Objective: The abdominal compartment syndrome (ACS) is a ‘conditionin which increased tissue pressure in a confined anatomic space, causesdecreased blood flow leading to ischaemia and dysfunction and leading topermanent impairment of function’.Methods: Between June 2007 and June 2008 we treated surgically 23 casesof AAA (14 in election and nine in emergency), with indirect intra- abdominalpressure (IAP) monitoring (intra-vescical catheter). Mean age was 68 (64–84)years, 19 males and 4 females. Mean transverse diameter was 6.2 cm(5.5–9.0). Preoperative diagnostic procedure was ultrasound and tomographywhen possible. All patients were managed in hypotensive hemostasis(restricting fluids and keeping blood pressure around 90 mmHg). Rise inIAP >20 mmHg was considered for surgical decompression. In one case weregistered preoperatively IAP >20 mmHg treated with only skin suture. No30-days mortality was occurred.Results: Is possible to distinguish an acute ACS, secondary to a rapid risein IAP, and a chronic (compensated by increased abdominal wall compliance).In vascular patients ACS may occur following free intraperitonealor contained retroperitoneal aneurysm rupture. ACS was defined as ‘killernumber one’ in rAAA treatment. Aggressive ACS treatment has determinedin Mayer experience overall 30-day mortality decreased by two-thirds to 12%in 94 patients treated by emergency EVAR for rAAA and 33% for 107 patientstreated by open repair over the past 10 years. Management for patientswith raised IAP, or at risk of developing ACS following aortic surgery, is toconsider urgent decompression in any patients with IAP over 20 mmHg orat lower pressures associated with worsening organ dysfunction. The riseof IPA >20 mmHg is the determinant of ACS that may lead to ischemia anddysfunction of the principal organ and system leading to Multi-Organ Failure.Measurement of IAP may be performed directly (intra-abdominal catheter)or indirectly (intra-vesical. All this methods have as objective IPA monitoringbefore its clinical manifestation. We used intra-vesical catheters for IPAmonitoring and in one case it leads to a surgical decompression.Conclusions: ACS can be a reliable predictive factor for aneurysm outcome.Prevention of ACS, with early recognition of rising IAP and urgent interventionto decompress the tense abdomen can lead to mortality reduction afteraneurysm rupture. IAP measurement IAP is simple and non-invasive, andshould be a routine component of physiological monitoring in patients afterrAAA in association with hypotensive hemostasis.
|Numero di pagine||1|
|Stato di pubblicazione||Published - 2009|
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