title: Translumbar extraperitoneal decompression for abdominal compartment syndrome after endovascular treatment of a ruptured AAA.
abstract: OBJECTIVE
  To report an unusual case of abdominal compartment syndrome (ACS) following endovascular repair of a ruptured abdominal aortic aneurysm (rAAA) that had been treated with a stent-graft 3 years prior.
  
  
  METHODS
  A 68-year-old man with a 3-year-old Vanguard bifurcated aortic stent-graft experienced sudden back pain and collapse. Aneurysm rupture documented by computed tomography was due to dislocation of the left graft limb. A Talent aortomonoiliac graft was deployed, followed by a femorofemoral bypass. No endoleak was evident. A few hours later, the patient became oliguric and hemodynamically unstable. Increased intra-abdominal pressure (IAP) was recorded. Abdominal decompression was performed, removing 1500 mL of blood from the retroperitoneum through an 18-cm lumbotomy; the peritoneum was opened, and another 500 mL of blood was aspirated. The IAP fell immediately, followed by diuresis a few hours later. The patient recovered and was discharged after 27 days.
  
  
  CONCLUSIONS
  Some of the perioperative complications seen after conventional rAAA repair are also encountered after endovascular treatment. ACS requires urgent decompression, and less invasive approaches, such as translumbar extraperitoneal decompression, may be a good alternative to a midline laparotomy.
authors.affiliation: Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. vhisabelle@hotmail.com
authors.forename: Isabelle
authors.initials: I
authors.lastname: Van Herzeele
authors.forename: Jan J
authors.initials: JJ
authors.lastname: De Waele
authors.forename: Frank
authors.initials: F
authors.lastname: Vermassen
mesh_terms: D000005:Abdomen; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001019:Aortic Rupture / Q000601:surgery; D001807:Blood Vessel Prosthesis; D003161:Compartment Syndromes / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D008297:Male; D010537:Peritoneum; D011183:Postoperative Complications / Q000601:surgery*; D015607:Stents