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Angiologia e Cirurgia Vascular
Print version ISSN 1646-706X
Abstract
PINTO, José Oliveira; SA, Pedro; SOUSA, Joel and MANSILHA, Armando. Abdominal compartment syndrome after endovascular treatment of ruptured abdominal aortic aneurysm: a topical review. Angiol Cir Vasc [online]. 2022, vol.18, n.2, pp.67-71. Epub Aug 30, 2022. ISSN 1646-706X. https://doi.org/10.48750/acv.338.
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 an 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:
In studies including a large population (n>100) ACS incidence ranged between 6.9 to 20%, with significant disparity between studied cohorts. Significant heterogeneity was also found regarding in-hospital mortality, ranging between 30 to 83%. One study reported that the need for decompressive laparotomy carried a significantly greater risk of in-hospital mortality (odds ratio 5.91; 95% confidence interval, 3.62-9.62; P<.001).
Medical treatment options for reducing IAP represent the first step whenever intra-abdominal pressure > 12mmHg. When the latter is ineffective, 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.
Conclusion:
Abdominal compartment syndrome represents a potentially lethal complication after rEVAR. Close abdominal pressure monitoring along with expedite decompressive laparotomy is mandatory to improve survival of such patients.
Keywords : Abdominal aortic aneurysm; Rupture; Endovascular aneurysm repair; Abdominal compartment syndrome; Decompressive laparotomy.