uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Intra-abdominal Hypertension and Abdominal Compartment Syndrome after Endovascular Repair of Ruptured Abdominal Aortic Aneurysm
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
2011 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 41, no 6, 742-747 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate the frequency of intra-abdominal hypertension (IAH)and abdominal compartment syndrome (ACS) after endovascular repair (EVAR) of rupturedabdominal aortic aneurysm (rAAA).Methods: This was a prospective clinical study. Patients with endovascular repair of rAAAbetween April 2004 and May 2010 were included. Intra-abdominal pressure (IAP) was measuredin the bladder every 4 h. IAH and ACS were defined according to the World Society of theAbdominal Compartment Syndrome consensus document. Early conservative treatments(diuretics, colloids and neuromuscular blockade) were given to patients with IAP > 12 mmHg.Results: Twenty-nine patients, who underwent endovascular repair of a rAAA, had their IAPmonitored. Twenty-five percent of them were in shock at arrival. Postoperatively, 10/29(34%) patients had an IAP > 15 mmHg and six (21%) had an IAP > 20 mmHg. Three (3/29,10%) patients developed ACS that necessitated abdominal decompression in two. Five out ofsix patients with IAP > 20 mmHg presented with preoperative shock. All patients except onewith preoperative shock developed some degree of IAH.Conclusion: IAH and ACS are common and potential serious complications after EVAR for rAAA.Successful outcome depends on early recognition, early conservative treatment to reduce IAHand decompression laparotomy if ACS develops.

Place, publisher, year, edition, pages
2011. Vol. 41, no 6, 742-747 p.
Keyword [en]
Intra-abdominal pressure, Intra-abdominal hypertension, Abdominal compartment syndrome, Abdominal aortic aneurysm, Rupture, Endovascular repair
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-149613DOI: doi:10.1016/j.ejvs.2011.02.021ISI: 000291840900007OAI: oai:DiVA.org:uu-149613DiVA: diva2:405163
Available from: 2011-03-21 Created: 2011-03-21 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Intra-abdominal Hypertension and Colonic Hypoperfusion after Abdominal Aortic Aneurysm Repair
Open this publication in new window or tab >>Intra-abdominal Hypertension and Colonic Hypoperfusion after Abdominal Aortic Aneurysm Repair
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Colonic ischaemia (CI), Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are devastating complications after abdominal aortic aneurysm (AAA) surgery. The aims of this thesis were to study the incidence and clinical consequences of IAH/ACS and the association between CI and intra-abdominal pressure (IAP) among patients undergoing OR for ruptured AAA (rAAA), to compare extraluminal pHi monitoring, with standard intra-luminal monitoring among patients operated on for AAA, and to study the frequency and clinical consequences of IAH/ACS after endovascular repair (EVAR) for rAAA.

The incidence of ACS was 26% in a retrospective study of 27 patients undergoing OR for rAAA. Consensus definitions on IAH/ACS were appropriate for patients after OR for rAAA: 78% (7/9) of patients with IAH grade III or IV developed organ failure and all patients who developed CI had some degree of IAH. Active fluid resuscitation treating hypovolaemia to avoid CI may partly cause IAH. The association between CI and IAP was investigated in a prospective study on 29 patients operated on for rAAA, 86% (25/29) were treated for hypovolaemia and ten (34%) had both IAH and CI. Since monitoring colonic perfusion is very important and there is no ideal method, a new technique, extraluminal colonic tonometry to detect colonic perfusion was compared with standard intraluminal tonometry. Although, this new method was not able to determine the severity of ischaemia it may serve as a screening test. EVAR of rAAA is feasible and patients may benefit from this less invasive procedure. Of 29 patients treated with this technique, 10% developed ACS, and all patients except one with preoperative shock developed some degree of IAH.

In conclusion, IAP/ACS is common after both OR and EVAR for rAAA, and is associated with adverse outcome. Monitoring IAP and colonic perfusion with timely intervention may improve outcome.

Place, publisher, year, edition, pages
Uppsala: Acta Unversitatis Upsaliensis, 2011. 64 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 666
Keyword
Abdominal aneurysm, Intra-abdomnial hypertension, Abdominal compartment syndrome, Colonic ischaemia, Colonic hypotension, Intra-abdominal pressure, rupture abdominal aortic aneurysm
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-149241 (URN)978-91-554-8053-0 (ISBN)
Public defence
2011-05-20, Universitetshuset sal IV, Övre Slottsgatan 2, 75105 Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-04-29 Created: 2011-03-16 Last updated: 2011-05-05Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Authority records BETA

Djavani Gidlund, KhaterehWanhainen, AndersBjörck, Martin

Search in DiVA

By author/editor
Djavani Gidlund, KhaterehWanhainen, AndersBjörck, Martin
By organisation
Department of Surgical Sciences
In the same journal
European Journal of Vascular and Endovascular Surgery
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 425 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf