Summary:
Abdominal aortic aneurysm (AAA) rupture represents a common cause of
death in Western countries. The overall mortality rate of AAA
rupture reaches 80 –
90%.
In 1994 a ruptured aortoiliac aneurysm has been treated for the
first time by endovascular means and since then this treatment
modality has become quite popular. Although endovascular repair of
ruptured AAA (rEVAR), as a minimally invasive technique, aspired to
overcome or even to substitute the open repair, this did not
happen. There are only a few multicenter, randomized controlled
trials published during the last years, that fail to show the
superiority of one technique in respect to the other, in terms of
short – term mortality
rates.
Abdominal compartment syndrome (ACS) comprises a potentially lethal
complication of AAA rupture. It has been described for the first
time after rEVAR in 2000 and its incidence can reach 21% or more.
It is true that the exact incidence of ACS is not easy to be
extracted from the literature, because the published series are small
and largely heterogeneous. The “closed”
repair of rupture, that does not permit hematoma evacuation and
bowel edema are both predisposing factors for continuous increase of
intra-abdominal pressure (IAP) and ACS development. It has been
calculated that 30 – day mortality after rEVAR varies between 13 and
31% and if the patient develops ACS, the mortality could reach
100%. Taking into consideration the above
elements, it must be underlined that prompt diagnosis and treatment
are of paramount importance. Clinical suspicion and close monitoring
of the patients after rEVAR can avert, through the adoption of
conservative measures, the continuous increase of IAP and the
development of ACS. If ACS develops, laparotomy and temporary
abdominal wall closure is the treatment of choice. Abdominal
decompression will lead to immediate improvement of symptoms and
hemodynamic status of the patient.
Keywords:
Abdominal Compartment Syndrome, Aneurysm, Aneurysm Rupture, Endovascular Repair, Abdominal Aorta
