Mesenteric infarction after aortoiliac surgery on the basis of 1752 operations from the national vascular registry

The present nationwide, multicenter clinical study was carried out in 26 de partments of surgery to define the incidence and attendant mortality of int estinal infarction following abdominal aortic surgery, and to identify pati ents at risk of it. The data consist of 1752 patients who underwent abdomin al aortic reconstruction during 1991-1993 as recorded in the Finnish nation al vascular registry (FINNVASC). Among the 1752 operations, 27 patients tre ated at 14 different hospitals had intestinal ischemia, and the complete pa tient records of all 27 cases were reanalyzed. The incidence of bowel infar ction was 1.2%. Among patients operated on for a ruptured aneurysm it was 3 .1%, whereas 1.0% of patients with nonruptured aneurysm and 0.6% of those o perated on for aortoiliac occlusive disease developed intestinal infarction . In 14 patients (67%) the lesion affected the left colon. The overall 30-d ay mortality rate was 13% but reached 67% among those with intestinal infar ction, We conclude that acute intestinal ischemia with bowel infarction is an infrequent but serious complication of abdominal aortic surgery. It is m ainly related to surgery due to aneurysmal disease, and patients with occlu sive aortoiliac disease present ischemic complications in the intestines le ss often. Hypotensive patients being treated for ruptured aneurysm are at g reatest risk of intestinal ischemia.