Open abdomen treatment following endovascular repair of ruptured abdominal aortic aneurysms

Abstract

The use of standardized novel techniques and a treatment protocol and algorithm for OAT after eEVAR for RAAA were feasible and safe. It decreased the workload of the medical and nursing staff, enhanced patient comfort because the need for dressing changes was minimized, and likely contributed to lower overall mortality in RAAA patients. Delayed direct fascial closure was possible in most patients.

Manejo Del Abdomen Abierto: Desde La Operación Inicial Al Cierre Definitivo

“…Del total de casos, entre un 10 y un 20% son cuadros graves y de estos un 30% muere en el transcurso de la primera semana de evolución, por distintas complicaciones y falla multiorgánica 38,69,[80][81][82][83][84][85][86][87][88][89] . Los factores de riesgo de mortalidad son la infección de la necrosis pancreática (NPI), la coexistencia de HIA y el SCA.…”

“…c) Isquemia mesentérica aguda Entre las catástrofes quirúrgicas abdominales, la isquemia mesentérica aguda grave tiene una de las tasas más altas de morbimortalidad 75,87 . Los retrasos en el diagnóstico aumentan el ya grave compromiso fisiológico asociado con la patología primaria.…”

Gastrointestinal Complications of Abdominal Aortic Aneurysms

“…It has a particularly relevant role following open repair for a ruptured aneurysm. Recording an intra-operative abdominal pressure of 12mmHg or above is described as an indication for this (Mayer et al, 2009). Here, it has been shown that in cases of ruptured AAA there is a 30% reduction in mortality associated with ACS using this technique (Mayer et al, 2009).…”

“…The use of a simple sterile plastic drape or bag allows for direct visualisation of the bowel and other intra-abdominal contents and is a convenient manner of observing for impending bowel ischaemia in a patient where this is a significant concern. A Bogota bag serves the same purpose, however it also has extra reserve capacity in that it allows for further intra-abdominal swelling to take place without impacting on venous return to the heart and general visceral perfusion (Mayer et al, 2009). In cases where a simple plastic bag or drape or the Bogota bag has been employed these temporary closure devices can be changed to a VAC closure device or a zip device at a later stage.…”

“…This is generally undertaken when the patient is clinically stable, their organ dysfunction is improving and their intra-abdominal pressure remains stable or is decreasing. In patients with a VAC or zip device a high level of monitoring of IAP is required to ensure that the patient doesn't deteriorate and develop ACS again (Mayer et al, 2009). The use of temporary closure devices or a staged or delayed closure in general is associated with an increased risk of ventral hernias, incisional hernias and fistulas.…”