Factors associated with abdominal compartment syndrome complicating endovascular repair of ruptured abdominal aortic aneurysms

Abstract

ACS is a potential complication of endovascular repair of r-AAA and negatively affects survival. Factors associated with the development of ACS include (1) use of an aortic occlusion balloon, (2) coagulopathy, (3) massive transfusion requirements, and (4) conversion of bifurcated stent grafts into aortouni-iliac devices. We recommend that, after endovascular repair of r-AAA, these patients undergo vigilant monitoring for the development of ACS.

Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

“…Although EVAR in the treatment of r-AAAs seems to be feasible [1][2][3], it has a potential disadvantage associated with endoleaks, which could be undesirable in cases of active bleeding. Continuous bleeding via endoleaks may exacerbate hemorrhagic shock and abdominal compartment syndrome [3,5].…”

“…Continuous bleeding via endoleaks may exacerbate hemorrhagic shock and abdominal compartment syndrome [3,5].…”

“…Endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (r-AAAs) is feasible and offers the potential for decreased morbidity and mortality [1][2][3]. There also is currently an increased recognition of abdominal compartment syndrome [3].…”

“…There also is currently an increased recognition of abdominal compartment syndrome [3]. Even after EVAR, ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy may contribute to the size of the hematoma [3].…”

Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

“…The pathophysiology is multifactorial resulting from existing retroperitoneal hematoma, ongoing, coagulopathic bleeding from aortic collaterals (lumbar and inferior mesenteric arteries from the disrupted aneurysm sac), and profound shock associated with ruptured AAA, which induce a systemic inflammatory response (SIRS) with increased capillary permeability and hemodynamic compromise (Mehta M., 2005). The incidence of ACS after rupture AAA is as high as 18% and carries with it a 7 fold increased risk of death (Mehta et al, 2010).…”