Intra-abdominal hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm

Abstract

Objectives: To investigate the frequency of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) after endovascular repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA).

Methods: This was a prospective clinical study. Patients with endovascular repair of rAAA between April 2004 and May 2010 were included. Intra-abdominal pressure (IAP) was measured in the bladder every 4 h. IAH and ACS were defined according to the World Society of the Abdominal 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 IAP monitored. 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 of six patients with IAP > 20 mmHg presented with preoperative shock. All patients except one with 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 IAH and decompression laparotomy if ACS develops.