This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Megalopoulos, A. Articles by Botsios, D. Search for Related Content PubMed Articles by Megalopoulos, A. Articles by Botsios, D. Social Bookmarking                         What's this?

Reliability of Selective Surveillance Colonoscopy in the Early Diagnosis of Colonic Ischemia After Successful Ruptured Abdominal Aortic Aneurysm Repair

4th Surgical Department, Aristotle University of Thessaloniki, General Regional Hospital "George Papanikolaou," Thessaloniki, Greece

Konstantinos Vasiliadis, MD, MSc

4th Surgical Department, Aristotle University of Thessaloniki, General Regional Hospital "George Papanikolaou," Thessaloniki, Greece, keva{at}med.auth.gr

Konstantinos Tsalis, MD

4th Surgical Department, Aristotle University of Thessaloniki, General Regional Hospital "George Papanikolaou," Thessaloniki, Greece

Dimitrios Kapetanos, MD

Department of Gastroenterology, Aristotle University of Thessaloniki, General Regional Hospital "George Papanikolaou," Thessaloniki, Greece

Militsa Bitzani, MD

Intensive Care Unit, Aristotle University of Thessaloniki, General Regional Hospital "George Papanikolaou," Thessaloniki, Greece

Theodor Tsachalis, MD

4th Surgical Department, Aristotle University of Thessaloniki, General Regional Hospital "George Papanikolaou," Thessaloniki, Greece

Eleni Batziou, MD

Department of Anesthesiology Aristotle University of Thessaloniki, General Regional Hospital "George Papanikolaou," Thessaloniki, Greece

Dimitrios Botsios, MD

4th Surgical Department, Aristotle University of Thessaloniki, General Regional Hospital "George Papanikolaou," Thessaloniki, Greece

Purpose To evaluate the reliability of selective surveillance colonoscopy based on 6 specific perioperative risk factors in the early diagnosis of colonic ischemia (CI) after successful ruptured abdominal aortic aneurysm (rAAA) repair.

Patients and Methods From 1999 to 2005, 62 consecutive patients underwent rAAA repair. In 59 of them, routine aggressive surveillance colonoscopy was offered every 12 hours within the first 48 hours, and CI was graded consistently. Patients with stage I or stage II CI were treated conservatively and were followed up with repeat colonoscopy, whereas patients with stage III CI underwent immediate laparotomy and colectomy. In parallel, 6 specific perioperative risk factors (PRFs) were retrospectively analyzed.

Results Overall mortality was 33.9%. Nineteen patients (32.2%) developed CI and 12 (63.2%) of them survived.

Thirteen (22%) had grade III CI and among these 6 survived. In patients with CI the mortality rate was 36.2%. Patients with less than 3 PRFs had no CI whereas all instances of CI could be diagnosed if colonoscopy was offered selectively in patients with more than 3 PRFs. The positive predictive value of CI increased with the number of PRFs. Patients with 5 or 6 PRFs were about 101 times more likely to develop CI compared with patients with 0 to 4 PRFs (P < .001).

Conclusion Our study showed that CI is a frequent complication after successful rAAA repair and could reliably be early diagnosed if surveillance colonoscopy was offered selectively in patients with more than three PRFs.

Key Words: ruptured abdominal aortic aneurysm • colonic ischemia • prognosis • colectomy

Vascular and Endovascular Surgery, Vol. 41, No. 6, 509-515 (2008)
DOI: 10.1177/1538574407306797


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?