Open Abdomen Therapy with Vacuum and Mesh Mediated Fascial Traction After Aortic Repair: an International Multicentre Study

Acosta, Stefan; Seternes, Arne; Venermo, Maarit; Vikatmaa, Leena; Sörelius, Karl; Wanhainen, Anders; Svensson, Mats; Djavani, Khatereh; Björck, Martin

doi:10.1016/j.ejvs.2017.09.002

Cited by 25 publications

(30 citation statements)

References 38 publications

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“…Age was also associated with mortality in two papers reporting on DL for ACS 4 and patients treated with OA. 24 Although the durations of IAH before treatment, tested as hours with IAP 15 mmHg and 20 mmHg, did not predict mortality, they were independent predictors of the need for RRT. Twenty years ago, in a study on temporary abdominal closure, Sugrue et al hypothesised that earlier use of temporary closure in situations of elevated IAP could reduce the rate of RRT.…”

Section: Discussionmentioning

confidence: 84%

Editor's Choice – Abdominal Compartment Syndrome after Surgery for Abdominal Aortic Aneurysm: Subgroups, Risk Factors, and Outcome

Ersryd

Gidlund

Wanhainen

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS This is the largest study to date on abdominal compartment syndrome (ACS) after abdominal aortic aneurysm (AAA) repair, including intact and ruptured AAAs. ACS subgroup outcomes and the impact of duration of intraabdominal hypertension (IAH) were investigated. Outcome was poor regardless of whether ACS was associated with post-operative bleeding, bowel ischaemia, or oedema, and regardless of timing of decompression. The duration of IAH before treatment predicted the need for renal replacement therapy. This emphasises the need to focus on prevention, through careful monitoring of intra-abdominal pressure, strategies for pre-emptive treatment of IAH, and swift treatment when ACS develops. Objectives: Abdominal compartment syndrome (ACS) is a serious complication after abdominal aortic aneurysm (AAA) repair. The aim was to investigate outcome among subgroups and factors associated with outcome, with emphasis on the duration of intra-abdominal hypertension before treatment. Methods: Since 2008, ACS and decompressive laparotomy (DL) after AAA repair are registered prospectively in the Swedish vascular registry (Swedvasc). Registry data and case records were reviewed. Subgroups were defined by main pathophysiological finding at DL, timing of DL after AAA repair, and treatment modality. Results: During 2008e2015, 120 of 8765 patients undergoing surgery for infrarenal AAA developed postoperative ACS (1.4%). Eighty-three followed ruptured AAA (rAAA); 45 open surgical repairs (OSR) and 38 endovascular (EVAR), and thirty-seven after intact AAA (iAAA); 30 OSR and seven EVAR. The main pathophysiological findings at DL were bowel ischaemia in 27 (23.3%), post-operative bleeding in 34 (29.3%), and general oedema in 55 (47.4%). DL was performed <24 hours after AAA repair in 56 (48.7%), 24e48 hours in 30 (26.1%), and >48 hours in 29 patients (25.2%). The overall 90 day mortality was 50.0%, neither different depending on main pathophysiological finding, nor on the timing of DL. In multivariable regression analysis, age was a predictor of mortality (p ¼ .017), while duration of intra-abdominal hypertension (IAH) prior to DL predicted the need for renal replacement therapy (RRT) (p ¼ .033). DL was performed earlier after EVAR compared with OSR in rAAA (p < .001). Conclusions: Mortality in ACS was high, irrespective of the main pathophysiological finding and timing of DL. The duration of IAH prior to DL predicted the need for RRT. DL was performed earlier after EVAR than after OSR for rAAA, underlining the importance of monitoring IAP after EVAR for rAAA.

