Open Surgical Decompression Is Useful for the Prevention and Treatment of Abdominal Compartment Syndrome after the Repair of Ruptured Abdominal Aortic and Iliac Artery Aneurysm.

Objective

This study was performed to determine whether open surgical decompression (OSD) decreased the mortality associated with abdominal compartment syndrome (ACS) following open repair (OR) of ruptured abdominal aortic aneurysm and iliac aneurysm (rAAA), and to investigate the risk factors associated with OSD. Material and

Methods

Total 113 consecutive patients with rAAA underwent OR in our institution. Ninety patients underwent primary abdominal closure; however, three of them developed ACS and required OSD. Prophylactic OSD was performed at the initial OR in 23 patients.

Results

The in-hospital mortality rate was higher in those who underwent OSD than in those who did not undergo OSD [27.0% (7/26) vs. 6.9% (6/87), respectively; p=0.01]. However, no ACS-related death occurred in the OSD group. Multivariate analyses revealed that a preoperative/intraoperative base excess (BE)<-11 [p=0.045; odds ratio (OR), 3.33; 95% confidence interval (CI), 1.021-10.850], performance of left thoracotomy (p=0.038; OR, 5.17; 95%CI, 1.098-24.357), and intraoperative blood transfusion >1,800 mL (p=0.012; OR, 4.30; 95%CI, 1.386-13.322) were associated with OSD.

Conclusion

The prevalence and mortality rates of ACS were low at our institution. OSD is considered to be useful for the prevention and treatment of ACS after repair of rAAA. OSD should be considered in patients with the above-mentioned factors.