Abdominal compartment syndrome after r-EVAR: a systematic review with meta-analysis on incidence and mortality.

Abstract

INTRODUCTION: Endovascular aneurysm repair for ruptured abdominal aortic aneurysms (r-EVAR) sometimes complicates with abdominal compartment syndrome (ACS) due to extensive retroperitoneal hematoma, with significant prognostic implications. This systematic review aimed to analyze the incidence of ACS and assess the impact of ACS on mortality in patients undergoing r-EVAR. Mortality after decompressive laparotomy was also assessed. EVIDENCE ACQUISITION: Two databases were searched: Medline and Web of Science. The search was conducted through October 2019. The titles and abstracts of the retrieved articles were independently reviewed. All studies reporting on the incidence of ACS after r-EVAR were initially included. From each study, eligibility was determined and descriptive, methodological, and outcome data was extracted. Summary proportion was used to calculate the incidence. Odds ratio was used to compare the mortality rate. Meta-analysis was performed with fixed effect model when calculating the incidence of ACS in r-EVAR patients and when assessing the impacts of ACS and DL in the mortality rate. EVIDENCE SYNTHESIS: A total of 46 studies were included, with a cumulative cohort of 3064 patients. The number of patients that developed ACS was 252 (8.2%). The ACS pooled incidence was 9% with a 95% confidence interval of [0.08; 0.11]. Among the 46 included studies, 19 studies reported data on the mortality rate, corresponding to 1825 of the 3064 patients. Of these, 169 (9.3%) had developed ACS and 94 (55.6%) of them died by multi organ failure. Among the 1656 patients without ACS, 328 died (19.8%). The mortality odds ratio meta-analysis was 6.25 with a 95% confidence interval of [4.44, 8.80]. Decompressive laparotomy was performed in 41 patients, decreasing mortality in 47%. CONCLUSIONS: ACS affects approximately 9% of patients submitted to r-EVAR, and significantly increases peri-operative mortality. Close post-operative surveillance to clinical signs of ACS is vital in this subset of patients.