Predictive Model for Colonic Ischemia Following Abdominal Aortic Aneurysm Repair

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Abstract
Colonic ischemia is a complication of abdominal aortic aneurysm (AAA) repair that results in significant morbidity and mortality. Numerous causes of colonic ischemia have been reported, but no attempt has been made to identify factors that predict its development. This study identifies those factors that increase risk for colonic ischemia following AAA repair and develops a predictive model for identification of patients who need more aggressive intervention. The records of 12 patients who underwent AAA repair at the authors' institution from 1987 to 1991 and developed colonic ischemia after surgery were reviewed along with a control group of 67 randomly chosen patients who also underwent AAA repair. Clinical factors in the following categories: vascular disease risk factors, medical history, presentation of aortic aneurysm, operative procedure, and postoperative course were examined. Fifteen factors, found to be significantly associated with the development of colonic ischemia (p<0.01), were used for the logistic analysis. Three factors: aneurysm rupture as indication for repair, coagulopathy, and intraoperative hypotension were identified as independent predictors. The presence of one of these factors gave an approximate probability of 10%, two factors 50%, and three factors 90% for development of colonic ischemia.