TY - JOUR
T1 - Mesenteric Artery Stenosis is a Risk Factor for Anastomotic Leakage in Colorectal Surgery
AU - Harmankaya, Duygu
AU - Vree Egberts, Koen J.
AU - Metz, Flores M.
AU - Vaassen, Harry G.M.
AU - Slagboom-van Eeden Petersman, Sharon
AU - Brusse-Keizer, Marjolein
AU - le Haen, Pum
AU - Bruno, Marco J.
AU - Geelkerken, Bob H.
AU - van Noord, Desiree
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2025/11/15
Y1 - 2025/11/15
N2 - Objective: Anastomotic leakage (AL) after colorectal surgery leads to substantial morbidity and mortality rates. Theoretically, compromised blood flow caused by mesenteric artery (MA) stenosis may create suboptimal healing conditions at the anastomotic site, increasing susceptibility to AL. The association between MA stenosis on pre-operative computed tomography (CT) scan and AL in patients undergoing colorectal surgery was investigated. Methods: A multicentre, retrospective, frequency matched, nested 1:5 case control study was conducted in the Netherlands. For each patient with AL, five controls without AL were recruited from the same database matched for age and body mass index. Pre-operative CT scans were assessed blindly to identify MA stenosis ≥ 50% as the primary outcome and atherosclerotic burden and vascular pathology as secondary outcomes. Results: One hundred and thirty patients with AL and 627 matched controls without AL were included. The prevalence of stenosis ≥ 50% in the superior mesenteric artery (SMA) was higher in patients with AL compared with controls (13.8% vs. 2.2%; p < .001). A stenosis ≥ 50% in the inferior mesenteric artery (IMA) was also more common in patients with AL (24.6% vs. 12.1%; p < .001). Multivariable regression analysis showed a 5.9 times higher risk (95% confidence interval [CI] 2.78 – 12.60; p < .001) of AL in patients with SMA stenosis and 2.1 times higher risk for patients with IMA stenosis (95% CI 1.11 – 3.63; p = .007). Stenosis ≥ 50% of the coeliac artery was not associated with AL. Conclusion: The presence of SMA or IMA stenosis ≥ 50% on pre-operative CT scans is associated with a six and two times higher odds of AL, respectively, when corrected for known risk factors for AL. Whether preventive stent placement reduces the risk of AL still needs to be investigated.
AB - Objective: Anastomotic leakage (AL) after colorectal surgery leads to substantial morbidity and mortality rates. Theoretically, compromised blood flow caused by mesenteric artery (MA) stenosis may create suboptimal healing conditions at the anastomotic site, increasing susceptibility to AL. The association between MA stenosis on pre-operative computed tomography (CT) scan and AL in patients undergoing colorectal surgery was investigated. Methods: A multicentre, retrospective, frequency matched, nested 1:5 case control study was conducted in the Netherlands. For each patient with AL, five controls without AL were recruited from the same database matched for age and body mass index. Pre-operative CT scans were assessed blindly to identify MA stenosis ≥ 50% as the primary outcome and atherosclerotic burden and vascular pathology as secondary outcomes. Results: One hundred and thirty patients with AL and 627 matched controls without AL were included. The prevalence of stenosis ≥ 50% in the superior mesenteric artery (SMA) was higher in patients with AL compared with controls (13.8% vs. 2.2%; p < .001). A stenosis ≥ 50% in the inferior mesenteric artery (IMA) was also more common in patients with AL (24.6% vs. 12.1%; p < .001). Multivariable regression analysis showed a 5.9 times higher risk (95% confidence interval [CI] 2.78 – 12.60; p < .001) of AL in patients with SMA stenosis and 2.1 times higher risk for patients with IMA stenosis (95% CI 1.11 – 3.63; p = .007). Stenosis ≥ 50% of the coeliac artery was not associated with AL. Conclusion: The presence of SMA or IMA stenosis ≥ 50% on pre-operative CT scans is associated with a six and two times higher odds of AL, respectively, when corrected for known risk factors for AL. Whether preventive stent placement reduces the risk of AL still needs to be investigated.
UR - http://www.scopus.com/inward/record.url?scp=85212310503&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2024.11.013
DO - 10.1016/j.ejvs.2024.11.013
M3 - Article
C2 - 39557379
AN - SCOPUS:85212310503
SN - 1078-5884
VL - 69
SP - 628
EP - 637
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 4
ER -