Incidence and clinical presentation of bowel ischaemia after aortoiliac surgery--2930 operations from a population-based registry in Sweden.

OBJECTIVES

To study the incidence and clinical presentation of intestinal ischaemia after aortoiliac/femoral surgery, and to validate a vascular registry concerning a serious complication.

DESIGN AND SETTING

In the Swedish Vascular Registry (SWEDVASC) the outcome and complications of all vascular procedures are registered prospectively.

MATERIALS AND METHODS

All 2930 patients operated in 1987-93 were analysed for notified complications. A 5% random sample of all patients and a 20% random sample of fatal cases were analysed for un-notified complications. Of 415 requested patient records 413 were analysed.

RESULTS

The estimated incidence of bowel ischaemia was 2.8%. Among patients operated on for a ruptured aneurysm in shock it was 7.3%. Of the 63 patients with intestinal ischaemia only 15 presented with early passage of bloody stools. In 60 patients (95%) the lesion affected the left colon within the reach of a sigmoidoscope. Bowel ischemia was unnotified only in fatal cases, the estimated un-notified complication rate was 0.7%.

CONCLUSIONS

The incidence in this study on unselected patients did not differ from previous reports from specialised centres. Diagnosis is difficult and justifies a high index of suspicion and early use of sigmoidoscopy. The validity of the SWEDVASC registry was confirmed by a high report-rate for this complication.