Abdominal compartment syndrome after endovascular treatment of ruptured abdominal aortic aneurysm: a topical review
DOI:
https://doi.org/10.48750/acv.338Keywords:
Abdominal aortic aneurysm, Rupture, Endovascular aneurysm repair, Abdominal compartment syndrome, Decompressive laparotomyAbstract
INTRODUCTION
Abdominal compartment syndrome (ACS), defined as intra-abdominal pressure (IAP) greater than 20 mm Hg that is associated with new organ dysfunction/failure, represents na uncommon but hazardous complication after endovascular aneurysm repair for ruptured abdominal aortic aneurysms (r-EVAR). The aim of this review is to overview incidence, mortality and potential benefit of expedite treatment of ACS.
METHODS
Pubmed databases were searched in order to find publications reporting incidence associated mortality of ACS after r-EVAR. Articles published before 2002 and non-human data was not included.
RESULTS
Among larger studies (n>100) ACS incidence ranged between 6.9 to 20%, with significant heterogeneity among included studies.
Significant heterogeneity was also find regarding in-hospital mortality, ranging between 30 to 83%. One study revealed that need for decompressive laparotomy carried a significan greater risk of in-hospital mortality (odds ratio [OR], 5.91; 95% confidence interval [CI], 3.62-9.62;P<.001).
Medical treatment options for reducing IAP represent the first step whenever intra-abdominal pressure > 12mmHg. When the latter reveal innefective, decompressive laparotomy is mandatory to avoid multi-organ failure. No studies comparing effectiveness of decompressive laparotomy exist in the literature as this represents a rescuing measure.
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References
O'Mara JE, Bersin RM. Endovascular Management of Abdominal Aortic Aneurysms: the Year in Review. Curr Treat Options Cardiovasc Med 2016;18:54.
Makar RR, Badger SA, O'Donnell ME, Loan W, Lau LL, Soong CV. The effects of abdominal compartment hypertension after open and endovascular repair of a ruptured abdominal aortic aneurysm. J Vasc Surg 2009;49:866-72.
Djavani K, Wanhainen A, Björck M. Intra-Abdominal Hypertension and Abdominal Compartment Syndrome Following Surgery for Ruptured Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2006;31:581-4.
Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 2006;32:1722-32.
Mehta M, Darling RC, 3rd, Roddy SP, et al. Factors associated with abdominal compartment syndrome complicating endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 2005;42:1047-51.
Ersryd S, Djavani-Gidlund K, Wanhainen A, Björck M. Editor's Choice - Abdominal Compartment Syndrome After Surgery for Abdominal Aortic Aneurysm: A Nationwide Population Based Study. Eur J Vasc Endovasc Surg 2016;52:158-65.
Hörer TM, Skoog P, Norgren L, Magnuson A, Berggren L, Jansson K, et al. Intra-peritoneal microdialysis and intra-abdominal pressure after endovascular repair of ruptured aortic aneurysms. Eur J Vasc Endovasc Surg 2013;45:596-606.
Ersryd S, Djavani Gidlund K, Wanhainen A, Smith L, Björck M. Editor's Choice - Abdominal Compartment Syndrome after Surgery for Abdominal Aortic Aneurysm: Subgroups, Risk Factors, and Outcome. Eur J Vasc Endovasc Surg 2019;58:671-9.
Adkar SS, Turley RS, Benrashid E, Cox MW, Mureebe L, Shortell CK. Laparotomy during endovascular repair of ruptured abdominal aortic aneurysms increases mortality. J Vasc Surg 2017;65:356-61.
Mehta M, Paty PS, Byrne J, Roddy SP, Taggert JB, Sternbach Y, et al. The impact of hemodynamic status on outcomes of endovascular abdominal aortic aneurysm repair for rupture. J Vasc Surg 2013;57:1255-60.
Mayer D, Rancic Z, Meier C, Pfammatter T, Veith FJ, Lachat M. Open abdomen treatment following endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 2009;50:1-7.
