Postoperative fever, bowel ischaemia and cytokine response to abdominal aortic aneurysm repair--a comparison between endovascular and open surgery.
OBJECTIVE
To study bowel ischaemia in transfemorally placed endoluminal grafting (TPEG) for abdominal aortic aneurysms, and any relation to cytokine response or postoperative fever.


METHODS
Prospective not randomised. University hospital setting.


METHODS
Fourteen cases of conventional surgery and 23 cases of endovascular technique for infrarenal abdominal aortic aneurysm repair.


METHODS
Tonometry was used for sigmoid colon pH, and ELISAs for serum IL-6.


RESULTS
Mucosal pH in the sigmoid colon fell significantly during clamping and reperfusion in both groups. Lowest measured sigmoid colon pH was 7.10 in the open group, compared to 7.22 in the TPEG group (p < 0.05). The IL-6 levels in serum peaked after 4 h of reperfusion; 249 pg/ml in the open group, compared to 89 pg/ml in the TPEG group (p < 0.05). High levels of IL-6 in the postoperative period and persisting low sigmoidal pH were associated with serious complications. Postoperative temperature did not differ significantly between the groups, and no significant correlation could be found with sigmoid colon pH or IL-6 levels.


CONCLUSIONS
The less pronounced perioperative bowel ischaemia in TPEG patients indicates an advantage of the TPEG technique. Splanchnic ischaemia was not related to postoperative fever, nor the IL-6 or TNF response.
Syk
I
I
Department of Surgery, Malmö University Hospital, Lund University, Sweden.
Brunkwall
J
J
Ivancev
K
K
Lindblad
B
B
Montgomery
A
A
Wellander
E
E
Wisniewski
J
J
Risberg
B
B
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002097:C-Reactive Protein / Q000032:analysis; D012809:Colon, Sigmoid / Q000098:blood supply* / Q000503:physiopathology; D003250:Constriction; D016207:Cytokines / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015850:Interleukin-6 / Q000097:blood; D007413:Intestinal Mucosa / Q000098:blood supply / Q000503:physiopathology; D007511:Ischemia / Q000209:etiology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D015424:Reperfusion; D013152:Splanchnic Circulation; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D016207:Cytokines; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein