Biological responses differ considerably between endovascular and conventional aortic aneurysm surgery.
OBJECTIVE
To determine the inflammatory responses in endovascular abdominal aortic aneurysm (AAA) repair and their relation to clinical findings.


METHODS
Prospective non-randomised study.


METHODS
University Hospital, Department of Surgery.


METHODS
Seven patients treated with an endoluminal procedure (AAA-E) and seven patients undergoing conventional surgery (AAA-C) were included. Inflammatory parameters were assessed by measurements of the cytokines interleukin (IL)-1 beta, IL-6, IL-8 and Tumour Necrosis Factor-alpha (TNF-alpha); analyses of complement proteins C1q, C4, C3, C5a and Terminal Complement Complexes (TCC); haematologic parameters and determination of C-reactive protein (CRP).


RESULTS
In six of seven patients in the AAA-E group blood pressure decreases were recorded during introduction of the device. IL-6 and CRP levels were found to be significantly higher in AAA-C patients compared to the AAA-E group. On the other hand, high TNF-alpha levels were recorded in the AAA-E group. Less consumption of the complement proteins C1q, C4 and C3 was observed in AAA-E compared to AAA-C patients. Increased C5a levels were recorded in the AAA-C group, whereas only slight fluctuations were noticed in the AAA-E group. TCC levels were unchanged in both groups.


CONCLUSIONS
Endovascular aortic aneurysm repair induced a significant inflammatory response, mainly involving TNF-alpha and differing from the findings during open AAA repair. These inflammatory responses were probably related to blood pressure decreases during the procedures. On the other hand, conventional repair induced responses related to the more extensive surgical trauma and reperfusion injury.
Swartbol
P
P
Department of Surgery, Lund University, Sweden.
Norgren
L
L
Albrechtsson
U
U
Cwikiel
W
W
Jahr
J
J
Jonung
T
T
Pärsson
H
H
Ribbe
E
E
Thörne
J
J
Truedsson
L
L
Zdanowski
Z
Z
D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001794:Blood Pressure; D001807:Blood Vessel Prosthesis; D002097:C-Reactive Protein / Q000032:analysis; D015922:Complement C1q / Q000032:analysis; D003176:Complement C3 / Q000032:analysis; D003181:Complement C4 / Q000032:analysis; D015936:Complement C5a / Q000032:analysis; D015938:Complement Membrane Attack Complex / Q000032:analysis; D016207:Cytokines / Q000032:analysis*; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007375:Interleukin-1 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D003176:Complement C3; D003181:Complement C4; D015938:Complement Membrane Attack Complex; D016207:Cytokines; D007375:Interleukin-1; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D015922:Complement C1q; D015936:Complement C5a; D002097:C-Reactive Protein