The effects of abdominal compartment hypertension after open and endovascular repair of a ruptured abdominal aortic aneurysm

Makar, Ragai R.; Badger, Stephen A.; O’Donnell, Mark E.; Loan, William; Lau, Louis; Soong, Chee V.

doi:10.1016/j.jvs.2008.11.027

Cited by 27 publications

(20 citation statements)

References 42 publications

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“…These results have been reported before [16]. However, in brief, during the two-year study period, 40 consecutive rAAA patients who reached the hospital alive were considered for the study.…”

Section: Resultssupporting

confidence: 81%

“…The baseline parameters were comparable for the two groups. The eEVAR group was associated with lower blood loss ( P < 0.001), less blood transfusion ( P < 0.001), and less total intraoperative intravenous fluid infusion ( P = 0.001) [16]. Interestingly, the duration of surgery was not significantly different ( P = 0.34) between the two surgical strategies, but while all eOR patients were admitted to intensive care unit, only 8 of the eEVAR patients did so [16].…”

Section: Resultsmentioning

confidence: 99%

“…The details of selection have been outlined before [16]. However, in brief, patients over the age of 50 years presenting to the Vascular Surgery Unit of the Belfast City Hospital with a diagnosis of infrarenal ruptured AAA were recruited after obtaining consent.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The Inflammatory Response to Ruptured Abdominal Aortic Aneurysm Is Altered by Endovascular Repair

Makar

Badger

O’Donnell

et al. 2013

International Journal of Vascular Medicine

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Introduction. Ruptured abdominal aortic aneurysm (rAAA) causes a significant inflammatory response. The study aims to investigate this response following endovascular and open repair of ruptured AAA. Patients and Methods. Consecutive rAAA patients had either endovascular aneurysm repair (EVAR) or open repair (OR). Blood samples were taken for cytokines, lipid hydroperoxides (LOOH), antioxidants, and neutrophil elastase/α1-anti-trypsin complexes (NE/AAT) before surgery, 6 hours after clamp release and 1, 3, 5 days postoperatively. Results. 30 patients were included in the study, with 14 undergoing eEVAR and 16 eOR, with comparable baseline comorbidities, age, and parameters. IL-6 peaked higher in eOR patients (P = 0.04), while p75TNFr was similar between groups except at day 5 (P = 0.04). The NE/AAT concentrations were higher in eOR patients (P = 0.01), particularly in the first postoperative day, and correlated with blood (r = 0.398, P = 0.029) and platelet (r = 0.424, P = 0.020) volume transfused. C-reactive protein rose and lipid hydroperoxide fell in both groups without significant intergroup difference. Vitamins C and E, lycopene, and β-carotene levels were similar between groups. Conclusion. EVAR is associated with lower systemic inflammatory response compared to OR. Its increased future use may thereby improve outcomes for patients.

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Section: Resultssupporting

confidence: 81%

Section: Resultsmentioning

confidence: 99%

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The Inflammatory Response to Ruptured Abdominal Aortic Aneurysm Is Altered by Endovascular Repair

Makar

Badger

O’Donnell

et al. 2013

International Journal of Vascular Medicine

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“…Pertinent postoperative wound closure may have an important role in prevention of ACS, which would otherwise be treated by decompression such as negative pressure dressings. Makar et al [29] demonstrated that in patients with ruptured AAAs, emergency EVAR compared with emergency conventional open repair is less stressful, reduces blood loss, requires less transfused and total intraoperative intravenous fluid infusion, and has a lower systemic inflammatory response syndrome score and lower lung injury score, in association with less intraabdominal hypertension. Within the limitations of the data published to date, EVAR as the primary treatment for ruptured AAA is achievable and seems to be associated with favorable mortality over open repair when cases are appropriately selected [30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors associated with mortality in patients undergoing emergency surgery for abdominal aortic aneurysms

et al. 2011

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The authors clarified that certain features such as age, persistent preoperative shock, and greater amounts of transfusion associated with greater blood loss and anemia were factors affecting the mortality in patients undergoing emergency surgery for AAAs. It might be of great importance to correct preoperative shock and anemia caused by massive bleeding before the onset of hemodynamic deterioration.

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“…The details of the overall project have been described before [17]. However, in brief, patients presenting to the vascular surgery unit with an infrarenal ruptured AAA were recruited after written informed consent from patient or next of kin.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Endovascular Repair of Ruptured Abdominal Aortic Aneurysm on the Gastrointestinal and Renal Function

Makar

Badger

O’Donnell

et al. 2014

International Journal of Vascular Medicine

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Introduction. Systemic effects of ruptured abdominal aortic aneurysm (rAAA) may be altered by the mode of surgery. This study aimed to determine systemic effects of endovascular aneurysm repair (EVAR) compared to open repair (OR). Patients and Methods. Consecutive patients with rAAA were repaired by OR or EVAR according to computerised tomographic (CT) findings. Renal function was monitored by estimated glomerular filtration rate (eGFR), serum urea and creatinine, and urinary albumin creatinine ratio (ACR). Hepatic function was assessed postoperatively for 5 days. Intestinal function was determined by the paracetamol absorption test. Intestinal permeability was assessed by urinary lactulose/mannitol ratio. Results. 30 rAAA patients were included. Fourteen had eEVAR and sixteen eOR. Serum urea were higher in eOR, while creatinine was similar between groups. Hepatic function showed no intergroup difference. Paracetamol absorption was increased in eEVAR group at day 3 compared to day 1 (P = 0.03), with no similar result in eOR (P = 0.24). Peak lactulose/mannitol ratio was higher in eOR (P = 0.03), with higher urinary L/M ratio in eOR at day 3 (P = 0.02). Clinical intestinal function returned quicker in eEVAR (P = 0.02). Conclusion. EVAR attenuated the organ dysfunction compared to open repair. However, a larger comparative trial would be required to validate this. The clinical trial is registered with reference number EUDRACT: 2013-003373-12.

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The effects of abdominal compartment hypertension after open and endovascular repair of a ruptured abdominal aortic aneurysm

Abstract: These results suggest that eEVR of ruptured AAA is less stressful and is associated with less intra-abdominal hypertension and host inflammatory response compared with eOR.

Cited by 27 publications

References 42 publications

The Inflammatory Response to Ruptured Abdominal Aortic Aneurysm Is Altered by Endovascular Repair

The Inflammatory Response to Ruptured Abdominal Aortic Aneurysm Is Altered by Endovascular Repair

Prognostic factors associated with mortality in patients undergoing emergency surgery for abdominal aortic aneurysms

The Impact of Endovascular Repair of Ruptured Abdominal Aortic Aneurysm on the Gastrointestinal and Renal Function

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