Delayed abdominal closure in the management of ruptured abdominal aortic aneurysm

Vascular. Nov-Dec 2009;17(6):309-15. doi: 10.2310/6670.2009.00048.

Abstract

The objective of this study was to compare initial use of the open abdomen using the vacuum-pack technique followed by delayed abdominal closure with standard primary abdominal closure in the treatment of ruptured abdominal aortic aneurysm (rAAA) repair. A retrospective review identified 122 rAAA cases, which were divided into two management eras: era 1 (primarily closed) and era 2 (47% open abdomen).One hundred three patients were included in this review: 58 in era 1 and 45 in era 2. Evidence of one of three ischemia-reperfusion (IR) criteria, preoperative hypotension, estimated blood loss > or = 6 L, or intraoperative resuscitation with > or = 12 L, predicted mortality. These criteria were also used as surrogate clinical markers for abdominal compartment syndrome. The in-hospital mortality was higher in those with at least one IR criterion: 43% versus 10% (p = .0003). In those with at least one IR criterion, the initial 24-hour mortality was 21% for era 1 versus 0% for era 2 (p = .03), and the 30-day mortality was 40% for era 1 and 32% for era 2 (p = .77).Three IR criteria were identified and were associated with increased mortality. Patients with these risk factors who were treated with delayed abdominal closure had an improved acute survival rate and a trend for improved long-term survival.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Rupture / mortality
  • Aortic Rupture / surgery*
  • Blood Loss, Surgical / prevention & control
  • Compartment Syndromes / etiology
  • Female
  • Hospital Mortality
  • Humans
  • Hypertension / etiology
  • Hypotension / complications
  • Male
  • Negative-Pressure Wound Therapy* / adverse effects
  • Negative-Pressure Wound Therapy* / mortality
  • Reperfusion Injury / etiology
  • Retrospective Studies
  • Risk Factors
  • Suture Techniques* / adverse effects
  • Suture Techniques* / mortality
  • Time Factors
  • Transfusion Reaction
  • Treatment Outcome
  • Vascular Surgical Procedures* / adverse effects
  • Vascular Surgical Procedures* / mortality