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Section: Discussionmentioning

confidence: 84%

Editor's Choice – Abdominal Compartment Syndrome after Surgery for Abdominal Aortic Aneurysm: Subgroups, Risk Factors, and Outcome

Ersryd

Gidlund

Wanhainen

et al. 2019

European Journal of Vascular and Endovascular Surgery

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“…Since ACS was first described by Kron et al in 1984 7, RAAA has been considered to be at a significant risk factor for ACS (1,2,7). The development of ACS has been shown to cause hypoperfusion syndrome leading to progressive multiple organ failure and to be frequently fatal (1-3, 7).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Open abdomen after ruptured abdominal aortic aneurysm (RAAA) repair is sometimes necessary to save lives (1,2). However, in RAAA patients requiring OA, it is sometimes difficult to achieve early primary fascial closure due to prolonged visceral edema, retroperitoneal hematoma and the lateralization of the abdominal musculature (1)(2)(3). An extended period of OA may results in severe complications, such as intra-abdominal abscess, intestinal fistula, graft infection, and large ventral hernia (1)(2)(3).…”

Section: Introductionmentioning

confidence: 99%

“…However, in RAAA patients requiring OA, it is sometimes difficult to achieve early primary fascial closure due to prolonged visceral edema, retroperitoneal hematoma and the lateralization of the abdominal musculature (1)(2)(3). An extended period of OA may results in severe complications, such as intra-abdominal abscess, intestinal fistula, graft infection, and large ventral hernia (1)(2)(3). We describe a case in which a staged strategy for abdominal wall closure was applied in the early phase of OA to prevent severe complications.…”

Section: Introductionmentioning

confidence: 99%

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Staged Strategy for Early Abdominal Wall Closure in a Case Involving Ruptured Abdominal Aortic Aneurysm Requiring Open Abdomen in Which Primary Fascial Closure was Difficult to Achieve: A Case Report

Arai¹,

Kim²

2018

chr

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Open abdomen is sometimes necessary to save lives after ruptured abdominal aortic aneurysm repair. We report a case in which a staged strategy for early abdominal wall closure was applied to prevent the severe complications due to the extended period of open abdomen. An 81-year-old man with ruptured abdominal aortic aneurysm was transported to our hospital. After the first operation, which required open abdomen, prolonged visceral edema and retroperitoneal hematoma made primary fascial closure difficult. Mesh mediated fascial traction was undergone to reduce the gap in fascial dehiscence under negative pressure wound therapy. However, primary fascial closure could not be accomplished, and abdominal wall reconstruction was performed using bilateral anterior rectus abdominis sheath turnover flap method. Moreover, the skin along the abdominal wall was too tight to be closed primarily. Thus, a bipedicled skin flap was applied. The patient was transferred to another hospital without any remarkable complications. In the present case, the application of a staged closure strategy, which was based on the duration of open abdomenand the condition of the fascia and skin was considered to be important for achieving definitive abdominal closure and preventing the severe complications.

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Negative pressure wound therapy for managing the open abdomen in non-trauma patients

Cheng

Gong

Liu

et al. 2020

Cochrane Database of Systematic Reviews

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Open Abdomen Therapy with Vacuum and Mesh Mediated Fascial Traction After Aortic Repair: an International Multicentre Study

Abstract: VACM was associated with a high PDFC rate after prolonged open abdomen therapy following aortic repair. Patient outcomes seemed better when open abdomen was initiated at primary, compared with secondary operation but a selection effect is possible.

Cited by 25 publications

References 38 publications

Editor's Choice – Abdominal Compartment Syndrome after Surgery for Abdominal Aortic Aneurysm: Subgroups, Risk Factors, and Outcome

Editor's Choice – Abdominal Compartment Syndrome after Surgery for Abdominal Aortic Aneurysm: Subgroups, Risk Factors, and Outcome

Staged Strategy for Early Abdominal Wall Closure in a Case Involving Ruptured Abdominal Aortic Aneurysm Requiring Open Abdomen in Which Primary Fascial Closure was Difficult to Achieve: A Case Report

Negative pressure wound therapy for managing the open abdomen in non-trauma patients

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