管化操作的关系。
我们利用 2011 年至 2018 年血管内动脉瘤修复术-美国外科医师学会国家手术质量改进计划参与者使用文件，分析了接受择期血管内肾下腹主动脉瘤修复术的患者。利用多变量建模技术，确定了一组术后发生缺血性结肠炎风险较高的患者。然后，根据是否进行了血管下腹膜后再血管化操作，使用 Pearson 卡方检验比较了这组患者的结局。
在国家手术质量改进计划队列中，4753 例接受血管内腹主动脉瘤修复术的患者中有 1161 例同时进行了血管下腹膜后再血管化操作。缺血性结肠炎的高危预测因素包括慢性阻塞性肺疾病和同时行肾动脉或髂外动脉支架置入术。在调整了患者和手术相关因素后，盆腔再血管化与术后缺血性结肠炎之间没有显著关联[盆腔再血管化组为 1.0%，无盆腔再血管化组为 0.5%；再血管化组发生缺血性结肠炎的调整优势比为 2.07（0.96，4.46）；P=0.06]。在髂总动脉以外的远端动脉瘤范围的亚组分析中，无盆腔再血管化组的缺血性结肠炎发生率明显较低（0.1%与 1.6%，P=0.004）。
我们对接受择期血管内修复肾下腹主动脉瘤疾病的患者进行的分析并未发现同时进行盆腔再血管化操作的患者术后缺血性结肠炎的发生率降低，这表明此类手术辅助操作实际上可能增加了这种并发症的风险。
