Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms

Rubenstein, Chen; Bietz, Gabriel; Davenport, Daniel L.; Winkler, Michael; Endean, Eric D.

doi:10.1016/j.jvs.2014.10.011

Cited by 66 publications

(60 citation statements)

References 21 publications

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“…[1] Although ACS is nowadays increasingly recognized for EVAR of rAAA by vascular surgeons, [2,3] reports are scare to the occurrence of ACS after EVAR of rAAA.…”

Section: Discussionmentioning

confidence: 99%

Abdominal compartment syndrome after endovascular repair for ruptured abdominal aortic aneurysm leads to acute intestinal necrosis

Chen

Zhao²,

Huang³

et al. 2016

Medicine

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Introduction:Abdominal compartment syndrome (ACS) after endovascular repair (EVAR) of rupture abdominal aortic aneurysm (rAAA) is a rare emergency situation, which has a high mortality. However, the progression of ACS is rapid and the diagnosis is usually been delayed, which increase the difficulties in treatment and affect the prognosis. We describe a case of a sever complication (acute intestinal necrosis) resulting from ACS after endovascular repair of rAAA.Clinical Finding:An elderly man, 81 years old, complained a sudden lower abdominal and back pain without any predisposing cause. He had a history of hypertension for 20 years without any regular anti-hypertensive therapy. Physical Examination revealed that the blood pressure was 89/54 mmHg, pulse was 120/min, oxygen saturation was 91%. The abdominal ultrasound and the CTA (computed tomography angiography) scan revealed a rAAA. Emergency EVAR under general anesthesia was performed for this patient.Diagnosis:Fourteen hours after endovascular repair, sudden decreased of blood pressure (70/50 mmHg) and oxygen saturation (70%) was observed. ACS or bleeding of retroperitoneal space was diagnosed.Interventions:Abdominal laparotomy was immediately performed. ACS was verified and a severe complication (acute intestinal necrosis) was observed, intestinal resection was performed for this patient.Outcomes:Unfortunately, this patient died after operation because of multi-organ failure in a very short period, which is very rare regarding to this condition. Surgical pathology, diagnosis and management were discussed.Conclusion:ACS was occurred with a severe complication (acute intestinal necrosis) in a very short period, which is very rare regarding to this condition after EVAR, it reminds us the severe result of ACS and more methods to prevent it happened after surgical management.

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“…[1] Although ACS is nowadays increasingly recognized for EVAR of rAAA by vascular surgeons, [2,3] reports are scare to the occurrence of ACS after EVAR of rAAA.…”

Section: Discussionmentioning

confidence: 99%

Abdominal compartment syndrome after endovascular repair for ruptured abdominal aortic aneurysm leads to acute intestinal necrosis

Chen

Zhao²,

Huang³

et al. 2016

Medicine

View full text Add to dashboard Cite

show abstract

“…Circulatory failure was defined as systolic blood pressure < 80 mmHg for >10 minutes upon hospitalization before a procedure, regardless of whether a vasopressor or volume replacement was used [2]. Abdominal compartment syndrome was diagnosed when the bladder pressure was >25 mmHg with abdominal distension and cardiovascular collapse [12]. Coronary artery disease was defined as a history of myocardial infarction or angina, percutaneous coronary intervention, coronary artery bypass grafting, and/or ischemic ST segment abnormalities on preoperative electrocardiography [13].…”

Section: Methodsmentioning

confidence: 99%

Analysis of in hospital mortality and long-term survival excluding in hospital mortality after open surgical repair of ruptured abdominal aortic aneurysm

et al. 2016

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PurposeThe aim of this study was to confirm the factors that affect the mortality associated with the open surgical repair of ruptured abdominal aortic aneurysm (rAAA) and to analyze the long-term survival rates.MethodsA retrospective review was performed on a prospectively collected database that included 455 consecutive patients who underwent open surgical repair for AAA between January 2001 and December 2012. We divided our analysis into in-hospital and postdischarge periods and analyzed the risk factors that affected the long-term survival of rAAA patients.ResultsOf the 455 patients who were initially screened, 103 were rAAA patients, and 352 were non-rAAA (nAAA) patients. In the rAAA group, 25 patients (24.2%) died in the hospital and 78 were discharged. Long-term survival was significantly better in the nAAA group (P = 0.001). The 2-, 5-, and 10-year survival rates of the rAAA patients were 87%, 73.4%, and 54.1%, respectively. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02–.08; P < 0.001) and aneurysm rupture (HR, 1.96; 95% CI, 1.12–.44; P = 0.01) significantly affected long-term survival.ConclusionPreoperative circulatory failure is the most common cause of death for in-hospital mortality of rAAA patients. After excluding patients who have died during the perioperative period, age is the only factor that affects the survival of rAAA patients.

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“…The strongest indication for initiation of open abdomen therapy is abdominal compartment syndrome (ACS). Around 20–30 per cent of patients develop ACS after open (and endovascular) aneurysm repair of ruptured AAA. When ACS is identified late and intra‐abdominal pressure reaches 30 mmHg, urgent decompression laparotomy is necessary to save life.…”

Section: Negative‐pressure Wound Therapy Of Open Abdomen After Aorticmentioning

confidence: 99%

“…If split-thickness skin grafting of the fasciotomy is necessary, it may be preferable to use the less adherent polyvinyl alcohol dressing (white foam) as a wound filler on top of the split-thickness skin graft 39 . 41,42 . When ACS is identified late and intra-abdominal pressure reaches 30 mmHg, urgent decompression laparotomy is necessary to save life 43 .…”

Section: Negative-pressure Wound Therapy For Lower Leg Fasciotomymentioning

confidence: 99%

Negative-pressure wound therapy for prevention and treatment of surgical-site infections after vascular surgery

Acosta

Björck

Wanhainen

2016

British Journal of Surgery

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Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms

Cited by 66 publications

References 21 publications

Abdominal compartment syndrome after endovascular repair for ruptured abdominal aortic aneurysm leads to acute intestinal necrosis

Abdominal compartment syndrome after endovascular repair for ruptured abdominal aortic aneurysm leads to acute intestinal necrosis

Analysis of in hospital mortality and long-term survival excluding in hospital mortality after open surgical repair of ruptured abdominal aortic aneurysm

Negative-pressure wound therapy for prevention and treatment of surgical-site infections after vascular surgery

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