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

Research output: Contribution to journalArticle

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.

Details

Authors
  • Stefan Acosta
  • Arne Seternes
  • Maarit Venermo
  • Leena Vikatmaa
  • Karl Sörelius
  • Anders Wanhainen
  • Mats Svensson
  • Khatereh Djavani
  • Martin Björck
Organisations
External organisations
  • Skåne University Hospital
  • St. Olav’s University Hospital
  • Helsinki University Central Hospital
  • Uppsala University
  • Falun Central Hospital
  • Gävle Hospital
Research areas and keywords

Keywords

  • Aortic repair, Endovascular repair, Mesh mediated fascial traction, Open abdomen, Open repair, Vacuum assisted closure
Original languageEnglish
Pages (from-to)697-705
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume54
Issue number6
Publication statusPublished - 2017
Publication categoryResearch
Peer-reviewedYes