Abdominal compartment syndrome after endovascular treatment of ruptured abdominal aortic aneurysm: a topical review
Keywords:Abdominal aortic aneurysm, Rupture, Endovascular aneurysm repair, Abdominal compartment syndrome, Decompressive laparotomy
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.
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.
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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