Background: Colonic ischemia after open repair of ruptured abdominal aortic aneurysm (rAAA) has been reported to be as high as 42% and is associated with high mortality rates when transmural necrosis is involved. With the evolution of endovascular aortic repair (EVAR) devices, some centers now primarily use this technique for rAAA. The objective of this study was to determine the incidence of colonic ischemia after EVAR of rAAA.
Study design: All patients who underwent EVAR of rAAA from January 2002 to January 2006 were included in this review. All flexible sigmoidoscopies were performed within 48 hours, ischemia was graded consistently, and treatment was initiated per protocol based on grade of ischemia. Patients with grades I and II ischemia were followed up with medical management and in some cases, repeat colonoscopy. All patients with grade III ischemia underwent bowel resection.
Results: Forty-four patients underwent EVAR of rAAA during the study period. Operative mortality was 11%. Sigmoidoscopy was performed in 36 of 39 patients who survived longer than 24 hours. Bowel ischemia was documented in 8 of the 36 patients (23%). Of these, five had grade I or grade II ischemia at both initial and repeat endoscopy, so these patients did not progress to resection. Three patients underwent exploratory laparotomy with bowel resection because of grade III ischemia; one of these procedures was performed for worsening ischemia discovered at repeat colonoscopy.
Conclusions: This study demonstrated that the overall incidence of colonic ischemia (23%) after EVAR of rAAA is less than that reported for the open repair. We would continue to recommend mandatory flexible sigmoidoscopy for these patients.