La Sindrome Compartimentale Addominale (ACS) dopo chirurgia dell'Aneurisma dell'Aorta Addominale (AAA)

Introduction: The Abdominal Compartment Syndrome (ACS) is a “condition in which increased tissue pressure in a confined anatomic space, causes decreased blood flow leading to ischaemia and dysfunction and may lead to permanent impairment of function” Materials and Methods: between june 2007 and june 2008 we treated surgically 23 cases of AAA (14 in election and 9 in emergency), with indirect intra-abdominal pressure (IAP) monitoring (intra-vescical catheter). Mean age was 68 (64-84) years. Mean transverse diameter was 6,2 cm (min 5,5 e max 9,0). Rise in IAP more then 20 mmHg was considered for surgical decompression. In 1 case we registered preoperatively IAP more than 20 mmHg treated with only skin suture. Discussion: is possible to distinguish an acute and a chronic ACS.In vascular patients the ACS may occur following free intraperitoneal or contained retroperitoneal aneurysm rupture due to increased IAP. Recently ACS was defined as "killer number one" in the vascular surgical treatment of rAAA. The suggested management for patients with raised IAP, or at risk of developing the ACS following aortic surgery, is to consider urgent decompression in any patients with IAP over 20 mmHg or at lower pressures associated with worsening organ dysfunction. Measurement of IAP may be performed directly or indirectly. All this methods have as objective IPA monitoring befor its clinical manifestation. Conclusion: ACS can be considered a reliable predictive factor for aneurysm surgery outcome. Prevention of the ACS, with early recognition of rising IAP and urgent intervention to decompress the tense abdomen can lead to mortality reduction after aneurysm rupture (after both Open or EVAR treatment). The measurement of IAP is simple and non-invasive, and should be a routine component of physiological monitoring in patients following ruptured aneurysm repair in association with hypotensive hemostasis.