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Ruptured aneurysm: therapy of abdominal compartment syndrome post EVAR

  • Vittorio Alberti1Email author,
  • Pierluigi Costa1,
  • Stefano Fazzini1,
  • Eugenia Serrao1,
  • Sonia Ronchey1 and
  • Nicola Mangialardi1
BMC Geriatrics201111(Suppl 1):A1

https://doi.org/10.1186/1471-2318-11-S1-A1

Published: 24 August 2011

Background

Endovascular treatment of ruptured abdominal aortic aneurysms (r-EVAR) has the potential to offer improved outcomes. A frequent cause of post-operative mortality following ruptured aortic aneurysm repair is multi-organ failure (MOF) as a consequence of abdominal compartment syndrome (ACS). We reviewed our experience to identify predisposing factors for ACS (Fig. 1) and a way for its treatment.
Figure 1

Chain of events triggered by retroperitoneal haematoma.

Materials and methods

From January 2005 to December 2009, 53 patients underwent emergent endovascular repair of r-AAA. We mainly used bifurcated prostheses (44 patients), apart from 5 cases of aorto-uni-iliac device and 4 cases of straight endografts. Nine patients developed ACS and were submitted to abdominal decompression by retroperitoneal surgical drainage (Fig. 2).
Figure 2

Surgical retroperitoneal access.

Results

Thirty-day mortality was 22.6% (12/53). Early mortality was recorded in unstable patients only. Stable patients (24) had no mortality in the first 30 days. Among patients who underwent retro-peritoneal drainage, the 30-day mortality rate was 33.3% (3/9). At a median follow up of 34 months (33.8 + 17.0) 3 patients died of aneurysm or procedure related causes.

Conclusions

One of the priorities in the management of r-EVAR is to prevent and eventually treat the ACS. A surgical evacuation of the retroperitoneal hematoma through extraperitoneal access has considerable advantages, mainly in high risk and older patients. In r-EVAR the particular factor is the retroperitoneal hematoma. Therefore we perform abdominal decompression via retroperitoneal access.

Authors’ Affiliations

(1)
Unit of Vascular Surgery, San Filippo Neri Hospital

References

  1. Marin ML, Veith FJ, Cynamon J, Sanchez LA, Lyon RT, Levine BA, et al: Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions. Ann Surg. 1995, 222: 449-65.PubMed CentralView ArticlePubMedGoogle Scholar
  2. Mastracci TM, Garrido-Olivares L, Cinà CS, Clase CM: Endovascular repair of ruptured abdominal aortic aneurysms: a systematic review and meta-analysis. J Vasc Surg. 2008, 47 (1): 214-221. 10.1016/j.jvs.2007.07.052.View ArticlePubMedGoogle Scholar
  3. Ten Bosch JA, Teijink JA, Willigendael EM, Prins MH: Endovascular aneurysm repair is superior to open surgery for ruptured abdominal aortic aneurysms in EVAR-suitable patients. J Vasc Surg. 2010, 52 (1): 13-8. 10.1016/j.jvs.2010.02.014.View ArticlePubMedGoogle Scholar

Copyright

© Alberti et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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