Abdominal Compartment Syndrome After Surgery for Abdominal Aortic Aneurysm: A Nationwide Population Based Study

Abstract

The understanding of abdominal compartment syndrome (ACS), and its importance for outcome, has increased over time. The aim was to investigate the incidence and clinical consequences of ACS after open (OR) and endovascular repair (EVAR) for ruptured and intact infrarenal abdominal aortic aneurysm (rAAA and iAAA, respectively). In 2008, ACS and decompression laparotomy (DL) were introduced as variables in the Swedish vascular registry (Swedvasc), offering an opportunity to study this complication in a prospective, population based design. Operations carried out in the period 2008-13 were analysed. Of 6612 operations, 1341 (20.3%) were for rAAA (72.0% OR) and 5271 (79.7%) for iAAA (41.9% OR). In all, 3171 (48.0%) were operated on by OR and 3441 by EVAR. Prophylactic open abdomen (OA) treatment was validated through case records. Cross-matching with the national population registry secured valid mortality data. After rAAA repair, ACS developed in 6.8% after OR vs 6.9% after EVAR (P = 1.0). All major complications were more common after ACS (P < .001). Prophylactic OA was performed in 10.7% of patients after OR. For ACS, DL was performed in 77.3% after OR and 84.6% after EVAR (P = .433). The 30 day mortality rate was 42.4% with ACS and 23.5% without ACS (P < .001); at 1 year it was 50.7% vs 31.8% (P < .001). After iAAA repair, ACS developed in 1.6% of patients after OR vs 0.5% after EVAR (P < .001). Among those with ACS, DL was performed in 68.6% after OR and in 25.0% after EVAR (P = .006). Thirty day mortality was 11.5% with ACS vs 1.8% without it (P < .001); at 1 year it was 27.5% vs 6.3% (P < .001). When ACS developed, renal failure, multiple organ failure, intestinal ischaemia, and prolonged intensive care were much more frequent (P < .001). Morbidity and mortality were similar, regardless of primary surgical technique (OR/EVAR/iAAA/rAAA). ACS and OA were common after treatment for rAAA. ACS is a devastating complication after surgery for rAAA and iAAA, irrespective of operative technique, emphasizing the importance of prevention.