February 24, 2005

Identifying Risk Factors For Complications Of Ruptured AAA Treated By Endovascular Means

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Abstract 06

Manish Mehta, MD, MPH, Scott R. Fecteau, MD, R. Clement Darling, III, MD, Sean P. Roddy, MD, Kathleen J. Ozsvath, MD, Paul B. Kreienberg, MD, Philip S.K. Paty, MD, Benjamin B. Chang, MD, Dhiraj M. Shah, MD.
Albany Medical College, Albany, NY, USA.

PURPOSE: Endovascular treatment of ruptured abdominal aortic aneurysms (AAA) can result in development of abdominal compartment syndrome (ACS). We reviewed our experience with endovascular repair of ruptured AAA to identify risk factors associated with development of ACS.
METHODS: From January 2002 to July 2004, 29 patients underwent emergent endovascular repair of ruptured AAA. All procedures were done via bilateral femoral cut-down, and a supra-celiac aortic occlusion balloon was placed only in hemodynamically unstable patients via brachial or femoral approach. All patients that developed ACS underwent emergent laparotomy. Physiological and clinical parameters were analyzed and patients that developed ACS were compared to patients without ACS.
RESULTS: Over the past 2 ½ years 29 patients underwent endovascular ruptured AAA repair. Of these 6 (22%) patients developed ACS at the completion of the procedure, or within 36 hours. Physiologic and clinical data are summarized below.


Patient Group	n	Operative Time (mean)	Aortic Occlusion	Blood Transfusion (mean)	aPTT at completion of EVAR (mean)	Bladder Pressure (mean)	Death
ACS	6	89 min	4 (67%)	8 units	128 sec	44 mm Hg	4 (67%)
No ACS	23	95 min	3 (13%)	2 units	52 sec	N/A	4 (17%)
p value		NS	<0.01	<0.01	<0.001	N/A	<0.05

CONCLUSIONS: ACS is a potential complication of endovascular repair of ruptured AAA and requires emergent laparotomy. Significant risk factors for the development of ACS include: 1) the need for aortic occlusion, 2) massive blood transfusion requirement, 3) coagulopathy, and 4) elevated bladder pressure. After endovascular repair of ruptured AAA, patients that have these risk factors require vigilant monitoring for the development of ACS.
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ACS

No ACS