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A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysms.
J Vasc Surg. 2014 Mar; 59(3):829-42.JV

Abstract

OBJECTIVE

Limited data exist regarding the development of abdominal compartment syndrome (ACS) after endovascular repair of ruptured abdominal aortic aneurysms (RAAAs). We aimed to record the incidence, management, and outcome of this complication.

METHODS

A systematic review and meta-analysis of the English language literature was undertaken through June 2012. Articles reporting data on outcome after endovascular repair of RAAAs were identified, and information regarding ACS was sought.

RESULTS

Included were 39 eligible studies reporting 1134 patients. The pooled perioperative mortality was 21% (95% confidence interval [CI], 18%-24%). A total of 109 cases of ACS were recorded. There was significant within-study heterogeneity (Cochran Q = 94.1; P < .0001), and the pooled ACS rate was 8% (95% CI, 5.6%-10.8%). Only six studies accurately defined ACS, and four focused specifically on ACS. When the meta-analysis was repeated after including only studies with a definition and those focusing on ACS, the pooled rate increased to 17% (95% CI, 10%-26%) and 21% (95% CI, 13%-30%), respectively. A random-effects meta-regression analysis investigating the effect of ACS and other risk factors on mortality revealed a significant linear correlation between hemodynamic instability and death (r = 0.303) and a nonlinear (second degree polynomial) association between bifurcated endograft approach and death (R(2) = 0.348; P = .0027). However, no statistically significant association could be found between ACS and death. A further meta-regression analysis failed to identify any statistically significant predictors of ACS. Treatment included open decompression in 86 patients, percutaneous drainage in 18 (catheter only in five, combined with tissue plasminogen activator infusion in 13), and conservative measures in five. Data on outcome of ACS were only available for 76 patients; 35 of these died, for a mortality rate of 47%.

CONCLUSIONS

The pooled ACS rate was calculated at 8%, but this figure may be >20% with improved awareness and vigilant monitoring. Although no statistically significant association could be found between ACS and death, almost half the patients who developed ACS after endovascular repair of RAAAs were likely to die.

Authors+Show Affiliations

Fifth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocrateio Hospital, Thessaloniki, Greece. Electronic address: ckarkos@hotmail.com.School of Agriculture; Aristotle University of Thessaloniki, Thessaloniki, Greece.First Department of Surgery, National Kapodistrian University of Athens, Laiko Hospital, Athens, Greece.Fifth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocrateio Hospital, Thessaloniki, Greece.Fifth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocrateio Hospital, Thessaloniki, Greece.Regional Vascular Surgery Unit, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

24439324

Citation

Karkos, Christos D., et al. "A Systematic Review and Meta-analysis of Abdominal Compartment Syndrome After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms." Journal of Vascular Surgery, vol. 59, no. 3, 2014, pp. 829-42.
Karkos CD, Menexes GC, Patelis N, et al. A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2014;59(3):829-42.
Karkos, C. D., Menexes, G. C., Patelis, N., Kalogirou, T. E., Giagtzidis, I. T., & Harkin, D. W. (2014). A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysms. Journal of Vascular Surgery, 59(3), 829-42. https://doi.org/10.1016/j.jvs.2013.11.085
Karkos CD, et al. A Systematic Review and Meta-analysis of Abdominal Compartment Syndrome After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms. J Vasc Surg. 2014;59(3):829-42. PubMed PMID: 24439324.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysms. AU - Karkos,Christos D, AU - Menexes,Georgios C, AU - Patelis,Nikolaos, AU - Kalogirou,Thomas E, AU - Giagtzidis,Ioakeim T, AU - Harkin,Denis W, Y1 - 2014/01/16/ PY - 2013/01/08/received PY - 2013/10/19/revised PY - 2013/11/23/accepted PY - 2014/1/21/entrez PY - 2014/1/21/pubmed PY - 2014/4/29/medline SP - 829 EP - 42 JF - Journal of vascular surgery JO - J Vasc Surg VL - 59 IS - 3 N2 - OBJECTIVE: Limited data exist regarding the development of abdominal compartment syndrome (ACS) after endovascular repair of ruptured abdominal aortic aneurysms (RAAAs). We aimed to record the incidence, management, and outcome of this complication. METHODS: A systematic review and meta-analysis of the English language literature was undertaken through June 2012. Articles reporting data on outcome after endovascular repair of RAAAs were identified, and information regarding ACS was sought. RESULTS: Included were 39 eligible studies reporting 1134 patients. The pooled perioperative mortality was 21% (95% confidence interval [CI], 18%-24%). A total of 109 cases of ACS were recorded. There was significant within-study heterogeneity (Cochran Q = 94.1; P < .0001), and the pooled ACS rate was 8% (95% CI, 5.6%-10.8%). Only six studies accurately defined ACS, and four focused specifically on ACS. When the meta-analysis was repeated after including only studies with a definition and those focusing on ACS, the pooled rate increased to 17% (95% CI, 10%-26%) and 21% (95% CI, 13%-30%), respectively. A random-effects meta-regression analysis investigating the effect of ACS and other risk factors on mortality revealed a significant linear correlation between hemodynamic instability and death (r = 0.303) and a nonlinear (second degree polynomial) association between bifurcated endograft approach and death (R(2) = 0.348; P = .0027). However, no statistically significant association could be found between ACS and death. A further meta-regression analysis failed to identify any statistically significant predictors of ACS. Treatment included open decompression in 86 patients, percutaneous drainage in 18 (catheter only in five, combined with tissue plasminogen activator infusion in 13), and conservative measures in five. Data on outcome of ACS were only available for 76 patients; 35 of these died, for a mortality rate of 47%. CONCLUSIONS: The pooled ACS rate was calculated at 8%, but this figure may be >20% with improved awareness and vigilant monitoring. Although no statistically significant association could be found between ACS and death, almost half the patients who developed ACS after endovascular repair of RAAAs were likely to die. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/24439324/A_systematic_review_and_meta_analysis_of_abdominal_compartment_syndrome_after_endovascular_repair_of_ruptured_abdominal_aortic_aneurysms_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(13)02212-X DB - PRIME DP - Unbound Medicine ER -