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Comparative outcomes of open abdominal therapy after ruptured abdominal aortic aneurysm via open and endovascular approaches.
- Source :
-
Annals of vascular surgery [Ann Vasc Surg] 2021 Nov; Vol. 77, pp. 164-171. Date of Electronic Publication: 2021 Aug 16. - Publication Year :
- 2021
-
Abstract
- Background: Open abdomen therapy is sometimes a necessary lifesaving procedure after repair of ruptured abdominal aortic aneurysm (rAAA). OAT aims to prevent or treat abdominal compartment syndrome (ACS). This study aims to evaluate our experience with open abdomen therapy (OAT) after repair of ruptured abdominal aortic aneurysms (rAAAs).<br />Design: Retrospective cohort study METHODS: Medical records were retrieved for ruptured abdominal aortic aneurysm patients who underwent open surgical repair (OS) or endovascular aneurysm repair (EVAR) between January 1, 2008 and December 12, 2015 from a single center. Univariate and multivariate analysis were performed with statistical significance.<br />Results: The study included 171 patients. Thirty-three patients (19.3%) required OAT. A smaller percentage of patients required OAT after EVAR (9.8%) compared to OS (23.3%) (P = 0.05). Patients with OAT also had a significantly longer operation (257 vs. 202.7 minutes; P < 0.05), required more intra-operative fluids (15,700 vs. 8,050 mL; P < 0.05), had a longer hospital stay (20 vs. 8.5 days; P < 0.05), and had a higher peri-operative mortality rate (48.5% vs 25.4%; P < 0.05). On multivariate logistic regression analysis, a lower preoperative SBP (OR 0.9, P = 0.01) and history of hypertension (OR 0.3, P = 0.02) were protective against OAT, while longer operative duration increased the risk of OAT (OR: 1.27, P = 0.05). Mean duration of OAT prior to closure was 4.76 days. Comparing OS patients (transperitoneal and retroperitoneal) that underwent OAT closure, patients who had a retroperitoneal repair received less intra-operative fluids (13.79 vs. 19.11 L; P = 0.212), had earlier return of bowel function (10 vs. 16.9 days; P = 0.08), and a shorter hospital stay (19.9 vs. 32.2 days; P = 0.03).<br />Conclusions: OAT is a lifesaving procedure that is associated with higher morbidity and mortality following OS and EVAR for rAAA. Patients with longer operations and extensive fluid resuscitation are at higher risk for OAT following rAAAs. Preoperative permissive hypotension may be protective against OAT. OAT following the RP approach to rAAA is associated with earlier abdominal wall closure, earlier bowel recovery, and shorter hospital stay.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aortic Aneurysm, Abdominal diagnostic imaging
Aortic Aneurysm, Abdominal mortality
Aortic Rupture diagnostic imaging
Aortic Rupture mortality
Comparative Effectiveness Research
Female
Fluid Therapy adverse effects
Hospital Mortality
Humans
Length of Stay
Male
Operative Time
Postoperative Complications etiology
Postoperative Complications mortality
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Aortic Aneurysm, Abdominal surgery
Aortic Rupture surgery
Blood Vessel Prosthesis Implantation adverse effects
Blood Vessel Prosthesis Implantation mortality
Endovascular Procedures adverse effects
Endovascular Procedures mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1615-5947
- Volume :
- 77
- Database :
- MEDLINE
- Journal :
- Annals of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 34411674
- Full Text :
- https://doi.org/10.1016/j.avsg.2021.05.013