Increasing Use of Prophylactic Open Abdomen Therapy With Vacuum Assisted Wound Closure and Mesh Mediated Fascial Traction After Repair of Ruptured Abdominal Aortic Aneurysm.

OBJECTIVE: Open abdomen therapy (OAT) is commonly used to prevent or treat abdominal compartment syndrome (ACS) in patients with ruptured abdominal aortic aneurysms (rAAAs). This study aimed to evaluate the incidence, treatment, and outcomes of OAT after rAAA from 2006 to 2021. Investigating data on resuscitation fluid, weight gain, and cumulative fluid balance could provide a more systematic approach to determining the timing of safe abdominal closure. METHODS: This was a single centre observational cohort study. The study included all patients treated for rAAA followed by OAT from October 2006 to December 2021. RESULTS: Seventy-two of the 244 patients who underwent surgery for rAAA received OAT. The mean age was 72 ± 7.85 years, and most were male (n = 61, 85%). The most frequent comorbidities were cardiac disease (n = 31, 43%) and hypertension (n = 31, 43%). Fifty-two patients (72%) received prophylactic OAT, and 20 received OAT for ACS (28%). There was a 25% mortality rate in the prophylactic OAT group compared with the 50% mortality in those who received OAT for ACS (p = .042). The 58 (81%) patients who survived until closure had a median of 12 (interquartile range [IQR] 9, 16.5) days of OAT and 5 (IQR 4, 7) dressing changes. There was one case of colocutaneous fistula and two cases of graft infection. All 58 patients underwent successful abdominal closure, with 55 (95%) undergoing delayed primary closure. In hospital survival was 85%. Treatment trends over time showed the increased use of prophylactic OAT (p ≤ .001) and fewer ACS cases (p = .03) assessed by Fisher's exact test. In multivariable regression analysis fluid overload and weight reduction predicted 26% of variability in time to closure. CONCLUSION: Prophylactic OAT after rAAA can be performed safely, with a high rate of delayed primary closure even after long term treatment.

Use of pocket-sized ultrasound device in vascular surgery. / Bruk av ultralydapparat i lommeformat ved karkirurgi.

BACKGROUND: Ultrasound is widely used in vascular surgery. Pocket-sized ultrasound devices have limited functionality compared to conventional ultrasound scanners, but are cheaper and highly portable. The aim of this study was to investigate whether vascular surgeons could benefit from using a pocket ultrasound device in everyday clinical practice. MATERIAL AND METHOD: Pocket-sized ultrasound devices were made available in the Department of Vascular Surgery at St. Olavs Hospital, Trondheim University Hospital, for a 10-month period. Eleven doctors participated and were free to choose between a conventional ultrasound scanner and a pocket ultrasound device. After each use of a pocket ultrasound device, participants completed a form describing the indication for use, whether the clinical question was answered, the image quality experienced and the need for supplementary diagnostic imaging. At the end of the study period, each user completed a questionnaire. RESULTS: Pocket ultrasound devices were mainly used preoperatively. The clinical question was answered in 51 (85 %) of 60 registered examinations with a pocket ultrasound device. Image quality was subjectively rated as good in 32 (53 %) examinations, moderate in 21 (35 %) and poor in 7 (12 %), with the clinical question answered in 94 %, 90 % and 29 % of cases, respectively. Doctors with less than five years of experience with ultrasound chose pocket ultrasound more frequently than more experienced users. INTERPRETATION: For the examinations selected, the images supplied by the pocket ultrasound device were generally of sufficient quality and often answered the clinical question. Pocket ultrasound devices can be a useful supplementary tool in vascular surgery, especially for venous examinations.