Six of the Best, Vascular 24

Abstract

Aims: Elevated intra-abdominal pressure (IAP) may cause widespread organ dysfunction (abdominal compartment syndrome) through effects on the respiratory, cardiac, renal and gastro-intestinal systems. The aim of this study was to document IAP following aneurysm surgery, and to determine the effect of IAH on the outcome. Methods: The patient cohort comprised 66 patients undergoing infra-renal aneurysm repair (45 nonruptured (32 conventional, 1 death; 13 endovascular); 21 ruptured AAA, 8 deaths). IAP was quantified at the termination of the procedure and 24 h postoperatively. Physiological indices of organ function were recorded, as were the levels of TNF-α and IL-6. Results: IAP was significantly higher at abdominal closure following ruptured aneurysm repair (15.4 mmHg [SE 1.6]) than conventional (10.5 [0.89]) or endovascular repair (6.4 [1.0]) of nonruptured AAA. The sensitivity and specificity of IAP to predict subsequent mortality was analysed using a receiver characteristic operating curve. This analysis demonstrated that a cut off of 15 mmHg was most useful for indicating patients at risk (sensitivity: 0.66; specificity: 0.79). Physiological indices of organ dysfunction (pH [0.027], base excess [0.005], peak inspiratory pressure [0.0015], CVP and urine output [0.0029]) were significantly impaired in patients with IAP > 15 mmHg in comparison to patients with lower pressures. Similarly, IAP correlated significantly with the concentrations of IL-6 (0.0075) and TNF-α (0.0025), as well as with indices of cardiac (CVP 0.038), respiratory (PaO2/FiO2 = 0.026), and renal function (urine output = 0.046). Conclusions: These data suggest that the management of IAP may have a role following repair of ruptured AAA.