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Regarding: Comparative Outcomes of Open Abdominal Therapy After Ruptured Abdominal Aortic Aneurysm via Open and Endovascular Approaches

      We read with great interest the study by Steenberge et al. recently published in Ann VascSurg.
      • Steenberge S.P.
      • Sorour A.A.
      • Sundaram A.
      • et al.
      Comparative outcomes of open abdominal therapy after ruptured abdominal aortic aneurysm via open and endovascular approaches.
      Abdominal compartment syndrome (ACS) is indeed a dreadful complication that can be frequently encountered after ruptured Abdominal Aortic Aneurysm (rAAA) repair.
      • Rubenstein C.
      • Bietz G.
      • Davenport D.L.
      • et al.
      Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms.
      If ACS develops, prognosis of patients is significantly worse with higher rates (almost double) of mortality having been reported among these patients compared to those without ACS. Therefore, a strategy of close monitoring of patients in the intensive care unit (ICU) is usually employed after rAAA repair, with frequent intra-abdominal pressure (IAP) measurements and in case of resistant ACS, decompressive laparotomy is indicated.
      • Kirkpatrick A.W.
      • Roberts D.J.
      • De Waele J.
      • Jaeschke R.
      • Malbrain M.L.
      • De Keulenaeret al
      Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome.
      The study from Steenberge et al. reported an ACS rate around 20%, where various modes of open abdomen were applied such as skin only closure or vacuum and negative pressure therapy to decompress the abdominal cavity. Secondary closure was achieved with either direct fascial or with mesh-mediated closure.
      • Steenberge S.P.
      • Sorour A.A.
      • Sundaram A.
      • et al.
      Comparative outcomes of open abdominal therapy after ruptured abdominal aortic aneurysm via open and endovascular approaches.
      Remarkably, patients that developed ACS presented a significantly higher mortality rate (48.5%, vs. 25.3%, P = 0.009), which is a finding consistent with what has been previously reported in the literature.
      • Rubenstein C.
      • Bietz G.
      • Davenport D.L.
      • et al.
      Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms.
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      References

        • Steenberge S.P.
        • Sorour A.A.
        • Sundaram A.
        • et al.
        Comparative outcomes of open abdominal therapy after ruptured abdominal aortic aneurysm via open and endovascular approaches.
        Ann Vasc Surg. 2021; 77: 164-171
        • Rubenstein C.
        • Bietz G.
        • Davenport D.L.
        • et al.
        Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms.
        J Vasc Surg. 2015; 61: 648-654
        • Kirkpatrick A.W.
        • Roberts D.J.
        • De Waele J.
        • Jaeschke R.
        • Malbrain M.L.
        • De Keulenaeret al
        Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome.
        Intensive Care Med. 2013; 39: 1190-1206
        • Acosta S.
        • Seternes A.
        • Venermo M.
        • et al.
        Open abdomen therapy with vacuum and mesh mediated fascial traction after aortic repair: an international multicentre study.
        Eur J Vascendovasc Surg. 2017; 54: 697-705