Open Abdomen Therapy with Vacuum and Mesh Mediated Fascial Traction After Aortic Repair : an International Multicentre Study

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Acosta , S , Seternes , A , Venermo , M , Vikatmaa , L , Sörelius , K , Wanhainen , A , Svensson , M , Djavani , K & Björck , M 2017 , ' Open Abdomen Therapy with Vacuum and Mesh Mediated Fascial Traction After Aortic Repair : an International Multicentre Study ' , European Journal of Vascular and Endovascular Surgery , vol. 54 , no. 6 , pp. 697-705 . https://doi.org/10.1016/j.ejvs.2017.09.002

Title: Open Abdomen Therapy with Vacuum and Mesh Mediated Fascial Traction After Aortic Repair : an International Multicentre Study
Author: Acosta, Stefan; Seternes, Arne; Venermo, Maarit; Vikatmaa, Leena; Sörelius, Karl; Wanhainen, Anders; Svensson, Mats; Djavani, Khatereh; Björck, Martin
Contributor: University of Helsinki, Verisuonikirurgian yksikkö
University of Helsinki, Department of Diagnostics and Therapeutics
Date: 2017-12
Language: eng
Number of pages: 9
Belongs to series: European Journal of Vascular and Endovascular Surgery
ISSN: 1078-5884
URI: http://hdl.handle.net/10138/298239
Abstract: Objectives: Open abdomen therapy may be necessary to prevent or treat abdominal compartment syndrome (ACS). The aim of the study was to analyse the primary delayed fascial closure (PDFC) rate and complications after open abdomen therapy with vacuum and mesh mediated fascial traction (VACM) after aortic repair and to compare outcomes between those treated with open abdomen after primary versus secondary operation. Methods: This was a retrospective cohort, multicentre study in Sweden, Finland, and Norway, including consecutive patients treated with open abdomen and VACM after aortic repair at six vascular centres in 2006-2015. The primary endpoint was PDFC rate. Results: Among 191 patients, 155 were men. The median age was 71 years (IQR 66-76). Ruptured abdominal aortic aneurysm (RAAA) occurred in 69.1%. Endovascular/hybrid and open repairs were performed in 49 and 142 patients, respectively. The indications for open abdomen were inability to close the abdomen (62%) at primary operation and ACS (80%) at secondary operation. Duration of open abdomen was 11 days (IQR 7-16) in 157 patients alive at open abdomen termination. The PDFC rate was 91.8%. Open abdomen initiated at primary (N = 103), compared with secondary operation (N = 88), was associated with less severe initial open abdomen status (p = .006), less intestinal ischaemia (p = .002), shorter duration of open abdomen (p = .007), and less renal replacement therapy (RRT, p <.001). In hospital mortality was 39.3%, and after entero-atmospheric fistula (N = 9) was 88.9%. Seven developed graft infection within 6 months, 1 year mortality was 28.6%. Intestinal ischaemia (OR 3.71, 95% CI 1.55-8.91), RRT (OR 3.62, 95% CI 1.72-7.65), and age (OR 1.12, 95% CI 1.06-1.12), were independent factors associated with in hospital mortality, but not open abdomen initiated at primary versus secondary operation. Conclusions: VACM was associated with a high PDFC rate after prolonged open abdomen therapy following aortic repair. Patient outcomes seemed better when open abdomen was initiated at primary, compared with secondary operation but a selection effect is possible. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Subject: Open abdomen
Aortic repair
Open repair
Endovascular repair
Vacuum assisted closure
Mesh mediated fascial traction
ABDOMINAL COMPARTMENT SYNDROME
ASSISTED WOUND CLOSURE
NEGATIVE-PRESSURE
ENDOVASCULAR REPAIR
ANEURYSM REPAIR
MANAGEMENT
INFECTION
METAANALYSIS
LAPAROTOMY
CONSENSUS
3126 Surgery, anesthesiology, intensive care, radiology
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