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Open abdomen treatment after aortic aneurysm repair with vacuum-assisted wound closure and mesh-mediated fascial closure

Sörelius, Karl ; Wanhainen, Anders ; Acosta, Stefan LU orcid ; Svensson, Mats ; Gidlund, Khatereh Djavani and Björck, Martin (2013) In European journal of vascular and endovascular surgery 45(6). p.588-594
Abstract
Objectives: Open abdomen (OA) treatment is sometimes necessary after surgery for aortic aneurysm (AA), to prevent or treat abdominal compartment syndrome (ACS). A multicentre study evaluating vacuum-assisted wound closure (100-150 mmHg) and mesh-mediated fascial traction (VAWCM) was performed.
Methods: All patients treated with OA after AA repair (2006-2009) were prospectively registered at four centres; those treated <5 days were excluded. All surviving patients underwent a 1-year follow-up, including computed tomography (CT) examination.
Results: Among 1041 patients treated with open or endovascular repair of AA, 28 (2.9%) had OA treatment with VAWCM; another two had VAWCM after hybrid operations for thoraco-abdominal AA.... (More)
Objectives: Open abdomen (OA) treatment is sometimes necessary after surgery for aortic aneurysm (AA), to prevent or treat abdominal compartment syndrome (ACS). A multicentre study evaluating vacuum-assisted wound closure (100-150 mmHg) and mesh-mediated fascial traction (VAWCM) was performed.
Methods: All patients treated with OA after AA repair (2006-2009) were prospectively registered at four centres; those treated <5 days were excluded. All surviving patients underwent a 1-year follow-up, including computed tomography (CT) examination.
Results: Among 1041 patients treated with open or endovascular repair of AA, 28 (2.9%) had OA treatment with VAWCM; another two had VAWCM after hybrid operations for thoraco-abdominal AA. Eighteen (60%) were operated on for rupture and 12 (40%) electively. Eight had suprarenal or thoraco-abdominal aneurysms. Eight (27%) died within 30 days, none due to OA-related complications. Four died before abdominal closure; primary delayed fascial closure was achieved in all survivors. One-year mortality was 50%. Ten (33%) had bowel ischaemia requiring bowel resection. Late potential OA-related infectious complications occurred in five (17%), all of whom first developed intestinal ischaemia: entero-atmospheric fistulae (two), graft infections (two), aorto-enteric fistula (one). One year follow-up with clinical evaluation and CT showed no signs of graft infection. Incisional hernias occurred in 9 of 15 patients (60%); only three were symptomatic.
Conclusion: VAWCM provided high fascial closure rate after AA repair and long-term OA treatment. Infectious complications occur after intestinal ischaemia and prolonged OA treatment, and are often fatal. The poor prognosis among patients needing OA after AA surgery may be improved by using VAWCM, permitting earlier closure. (Less)
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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European journal of vascular and endovascular surgery
volume
45
issue
6
pages
588 - 594
publisher
Elsevier
external identifiers
  • scopus:84878115244
ISSN
1532-2165
DOI
10.1016/j.ejvs.2013.01.041
language
English
LU publication?
yes
id
ee4c5544-166a-41b9-b349-f9f0f3d87435
date added to LUP
2020-12-14 15:53:38
date last changed
2022-02-01 18:30:33
@article{ee4c5544-166a-41b9-b349-f9f0f3d87435,
  abstract     = {{Objectives: Open abdomen (OA) treatment is sometimes necessary after surgery for aortic aneurysm (AA), to prevent or treat abdominal compartment syndrome (ACS). A multicentre study evaluating vacuum-assisted wound closure (100-150 mmHg) and mesh-mediated fascial traction (VAWCM) was performed.<br>
Methods: All patients treated with OA after AA repair (2006-2009) were prospectively registered at four centres; those treated &lt;5 days were excluded. All surviving patients underwent a 1-year follow-up, including computed tomography (CT) examination.<br>
Results: Among 1041 patients treated with open or endovascular repair of AA, 28 (2.9%) had OA treatment with VAWCM; another two had VAWCM after hybrid operations for thoraco-abdominal AA. Eighteen (60%) were operated on for rupture and 12 (40%) electively. Eight had suprarenal or thoraco-abdominal aneurysms. Eight (27%) died within 30 days, none due to OA-related complications. Four died before abdominal closure; primary delayed fascial closure was achieved in all survivors. One-year mortality was 50%. Ten (33%) had bowel ischaemia requiring bowel resection. Late potential OA-related infectious complications occurred in five (17%), all of whom first developed intestinal ischaemia: entero-atmospheric fistulae (two), graft infections (two), aorto-enteric fistula (one). One year follow-up with clinical evaluation and CT showed no signs of graft infection. Incisional hernias occurred in 9 of 15 patients (60%); only three were symptomatic.<br>
Conclusion: VAWCM provided high fascial closure rate after AA repair and long-term OA treatment. Infectious complications occur after intestinal ischaemia and prolonged OA treatment, and are often fatal. The poor prognosis among patients needing OA after AA surgery may be improved by using VAWCM, permitting earlier closure.}},
  author       = {{Sörelius, Karl and Wanhainen, Anders and Acosta, Stefan and Svensson, Mats and Gidlund, Khatereh Djavani and Björck, Martin}},
  issn         = {{1532-2165}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{588--594}},
  publisher    = {{Elsevier}},
  series       = {{European journal of vascular and endovascular surgery}},
  title        = {{Open abdomen treatment after aortic aneurysm repair with vacuum-assisted wound closure and mesh-mediated fascial closure}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2013.01.041}},
  doi          = {{10.1016/j.ejvs.2013.01.041}},
  volume       = {{45}},
  year         = {{2013}},
}