Incidence and clinical presentation of bowel ischaemia after aortoiliac surgery - 2930 operations from a population-based registry in Sweden

Objectives: To study the incidence and clinical presentation of intestinal ischaemia after aortoiliac/femoral surgery, and to validate a vascular registry concerning a serious complication. Design and setting: In the Swedish Vascular Registry (SWEDVASC) the outcome and complications of all vascular procedures are registered prospectively. Materials and methods: All 2930 patients operated in 1987-93 were analysed for notified complications. A 5% random sample of all patients and a 20% random sample of fatal cases were analysed for un-notified complications. Of 415 requested patient records 413 were analysed. Results: The estimated incidence of bowel ischaemia was 2.8%. Among patients operated on for a ruptured aneurysm in shock it was 7.3%. Of the 63 patients with intestinal ischaemia only 15 presented with early passage of bloody stools. In 60 patients (95%) the lesion affected the left colon within the reach of a sigmoidoscope. Bowel ischemia was un-notified only in fatal cases, the estimated un-notified complication rate was 0.7%. Conclusions: The incidence in this study on unselected patients did not differ from previous reports from specialised centres. Diagnosis is difficult and justifies a high index of suspicion and early use of sigmoidoscopy. The validity of the SWEDVASC registry was confirmed by a high report-rate for this complication.