# Risk Factors for Acute Hemorrhagic Rectal Ulcers after Bypass Surgery for Chronic Limb-Threatening Ischemia

## TL;DR

This study finds that using steroids and being unable to walk after surgery increase the risk of rectal ulcers in patients with severe leg blood flow issues.

## Contribution

Identifies steroid use and postoperative nonambulatory status as novel risk factors for acute hemorrhagic rectal ulcers after bypass surgery in CLTI patients.

## Key findings

- 6 out of 80 CLTI patients developed AHRU after bypass surgery.
- Steroid use and postoperative nonambulatory status were significant risk factors for AHRU.
- AHRU patients had longer hospital stays and higher steroid use compared to non-AHRU patients.

## Abstract

Objectives: Acute hemorrhagic rectal ulcer (AHRU) occurs with a sudden onset of painless bloody stools and is caused by impaired blood flow in the rectal mucosa due to arteriosclerosis or prolonged bedridden status. Little information is available about AHRU in patients with chronic limb-threatening ischemia (CLTI). This study aimed to identify factors related to AHRU among CLTI patients after bypass surgery.

Methods: Between 2019 and 2023, we enrolled 80 CLTI patients at our institution who underwent bypass surgery using autogenous veins. Data were collected prospectively and supplemented with retrospective medical record reviews. Information regarding demographic and clinical characteristics was collected. The outcomes of patients without AHRU (non-AHRU group) and those with AHRU (AHRU group) were compared. Logistic regression analysis was used to assess factors associated with AHRU after bypass surgery.

Results: During the study period, 6 of the 80 patients (7.5%) experienced AHRU after bypass surgery. There was no significant difference in the global limb anatomic staging system (GLASS) or wound ischemia and foot infection (WIfI) stage between the 2 groups. The percentage of patients taking oral steroids was significantly greater in the AHRU group. In addition, the AHRU group had a significantly greater percentage of postoperative ambulatory failure and a longer hospital stay. In the univariate analysis of factors associated with the incidence of AHRU after bypass surgery, steroid use (odds ratio [OR], 13.8; 95% confidence interval [CI], 2.19–86.9; P = 0.005) and nonambulatory status after surgery (OR, 7.22; 95% CI, 1.26–41.4; P = 0.026) were significant factors.

Conclusions: Steroid use and postoperative nonambulatory status were associated with AHRU after bypass surgery for CLTI.