Comparative outcomes of open abdominal therapy after ruptured abdominal aortic aneurysm via open and endovascular approaches

• Published in: Annals of vascular surgery Vol. 77; pp. 164 - 171
• Main Authors: Steenberge, Sean P., Sorour, Ahmed A., Sundaram, Abishek, Bena, James, Kirksey, Lee
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-11-2021
• Subjects: Aged; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - diagnostic imaging; Aortic Rupture - mortality; Aortic Rupture - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Comparative Effectiveness Research; endovascular procedure; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Fluid Therapy - adverse effects; Hospital Mortality; Humans; Length of Stay; Male; open abdomen therapy; Operative Time; Postoperative Complications - etiology; Postoperative Complications - mortality; Retrospective Studies; Risk Assessment; Risk Factors; ruptured abdominal aortic aneurysm; Time Factors; Treatment Outcome; vacuum assisted wound closure; SBP; EVAR; ruptured abdominal aortic aneurysm; vacuum assisted wound closure; OR; OS; endovascular procedure; open abdomen therapy; ACS; CTA; ICU; rAAA; NPWT; TP; RP
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2021.05.013

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).
Retrospective cohort study
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.
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).
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.