[Mechanisms and prediction of hemorrhagic complications during surgery of thoraco-abdominal aortic aneurysms].
This study, including 33 consecutive patients was designed to assess the haemostatic alterations occurring during repair of thoracoabdominal aneurysms. The surgical procedure consisted in Dacron graft replacement of the diseased aorta, using neither cardiopulmonary bypass, nor any shunting technique, nor any heparin. Blood samples were drawn before anaesthesia, before and 30 min after unclamping, and on the first postoperative day. The measured parameters were: haematocrit, platelet count, bleeding, activated cephalin, thrombin and prothrombin times, and concentrations of fibrinogen, factors V, VII, X and II, anti-thrombin III, proteins C and S, fibrin degradation products, D-dimers, alpha 2-antiplasmin, plasminogen, tissue plasminogen activator, plasminogen activator inhibitor, and serum protein. Eight patients developed severe multiple haemorrhages; 3 of them died during the procedure because of uncontrollable bleeding. Although the measured parameters were similar in the "bleeding" and control (n = 25) groups before surgery, there was, before unclamping in the first group, an important increase in activated cephalin and thrombin times, with a fall in concentrations of factor II and V, protein C, fibrinogen, and alpha 2-antiplasmin, and in platelet numbers. After unclamping, these changes worsened further, with an increase in prothrombin time and in fibrinogen levels (0,8 g.l-1), without any increase in fibrin degradation products. Abnormal bleeding started about 30 min after this in all the patients of the "bleeding" group. These changes, involving the fibrinolytic system as well as a fall in concentration of all the coagulation factors, can probably be partly explained by the clamping and unclamping of mesenteric vessels.(ABSTRACT TRUNCATED AT 250 WORDS)
Godet
G
G
Département d'Anesthésie-Réanimation, Hôpital de la Pitié-Salpêtrière, Paris.
Samama
C M
CM
Ankri
A
A
Barre
E
E
Soughir
S
S
Kieffer
E
E
Viars
P
P
D001014:Aortic Aneurysm / Q000601:surgery*; D001778:Blood Coagulation Disorders / Q000150:complications; D001779:Blood Coagulation Factors / Q000032:analysis; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical; D001807:Blood Vessel Prosthesis; D003250:Constriction; D006470:Hemorrhage / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007431:Intraoperative Complications; D011446:Prospective Studies; D013997:Time Factors
D001779:Blood Coagulation Factors
Mécanismes et prédiction des complications hémorragiques au cours de la chirurgie des anévrysmes de l'aorte thoracoabdominale.