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Intra-abdominal hypertension and abdominal compartment syndrome following surgery for ruptured abdominal aortic aneurysm.
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences. Interfaculty Units, Centrum för klinisk forskning, Gävleborg. (Vascular Surgery)
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences. (Vascular Surgery)
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences. (Vascular Surgery)
2006 (English)In: Eur J Vasc Endovasc Surg, ISSN 1078-5884, Vol. 31, no 6, 581-4 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To investigate the importance of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), based on the December 2004 consensus definition, on outcome after surgery for ruptured abdominal aortic aneurysm (rAAA). METHODS: Twenty-seven patients underwent open surgery for rAAA after the introduction of intra-abdominal pressure (IAP) measurements among patients at risk of IAH. Case-records were reviewed retrospectively. Seventeen patients underwent IAP-monitoring. RESULTS: Of eight patients with IAP <21 mmHg none developed colonic ischaemia or ACS. Of four patients with IAP 21-25 mmHg (IAH grade III), two underwent colonic resection. One patient treated with open abdomen died from cardiac arrhythmia. Five patients had IAP >25 mmHg (IAH grade IV). All developed ACS. Two were not decompressed and both developed pulmonary complications, one died. Two underwent colonic resection and one was treated with open abdomen, all three survived. Of 10 patients not monitored for IAP, one died of cardiac complications, but no patient developed signs of colonic ischaemia or ACS. Mortality at 30 days and 1 year was 3/27 (11%). CONCLUSION: IAH and ACS were common among patients undergoing surgery for rAAA. The ACS consensus definition seems appropriate in this clinical context. Monitoring IAP, and timely decompression of patients with IAH might improve outcome after surgery for rAAA.

Place, publisher, year, edition, pages
2006. Vol. 31, no 6, 581-4 p.
Keyword [en]
Abdomen/blood supply, Aged, Aneurysm; Ruptured/*surgery, Aortic Aneurysm; Abdominal/*surgery, Compartment Syndromes/*etiology, Consensus, Female, Humans, Hypertension/*etiology, Incidence, Male, Pilot Projects, Postoperative Complications, Retrospective Studies, Rupture; Spontaneous
Identifiers
URN: urn:nbn:se:uu:diva-24385PubMedID: 16458547OAI: oai:DiVA.org:uu-24385DiVA: diva2:52159
Available from: 2007-04-16 Created: 2007-04-16 Last updated: 2011-05-05
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

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Wanhainen, ABjörck, M

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