Incidencia y evolución del síndrome compartimental abdominal en aneurismas de aorta rotos tratados con endoprótesis

Abstract

ObjectiveTo study the incidence, evolution and management of abdominal compartment syndrome (ACS) in ruptured abdominal aortic aneurysms (RAAA) after endovascular aneurysm repair. Material and methodsRetrospective observational study. We analyzed all emergency EVAR performed from October 2001 to December 2015. Only RAAA were included. Symptomatic aortic aneurysms were excluded. We studied the incidence, evolution and management of ACS. Diagnosis of ACS was established with intraabdominal pressure more than 20mmHg plus the development of a new organic dysfunction. Preoperative and postoperative variables were analyzed for ACS. Fisher exact test and Mann-Whitney U-test were used for the statistical analysis. ResultsSixty-five emergency EVAR were performed during the analyzed period, 42 were RAAA. The mean age was 77 ± 8 years; 98% were men. Nine of 42 patients (21.4%) died in the operating room. The incidence of ACS in the 33 remaining patients was 18.2% (6/33 patients). The mortality for ACS was 66.7% vs 18.5% (p=0.034). Decompressive laparotomy was performed in 4 patients (4/6). The mortality after decompressive laparotomy was 50% vs 100% (p= 0.4). The incidence of ACS for postoperative acidosis was 57.7% vs 7.7% (p=0.01), for preoperative coagulopathy 41.7% vs 4.8% (p=0.01), for preoperative systolic blood pressure <90 mmHg 46.2% vs 0% (p=0.002). The incidence of ACS after overload of more than 3 liters of crystalloids per 24 hours in the postoperative period was 38.5% vs 5% (p=0.02). Patients with ACS received intraoperatively 8 ± 3.6 packed erythrocytes vs 2 ± 2.7 (p= 0.002). ConclusionsThese findings confirm that ACS is a common disease that is associated with a high mortality in patients with RAAA after EVAR. Patients with a compromise hemodynamic status, multiple transfusions and those with overload of intravenous crystalloids during management were associated with higher incidence of ACS.