Intra-peritoneal Microdialysis and Intra-abdominal Pressure after Endovascular Repair of Ruptured Aortic Aneurysms

• Published in: European journal of vascular and endovascular surgery 2013-06, Vol.45 (6), p.596-606
• Main Authors: Hörer, T.M, Skoog, P, Norgren, L, Magnuson, A, Berggren, L, Jansson, K, Larzon, T
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Analysis of Variance; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - surgery; Biomarkers - metabolism; Decompression, Surgical; Early Diagnosis; Endovascular Procedures - adverse effects; Female; Glucose - metabolism; Glycerol; Glycerol - metabolism; Humans; Intra-abdominal hypertension; Intra-Abdominal Hypertension - diagnosis; Intra-Abdominal Hypertension - metabolism; Intra-Abdominal Hypertension - physiopathology; Intra-Abdominal Hypertension - surgery; Lactate; Lactic Acid - metabolism; Male; Medicin; Medicine; Metabolism; Microdialysis; Middle Aged; Peritoneal Cavity; Predictive Value of Tests; Pressure; Pyruvate; Pyruvic Acid - metabolism; Ruptured aortic aneurysm; Surgery; Time Factors; Treatment Outcome; Urination
• ISSN: 1078-5884; 1532-2165; 1532-2165
• DOI: 10.1016/j.ejvs.2013.03.002

Objectives This study aims to evaluate intra-peritoneal (ip) microdialysis after endovascular aortic repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) in patients developing intra-abdominal hypertension (IAH), requiring abdominal decompression. Design Prospective study. Material and methods A total of 16 patients with rAAA treated with an emergency EVAR were followed up hourly for intra-abdominal pressure (IAP), urine production and ip lactate, pyruvate, glycerol and glucose by microdialysis, analysed only at the end of the study. Abdominal decompression was performed on clinical criteria, and decompressed (D) and non-decompressed (ND) patients were compared. Results The ip lactate/pyruvate (l/p) ratio was higher in the D group than in the ND group during the first five postoperative hours (mean 20 vs. 12), p  = 0.005 and at 1 h prior to decompression compared to the fifth hour in the ND group (24 vs. 13), p  = 0.016. Glycerol levels were higher in the D group during the first postoperative hours (mean 274.6 vs. 121.7 μM), p  = 0.022. The IAP was higher only at 1 h prior to decompression in the D group compared to the ND group at the fifth hour (mean 19 vs. 14 mmHg). Conclusions Ip l/p ratio and glycerol levels are elevated immediately postoperatively in patients developing IAH leading to organ failure and subsequent abdominal decompression.