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Tissue plasminogen activator-assisted hematoma evacuation to relieve abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm
Örebro University Hospital. Department of Cardio-Vascular and Thoracic Surgery.
Department of Cardio-Vascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-0934-0063
Department of Cardio-Vascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden.
Örebro University Hospital. Department of Cardio-Vascular and Thoracic Surgery.
2012 (English)In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 19, no 2, 144-148 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To describe our experience with a novel technique to decompress abdominal compartment syndrome after endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA).

Method: From January 2003 to April 2010, 13 patients (12 men; mean age 75 years) treated for rAAA with EVAR underwent tissue plasminogen activator (tPA)-assisted decompression for intra-abdominal hypertension. All of the patients but one had intra-abdominal pressure >20 mmHg, with signs of multiple organ failure or abdominal perfusion pressure <60 mmHg. With computed tomography guidance, a drain was inserted into the retroperitoneal hematoma, and tPA solution was injected to facilitate evacuation of the coagulated hematoma and decrease the abdominal pressure.

Results: In the 13 patients, the mean intra-abdominal pressure decreased from 23.5 mmHg (range 12-35) to 16 mmHg (range 10-28.5). A mean 1520 mL (range 170-2900) of blood was evacuated. Urine production (mean 130 mL/h, range 50-270) increased in 7 patients at 24 hours after tPA-assisted decompression; among the 5 patients in which urine output did not increase, 3 underwent hemodialysis by the 30-day follow-up. One patient did not respond with clinical improvement and required laparotomy. The 30-day, 90-day, and 1-year mortality was 38% (5/13 patients); none of the deaths was related to the decompression technique.

Conclusion: tPA-assisted decompression of abdominal compartment syndrome after EVAR can decrease the intra-abdominal pressure and could be useful in preventing multiple organ failure. It is a minimally invasive technique that can be used in selected cases but does not replace laparotomy or retroperitoneal surgical procedures as the gold standard treatments. J Endovasc Thor. 2012;19:144-148

Place, publisher, year, edition, pages
Sage Publications, 2012. Vol. 19, no 2, 144-148 p.
Keyword [en]
abdominal compartment syndrome, decompression, endovascular aneurysm repair, ruptured abdominal aorta aneurysm, tissue plasminogen activator
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
URN: urn:nbn:se:oru:diva-58683ISI: 000303644300003PubMedID: 22545876Scopus ID: 2-s2.0-84860752930OAI: oai:DiVA.org:oru-58683DiVA: diva2:1123234
Available from: 2017-07-12 Created: 2017-07-12 Last updated: 2017-09-12Bibliographically approved

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Hörer, Tal M.Skoog, PerPirouzram, ArtaiLarzon, Thomas

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