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Value of Routine Flexible Sigmoidoscopy and Potential Predictive Factors for Colonic Ischemia after Open Ruptured Abdominal Aortic Aneurysm Repair

1
Department of Vascular Surgery, Cardiovascular research Unit, Viborg Regional Hospital, 8800 Viborg, Denmark
2
Institute of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
3
Department of Vascular Surgery, Flensburg Hospital, 24943 Flensburg, Germany
4
Department of Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
5
Department of Vascular Surgery, Vilnius University Hospital Santaros Clinics, 08406 Vilnius, Lithuania
*
Author to whom correspondence should be addressed.
Medicina 2020, 56(5), 229; https://doi.org/10.3390/medicina56050229
Received: 25 March 2020 / Revised: 3 May 2020 / Accepted: 7 May 2020 / Published: 11 May 2020
(This article belongs to the Section Surgery)
Background and Objectives: colonic ischemia (CI) after ruptured abdominal aortic aneurysm (rAAA) repair is associated with increased morbidity and mortality. CI may be detected by using flexible sigmoidoscopy, but routine use of flexible sigmoidoscopy after rAAA is not clearly proven. The objective of this study was to evaluate the efficacy of routine flexible sigmoidoscopy in detecting CI after rAAA repair, and to identify potential hemodynamic, biochemical, and clinical variables that can predict the development of CI in the patients who underwent rAAA surgery. Materials and Methods: we retrospectively included all rAAA cases treated in Viborg hospital from 1 April 2014 until 31 August 2017, recorded the findings on flexible sigmoidoscopy, and the incidence of CI. We collected specific hemodynamic, biochemical, and clinical variables, measured pre- and perioperatively, and the first three postoperative days. The association between CI and possible predictors was analyzed in a logistic regression model. Results: a total of 80 patients underwent open rAAA repair during the study period. Flexible sigmoidoscopy was performed in 58 of 80 patients (73.5%) who survived at least 24 h after open rAAA surgery. Perioperative variables lowest arterial pH (p = 0.02) and types of operations—aortobifemoral bypass vs. straight graft (p = 0.04) showed statistically significant differences between CI groups. The analysis of the postoperative variables showed statistically significant difference in highest lactate on postoperative day 1 (p = 0.01), and lowest hemoglobin on postoperative day 2 (p = 0.04) comparing CI groups. Logistic regression model revealed that postoperative hemoglobin and lactate turned out to be independent risk factors for the development of CI (respectively OR = 0.44 (95% CI = 0.29–0.67) and OR = 1.91 (95% CI = 1.2–3.05)). Conclusions: flexible sigmoidoscopy can identify patients being at higher risk of mortality after open rAAA repair. The postoperative lactate and hemoglobin were found to be independent risk factors for the development of CI after open rAAA repair. Further larger studies are warranted to demonstrate these findings. View Full-Text
Keywords: flexible sigmoidoscopy; colonic ischemia; ruptured abdominal aortic aneurysms; mortality flexible sigmoidoscopy; colonic ischemia; ruptured abdominal aortic aneurysms; mortality
MDPI and ACS Style

Urbonavicius, S.; Feuerhake, I.L.; Srinanthalogen, R.; Urbonavicius, M.; Baltrunas, T.; Grøndal, N.F.; Randsbæk, F. Value of Routine Flexible Sigmoidoscopy and Potential Predictive Factors for Colonic Ischemia after Open Ruptured Abdominal Aortic Aneurysm Repair. Medicina 2020, 56, 229.

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