Open Abdominal Management for a Ruptured Abdominal Aortic Aneurysm

Abstract

We reviewed the outcome of 126 patients between 1981 and 2010 who required emergency surgery for a ruptured abdominal aortic aneurysm. Since 2008, we applied a proactive strategy to abdominal compartment syndrome after abdominal aortic repair. When primary abdominal closure seemed to increase intra-abdominal pressure, patients underwent open abdominal management using a vacuum-assisted closure technique. One hundred one patients underwent aortic repair before 2008 (group A) and 25 patients after 2008 (group B). In the group B delayed abdominal closure was performed in 11 patients. Operative mortality was significantly lower in group B (8% vs 31%, p=0.02). Postoperative bowel ischemia or necrosis was remarkably decreased in group B (4% vs 24%, p=0.001). On multivariate logistic regression, the current proactive strategy to abdominal compartment syndrome was associated with prevention of bowel ischemia or infarction. In conclusion, open abdominal management for selected patients with ruptured abdominal aortic aneurysm may prevent bowel ischemia and confer a survival benefit.