Ilic Nikola, Zlatanovic Petar, Koncar Igor, Dragas Marko, Mutavdzic Perica, Trailovic Ranko, Stevanovic Ksenija, Davidovic Lazar
School of Medicine, University of Belgrade, Belgrade, Serbia.
Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
J Cardiovasc Surg (Torino). 2022 Feb;63(1):52-59. doi: 10.23736/S0021-9509.21.11861-0. Epub 2021 Jul 8.
Development of colonic ischemia (CI) after ruptured abdominal aortic aneurysm (RAAA) treatment is a lethal complication with perioperative mortality reported to be high as 50%. Therefore, the main goal of this study was to identify pre-, intra- and postoperative risk factors associated with CI in patients undergoing open repair (OR) due to RAAA, that might help to select patients who are more prone to develop CI.
This was a single-center prospective cohort study on patients with RAAA undergoing OR between January 1 2018 and July 1 2019, at the Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia. During this period 89 patients were treated due to RAAA and all were included in the study. The primary endpoint was grade III CI, or transmural necrosis, diagnosed by laparotomy.
Out of 89 patients operated due to RAAA, CI was diagnosed in 14 (15.73%). During the operation, patients with CI had a longer duration of hypotension (42.86±35.82 vs. 24.13±23.48, P=0.021) and more common significant hypotension (54.54% vs. 14.66%, P=0.024). In the postoperative course, patients with CI had more common signs of abdominal compartment syndrome (71.42% vs. 25.33%, P=0.001) and higher mortality rate (78.57% vs 29.33%, P=0.001). The univariate regression model showed that one of the most significant factors that were associated with CI were age higher than 75 years, significant hypotension lasting more than one hour, organ lesion, development of abdominal compartment syndrome and higher potassium values on third and fourth quartile.
Grade III colon ischemia (transmural) remains the important cause of mortality after ruptured abdominal aortic aneurysm repair. We identified pre- and intraoperative and postoperative risk factors that could improve the selection of patients for primary open abdomen treatment or early exploratory laparotomy in order to prevent or timely diagnose colon ischemia.
腹主动脉瘤破裂（RAAA）治疗后发生结肠缺血（CI）是一种致命并发症，据报道围手术期死亡率高达50%。因此，本研究的主要目的是确定因RAAA接受开放修复（OR）的患者中与CI相关的术前、术中和术后危险因素，这可能有助于选择更易发生CI的患者。
这是一项单中心前瞻性队列研究，研究对象为2018年1月1日至2019年7月1日期间在塞尔维亚临床中心血管和血管内外科诊所因RAAA接受OR的患者。在此期间，89例因RAAA接受治疗的患者均纳入研究。主要终点是通过剖腹手术诊断的III级CI或透壁坏死。
在89例因RAAA接受手术的患者中，14例（15.73%）被诊断为CI。手术期间，发生CI的患者低血压持续时间更长（42.86±35.82 vs. 24.13±23.48，P=0.021），严重低血压更常见（54.54% vs. 14.66%，P=0.024）。在术后过程中，发生CI的患者腹部间隔综合征体征更常见（71.42% vs. 25.33%，P=0.001），死亡率更高（78.57% vs 29.33%，P=0.001）。单变量回归模型显示，与CI相关的最显著因素之一是年龄大于75岁、持续超过1小时的严重低血压、器官损伤、腹部间隔综合征的发生以及第三和第四四分位数时较高的钾值。
III级结肠缺血（透壁性）仍然是腹主动脉瘤破裂修复术后死亡的重要原因。我们确定了术前、术中和术后的危险因素，这些因素可以改善对患者进行初次开放腹部治疗或早期探查性剖腹手术的选择，以预防或及时诊断结肠缺血。
