The high mortality rate among elderly patients who develop ischemic colitis after hybrid endovascular repair of complex aortic aneurysms suggests that a different approach may be warranted, judging by operative outcomes in more than 200 patients.
Patient survival at 1 year was significantly decreased among patients who had ischemic colitis, compared with those who did not have this complication (51% vs. 79%), Dr. Carlos H. Timaran reported at the Vascular Annual Meeting in National Harbor, Md.
Dr. Carlos H. Timaran
Dr. Timaran and his colleagues at the University of Texas Southwestern Medical Center, Dallas, studied the frequency, predictors, and outcomes of ischemic colitis after abdominal debranching combined with aortic stent grafts (ADSG), which was the approach used to treat pararenal and thoracoabdominal aortic aneurysms (TAAs).
They reviewed clinical data in the North American Complex Abdominal Aortic Debranching (NACAAD) Registry of 208 patients treated by ADSG in 13 North American academic centers between 1999 and 2010. Ischemic colitis was identified by colonoscopy and/or operative findings. End points included the need for colon resection, morbidity, and mortality.
The researchers used univariate and multivariate logistic regression analysis to identify predictive factors for ischemic colitis.
Of the 208 patients, 118 men and 90 women (mean age, 72 ± 10 years) were treated for 45 pararenal aneurysms and 163 TAAs.
ADSG required reconstruction of 468 vessels (2.8 per patient), done in a single stage in 92 patients (44%). Ischemic colitis occurred in 13 patients (6%), and four patients (2%) developed transmural necrosis that required colon resection.
The 30-day mortality was 14% for the entire cohort. According to the investigators, this rate was significantly higher among patients who had ischemic colitis (46% vs. 12%; P less than .05), including those who required colon resection (50%).
Univariate analysis found that significantly higher rates of ischemic colitis were associated with age, Society for Vascular Surgery comorbidity score, chronic kidney disease, ruptured or symptomatic aneurysm, and whether patients had undergone a single-stage operation.
Independent predictors for ischemic colitis included age (odds ratio, 1.12), Society for Vascular Surgery comorbidity score (OR, 1.02), and single-stage operation (OR, 1.3).
"In elderly sicker patients, it appears that a staged approach or another treatment strategy, such as fenestrated or branched endovascular repair, may be better alternatives," Dr. Timaran concluded.
Dr. Timaran disclosed that he has received consulting fees or other remuneration from W.L. Gore & Associates.