RESUMO
OBJECTIVE: The purpose of this study was to analyze the incidence, severity, and etiologic factors of the development of colon ischemia after endovascular aortoiliac aneurysm repair (EVAR). METHODS: During the last 9 years we performed 278 elective EVARs using a variety of grafts. To facilitate these repairs, one hypogastric artery (HA) was coil embolized in 109 patients and both HAs were coil embolized in 13 patients. The preprocedural status of the inferior mesenteric, hypogastric, and iliac arteries as well as anatomical characteristics of the abdominal aortic aneurysm were determined arteriographically and by computerized tomographic scans. Postoperative colon ischemia was documented by colonoscopy or operative findings. RESULTS: Colon ischemia occurred in eight patients (2.9%). Three patients with colon ischemia died and had evidence of widespread (cutaneous, renal, small bowel, and/or lower extremity) microembolization. One of these three had a colectomy and microscopic emboli were present. One other patient who required a colectomy also had pathologic evidence of colonic microembolization but survived. Four other patients with colon ischemia were treated conservatively and survived. In one patient, previous colectomy with interruption of mesenteric collaterals may have been a contributory cause of colon ischemia. Of the eight patients with colon ischemia, only one had unilateral HA occlusion, and none had bilateral HA occlusion. The other 121 patients with unilateral and bilateral HA occlusion had no evidence of colon ischemia. CONCLUSIONS: Colon ischemia occurs after EVAR with an incidence approximating that of open repair. Colon ischemia was unrelated to HA interruption. Embolization appears to be a major cause of colon ischemia, although inadequate mesenteric collateral circulation may also play an etiologic role. Mortality with colon ischemia accompanied by widespread embolization was high, whereas colon ischemia without it was often mild and amenable to nonoperative management.
Assuntos
Angioplastia/efeitos adversos , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Doenças do Colo/etiologia , Embolia/etiologia , Aneurisma Ilíaco/cirurgia , Isquemia/etiologia , Idoso , Idoso de 80 Anos ou mais , Angiografia , Angioplastia/instrumentação , Angioplastia/métodos , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Colectomia , Doenças do Colo/classificação , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/epidemiologia , Doenças do Colo/terapia , Colonoscopia , Embolia/diagnóstico , Embolia/epidemiologia , Embolia/terapia , Embolização Terapêutica/efeitos adversos , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Artéria Ilíaca , Incidência , Isquemia/diagnóstico , Isquemia/epidemiologia , Isquemia/terapia , Pessoa de Meia-Idade , Politetrafluoretileno , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Stents , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A variety of techniques are available for the construction of a gastrojejunostomy. Little information is available regarding the influence of anastomotic technique on functional outcome, particularly delayed gastric emptying and other postgastrectomy syndromes. Twenty-seven cases were reviewed in which single-layer continuous suture was used for gastrojejunostomy. Most patients underwent pancreatoduodenectomy, subtotal gastrectomy, or gastrojejunal bypass for malignant obstruction. There were no anastomotic leaks. A regular diet was tolerated at a median of 6 days. There were no cases of delayed gastric emptying, and follow-up to date demonstrates a low incidence of postgastrectomy morbidity.