Colonic Infarction following Endovascular AAA Repair: A Multifactorial Complication

Abstract

Purpose:

To report a case of colonic infarction following endovascular abdominal aortic aneurysm (AAA) repair in a patient with both internal iliac arteries (IIA) unobstructed by the endograft.

Case Report:

A 73-year-old man presented with blue toes as a result of emboli from a 6.4-cm AAA. As he was medically at high risk for open repair and his aneurysm morphology was suitable for a modular bifurcated endovascular graft, a Zenith endograft was used to exclude the aneurysm. Twenty hours after the successful procedure, in which both IIAs were preserved, the patient regurgitated coffee-ground vomit; an upper gastrointestinal endoscopy found a small Mallory-Weiss tear and antral gastritis. A proton-pump inhibitor was begun, but his symptoms progressed. Laparotomy revealed transmural ischemia and infarction of the upper rectum, sigmoid, descending colon, and the splenic flexure; a colonic resection with formation of Hartmann's pouch and colostomy was performed. He made a slow but uncomplicated recovery.

Conclusions:

Colonic necrosis can complicate endovascular AAA repair even when both IIAs are preserved. Advantageously, the clinical signs of severe colonic ischemia in endograft patients are not obscured by aftereffects of a laparotomy.

Keywords

colonic ischemia internal iliac artery inferior mesenteric artery superior mesenteric artery Zenith endograft

Get full access to this article

View all access options for this article.

References

Ernst

Hagihara

Daugherty

. Ischemic colitis incidence following abdominal aortic reconstruction: a prospective study. Surgery. 1976;80:417–421.

Fanti

Masci

Marini

. Is endoscopy useful for early diagnosis of ischaemic colitis after aortic surgery? Results of a prospective trial. Ital J Gastroenterol Hepatol. 1997;29:357–360.

Elmarasy

Soong

Walker

. Sigmoid ischemia and the inflammatory response following endovascular abdominal aortic aneurysm repair. J Endovasc Ther. 2000;7:21–30.

Syk

Bunkwall

Ivancev

. Postoperative fever, bowel ischaemia and cytokine response to abdominal aortic aneurysm repair—a comparison between endovascular and open surgery. Eur J Vasc Endovasc Surg. 1998;15:398–405.

Jaeger

Mathias

Gissler

. Rectum and sigmoid colon necrosis due to cholesterol embolization after implantation of an aortic stent-graft. J Vasc Interv Radiol. 1999;10:751–755.

Sandison

Edmondson

Panayiotopoulos

. Fatal colonic ischaemia after stent graft for aortic aneurysm. Eur J Vasc Endovasc Surg. 1997;13:219–220.

Thomas

Gaines

Beard

. Vascular Surgical Society of Great Britain and Ireland: RETA: the registry of endovascular treatment of abdominal aortic aneurysms. Br J Surg. 1999;86:711.

Calvin

Ernst

. Colon ischaemia following aortic reconstruction. In: Rutherford

, ed. Vascular Surgery. 5th ed. London: WB Saunders; 2000:1542–1549.

Bayne

Donovan

Henthorne

. A rare complication in elective repair of an abdominal aortic aneurysm: multiple transmural colonic infarcts secondary to atheroemboli. Ann Vasc Surg. 1994;8:290–295.

10.

Karch

Hodgson

Mattos

. Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2000;32:676–683.

11.

Velazquez

Baum

Carpenter

. Relationship between preoperative patency of the inferior mesenteric artery and subsequent occurrence of type II endoleak in patients undergoing endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2000;32:777–788.

12.

Brewster

Franklin

Cambria

. Intestinal ischemia complicating abdominal aortic surgery. Surgery. 1991;109:447–454.

13.

Piotrowski

Ripepi

Yuhas

. Colonic ischemia: the Achilles heel of ruptured aortic aneurysm repair. Am Surg. 1996;62:557–561.

14.

Ernst

Hagihara

Daugherty

. Inferior mesenteric artery stump pressure: a reliable index for safe IMA ligation during abdominal aortic aneurysmectomy. Ann Surg. 1978;187:641–646.

15.

Houe

Thorboll

Sigild

. Can colonoscopy diagnose transmural ischaemic colitis after abdominal aortic surgery? An evidence-based approach. Eur J Vasc Endovasc Surg. 2000;19:304–307.