Abdominal compartment syndrome after endovascular treatment of ruptured abdominal aortic aneurysm: a topical review

• Author(s): Pinto,José Oliveira ; Sá,Pedro ; Sousa,Joel ; Mansilha,Armando
• Date: 2022
• Origin: SciELO Portugal
• Subject(s): Abdominal aortic aneurysm; Rupture; Endovascular aneurysm repair; Abdominal compartment syndrome; Decompressive laparotomy
• Document Type: Journal article
• Language: English

Description

Abstract 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.