Murakami Y, Toya N, Fukushima S, Ito E, Akiba T, Ohki T. Endovascular Aneurysm Repair-First Strategy for Ruptured Aneurysm Focuses on Fitzgerald Classification and Vein Thrombosis. Ann Vasc Surg 2018;52:36-40.
Oyague KS, Mubarak OA, Nowak LR, Nowak LR, Gainer JG, Rehring TF, et al. Endovascular repair of ruptured and symptomatic abdominal aortic aneurysms using a structured protocol in a community teaching hospital. Ann Vasc Surg 2015;29:76-83.
Djavani Gidlund K, Wanhainen A, Björck M. Intra-abdominal hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2011;41:742-7.
Rubenstein C, Bietz G, Davenport DL, Winkler M, Endean ED. Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms. J Vasc Surg 2015;61:648-54.
Fossaceca R, Guzzardi G, Cerini P, Malatesta E, Divenuto I, Stecco A, et al. Endovascular treatment of ruptured abdominal aortic aneurysms: is now EVAR the first choice of treatment? Cardiovasc Intervent Radiol 2014;37:1156-64.
Mehta M, Taggert J, Darling RC, 3rd, Chang B, Kreienberg P, Patty P et al. Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. J Vasc Surg 2006;44:1-8
Acosta S, Lindblad B, Zdanowski Z. Predictors for outcome after open and endovascular repair of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2007;33:277-84.
Saqib N, Park SC, Park T, Rhee RY, Chaer RA, Makaroun MS, et al. Endovascular repair of ruptured abdominal aortic aneurysm does not confer survival benefits over open repair. J Vasc Surg 2012;56:614-9.
Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Brown E, Cohnert T, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019;57:8-93.
Karkos CD, Menexes GC, Patelis N, Kalogirou TE, Giagtzidis IT, Harkin DW. A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 2014;59:829-42.
Van Herzeele I, Vermassen F, Durieux C, Randon C, De Roose J. Endovascular repair of aortic rupture. Eur J Vasc Endovasc Surg 2003;26:311-6.
De Laet IE, Malbrain M, De Waele JJ. A Clinician's Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients. Crit Care 2020;24:97.
Veith FJ, Ohki T, Lipsitz EC, Suggs WD, Cynamon J. Treatment of ruptured abdominal aneurysms with stent grafts: a new gold standard? Semin Vasc Surg 2003;16:171-5.
Loftus IM, Thompson MM. The abdominal compartment syndrome following aortic surgery. Eur J Vasc Endovasc Surg 2003;25:97-109.
Rasmussen TE, Hallett JW, Jr., Noel AA, Jenkins G, Bower TC, Cherry KJ Jr, et al. Early abdominal closure with mesh reduces multiple organ failure after ruptured abdominal aortic aneurysm repair: guidelines from a 10-year case-control study. J Vasc Surg 2002;35:246-53.
Rojas Esquivel DJ, Marín Manzano E, Fernández Heredero Á, Hernández Ruíz T, Concepción Rodríguez NA, Riera de Cubas L. Incidencia y evolución del síndrome compartimental abdominal en aneurismas de aorta rotos tratados con endoprótesis. Angiología 2017;69:78-82.
Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984;199:28-30.
Bickell WH, Wall MJ, Jr., Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994;331:1105-9.
Dutton RP, Mackenzie CF, Scalea TM. Hypotensive Resuscitation during Active Hemorrhage: Impact on In-Hospital Mortality. J Trauma 2002;52:1141-6.
Morrison CA, Carrick MM, Norman MA, Scott BG, Welsh FJ, Tsai P, et al. Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: Preliminary results of a randomized controlled trial. J Trauma 2011;70:652-63.
Varela JE, Cohn SM, Diaz I, Giannotti GD, Proctor KG. Splanchnic perfusion during delayed, hypotensive, or aggressive fluid resuscitation from uncontrolled hemorrhage. Shock 2003;20:476-80.
Kowalenko T, Stern S, Dronen S, Wang X. Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. J Trauma 1992;33:349-53.
