Inflammatory response to aorto-bifemoral graft surgery.
OBJECTIVE
To evaluate the systemic release of major cytokines and complemental activation during elective aorto-bifemoral bypass surgery and the influence on the postoperative course.


METHODS
Prospective randomised study.


METHODS
University hospital, Sweden.


METHODS
Fourteen consecutive patients with aorto-iliac occlusive disease were randomised to receive either a bifurcated e PTFE graft with stretch properties or a collagen coated Dacron graft.


METHODS
Immunologic parameters were assessed and included the cytokines TNF alpha (tumor necrosis factor), IL-6, IL-8, S-IL-2R and complemental factor C5a. Furthermore, acute plasma proteins, including C-reactive protein, and the different white blood cell fractions were determined. Sampling was performed frequently during surgery and postoperatively up to one month.


RESULTS
An increase of serum-TNF alpha levels was observed early after declamping. This response preceded an increase of IL-6 levels and of C-reactive protein. No release of IL-8 was identified. A significant correlation between TNF alpha, IL-6 and C-reactive protein was observed (p < 0.001). A positive correlation was also observed for the degree of surgical trauma (blood loss). No significant differences between the two graft materials were encountered. The complemental system was also involved in the acute reactions and a marked increase of C5a levels was noted. A decrease of S-IL-2R levels as well as lymphocyte concentrations was also observed postoperatively and was interpreted as a downregulation of the immune-system in the immediate postoperative course.


CONCLUSIONS
The results demonstrate an early and generalized inflammatory response during and after aortic surgery with involvement of different cytokines as well as the complemental system. TNF alpha appears to play a central role in the release of other cytokines, but IL-6 seemed to correlate best with later development of nonvascular complications. Few differences were found between the different grafts and the response seems to be influenced by other factors such as the surgical procedure and ischaemia/reperfusion injury.
Pärsson
H N
HN
Department of Surgery, Lund University, Sweden.
Nässberger
L
L
Norgren
L
L
D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000601:surgery; D001807:Blood Vessel Prosthesis; D003167:Complement Activation; D016207:Cytokines / Q000097:blood; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007383:Intermittent Claudication / Q000097:blood / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D013997:Time Factors
D016207:Cytokines; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene