Systemic endotoxaemia and fibrinolysis during aortic surgery.
OBJECTIVE
To determine whether endotoxaemia and activation of the systemic fibrinolytic system occurs during and after aortic surgery.


METHODS
Prospective clinical study.


METHODS
University Hospital.


METHODS
31 patients undergoing aortic surgery.


METHODS
Venous blood assay for endotoxin and plasminogen activator inhibitor-1 (PAI-1). Samples were obtained preoperatively, immediately before and 5 minutes after cross-clamp application and removal, and at 2, 4, 6 and 24 hours postoperatively. Tonometric sigmoid intramural pH was monitored throughout this period as a means of detecting colonic mucosal ischaemia.


RESULTS
Endotoxin levels increased after clamping of the aorta, peaking immediately before clamp removal, mean value 34.5 pg/ml, p < 0.01, but returning to preoperative levels by 24 hours. PAI-1 levels progressively increased after surgery, with persistently high levels remaining at 24 hours (p < 0.01).


CONCLUSIONS
Endotoxaemia does occur during aortic surgery and appears to be associated with activation of the systemic fibrinolytic system.
Welch
M
M
Department of Vascular Surgery, Manchester Royal Infirmary & Medical School, U.K.
Douglas
J T
JT
Smyth
J V
JV
Walker
M G
MG
D000138:Acidosis / Q000097:blood; D017545:Aortic Aneurysm, Thoracic / Q000097:blood / Q000601:surgery*; D001018:Aortic Diseases / Q000097:blood / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000601:surgery*; D001639:Bicarbonates / Q000097:blood; D002245:Carbon Dioxide / Q000097:blood; D002315:Cardiopulmonary Bypass; D012809:Colon, Sigmoid / Q000098:blood supply / Q000503:physiopathology; D004731:Endotoxins / Q000097:blood*; D005342:Fibrinolysis; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007413:Intestinal Mucosa / Q000098:blood supply; D007511:Ischemia / Q000097:blood / Q000150:complications; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011312:Pressure; D011446:Prospective Studies
D001639:Bicarbonates; D004731:Endotoxins; D017395:Plasminogen Activator Inhibitor 1; D002245:Carbon Dioxide