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Invited Critique
October 19, 2009

“Hardening of the Arteries” Is a Systemic DiseaseComment on “Ischemic Colitis After Endovascular Aortoiliac Aneurysm Repair”

Arch Surg. 2009;144(10):903. doi:10.1001/archsurg.2009.35

As a complication of both open and endovascular repair of AAAs, colonic ischemia, or ischemic colitis, may require nonvascular abdominal surgeons to assist in diagnosis and management. This report documents a large experience with elective EVAR for infrarenal AAA with a commendably low incidence of colonic ischemia of 1.4%. This low incidence is all the more admirable in that it includes late-appearing colonic ischemia beyond the immediate postoperative interval.

Among the frequently cited mechanisms for colonic ischemia after intervention for AAA, this series illustrates that emboli from intraluminal manipulations can cause severe, even fatal, ischemia and that coil embolization of 1 hypogastric artery is associated with a small increase in the incidence of ischemia. Intraoperative occlusion of the IMA, commonly part of open aneurysm repair and universal with EVAR, did not by itself cause ischemia in this series.

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