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Introduction: The use of endovascular stent grafts for repair of abdominal aortic aneurysms (AAA) has become increasingly popular since its initial introduction in the early 1990’s. Endovascular stents are less invasive and can be done under spinal anesthesia, thus, generally providing less risk to the patient and quicker recovery times when compared with the traditional open repair. A major complication after traditional open repair is ischemic colitis, reported to be approximately 2-3 percent in the literature. The goal of this study is to examine the incidence, cause and outcomes of ischemic colitis after endovascular stent graft repair of aortoiliac aneurysms (EVAR).
Methods: 809 total patients from 1996 to April 2007 who underwent EVAR at the Mt. Sinai Hospital were included in the study. Preoperative data regarding the size of the AAA, hypogastric coil embolization and inferior mesenteric artery (IMA) patency were evaluated using CT scans and aortograms. Patients with suspicion of colonic ischemia underwent a lower endoscopy and/or surgical exploration. The diagnosis of ischemic colitis was made via lower endoscopy reports or pathological examination of specimens.
Results: Eleven patients total were found to have ischemic colitis (1.4%). Seven patients’ episode occurred less than 30 days from repair (early) while the other 4 occurred 30 days or later from repair (late). Three of the 4 patients with late ischemic colitis had factors other then the EVAR to explain the ischemia while this was not true for any of the 7 patients with early ischemic colitis. Microembolization was seen histologically in 2 patients with both of these patients undergoing bowel resections and ultimately expiring. The IMA was occluded in 10 of 11 patients preoperatively and the one patient it was patent had evidence of extensive microembolization. Six patients (3 early and 3 late) underwent preoperative unilateral hypogastric coil embolization and there was a significant increase in ischemic colitis in these patients(p=0.02).
Conclusion: The incidence of ischemic colitis is decreased in patients undergoing EVAR versus traditional open repair. Ischemic colitis occurring early is directly related to the surgery and is often multifactorial. When microembolization is involved, the patients tend to have more extensive ischemia with a higher incidence of bowel resection and mortality. Patients with late ischemic colitis often have another co-morbidity to explain the ischemia. The incidence of ischemic colitis is increased in patients with preoperative hypogastric coil embolization, and it seems to affect patients with both early and late ischemia.

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