Risk factors for intestinal ischaemia after aortoiliac surgery: A combined cohort and case-control study of 2824 operations

Objectives: To identify risk factor for intestinal ischemia after aortoiliac surgery. Materials and methods: Among 2824 patients operated on during 1987-93 and registered prospectively in the Swedish Vascular Registry, 62 cases of postoperative intestinal ischaemia were identified. They were compared with the remaining 2762 patients through the registry and with a random sample of 127 controls through patient records. Multivariate analysis was performed. Results: Patients in shock operated on for ruptured aneurysms were at greatest risk of developing postoperative intestinal ischemia. Excluding patients in shock, operation for aneurysmal disease and for occlusive disease carried the same risk. Renal disease, emergency surgery, age, type of hospital, aortobifemoral graft, operating time, cross-clamping time and ligation of one or both internal iliac arteries were independent risk factors. Conclusion: Patient-related hemodynamic risk factors together with surgical skill and decision making defines the risk for this serious complication.