Editor's Choice - Abdominal Compartment Syndrome after Surgery for Abdominal Aortic Aneurysm: Subgroups, Risk Factors, and Outcome

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Ersryd, SamuelUppsala universitet,Centrum för klinisk forskning, Gävleborg,Kärlkirurgi (författare)

Editor's Choice - Abdominal Compartment Syndrome after Surgery for Abdominal Aortic Aneurysm : Subgroups, Risk Factors, and Outcome

Artikel/kapitelEngelska2019

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W B SAUNDERS CO LTD,2019
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LIBRIS-ID:oai:DiVA.org:uu-397582
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-397582URI
https://doi.org/10.1016/j.ejvs.2019.04.007DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:142226176URI

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Språk:engelska
Sammanfattning på:engelska

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Objectives: Abdominal compartment syndrome (ACS) is a serious complication after abdominal aortic aneurysm (AAA) repair. The aim was to investigate outcome among subgroups and factors associated with outcome, with emphasis on the duration of intra-abdominal hypertension before treatment.Methods: Since 2008, ACS and decompressive laparotomy (DL) after AAA repair are registered prospectively in the Swedish vascular registry (Swedvasc). Registry data and case records were reviewed. Subgroups were defined by main pathophysiological finding at DL, timing of DL after AAA repair, and treatment modality.Results: During 2008-2015, 120 of 8765 patients undergoing surgery for infrarenal AAA developed postoperative ACS (1.4%). Eighty-three followed ruptured AAA (rAAA); 45 open surgical repairs (OSR) and 38 endovascular (EVAR), and thirty-seven after intact AAA (iAAA); 30 OSR and seven EVAR. The main pathophysiological findings at DL were bowel ischaemia in 27 (23.3%), post-operative bleeding in 34 (29.3%), and general oedema in 55 (47.4%). DL was performed <24 hours after AAA repair in 56 (48.7%), 24-48 hours in 30 (26.1%), and >48 hours in 29 patients (25.2%). The overall 90 day mortality was 50.0%, neither different depending on main pathophysiological finding, nor on the timing of DL. In multivariable regression analysis, age was a predictor of mortality (p = .017), while duration of intra-abdominal hypertension (IAH) prior to DL predicted the need for renal replacement therapy (RRT) (p = .033). DL was performed earlier after EVAR compared with OSR in rAAA (p < .001).Conclusions: Mortality in ACS was high, irrespective of the main pathophysiological finding and timing of DL. The duration of IAH prior to DL predicted the need for RRT. DL was performed earlier after EVAR than after OSR for rAAA, underlining the importance of monitoring IAP after EVAR for rAAA.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
Abdominal compartment syndrome
Aortic aneurysm-abdominal
Bowel ischaemia
Intra-abdominal pressure
Mortality
Renal replacement therapy

Biuppslag (personer, institutioner, konferenser, titlar ...)

Gidlund, Khatereh DjavaniUppsala universitet,Kärlkirurgi,Centrum för klinisk forskning, Gävleborg(Swepub:uu)khadj328 (författare)
Wanhainen, AndersUppsala universitet,Kärlkirurgi(Swepub:uu)anwan103 (författare)
Smith, LinnKarolinska Institutet,Karolinska Univ Hosp, Karolinska Inst, Dept Vasc Surg, Stockholm, Sweden (författare)
Björck, MartinUppsala universitet,Kärlkirurgi(Swepub:uu)mabjo425 (författare)
Uppsala universitetCentrum för klinisk forskning, Gävleborg (creator_code:org_t)

Sammanhörande titlar

Ingår i:European Journal of Vascular and Endovascular Surgery: W B SAUNDERS CO LTD58:5, s. 671-6791078-58841532-2165

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European Journal of Vascular and Endovascular Surgery (Sök värdpublikationen i LIBRIS)

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Av författaren/redakt...: Ersryd, Samuel; Gidlund, Khatere ...; Wanhainen, Ander ...; Smith, Linn; Björck, Martin

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

Artiklar i publikationen: European Journal ...

Av lärosätet: Uppsala universitet; Karolinska Institutet

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