Cytokine activation and intestinal mucosal and renal dysfunction are reduced in endovascular AAA repair compared to surgery.
OBJECTIVE
To compare endovascular (EVR) to open repair (OR) of abdominal aortic aneurysm (AAA) for cytokine activation, changes in the intestinal mucosal barrier, and renal dysfunction.


METHODS
In a prospective nonrandomized study, 15 patients admitted to a university hospital for elective infrarenal AAA repair (8 OR and 7 EVR) were recruited. Intestinal permeability was assessed preoperatively (PO), at day 1 (D1), and at day 3 (D3) after surgery using the lactulose/mannitol differential excretion (LMR) test. Renal damage was assessed from measurements of the urinary albumin:creatinine ratio (ACR); cytokine activation was based on the urinary concentration of tumor necrosis factor receptor p55 (TNF-Rp55) at the same time points. Serum creatinine and urea concentrations were measured preoperatively and daily for 5 days postoperatively.


RESULTS
A significant increase in LMR was found in the OR group at D1 and D3 compared to PO (p<0.05). The LMR increase at D3 was significantly greater in the OR group (p<0.01). A significant difference was observed in the percentage rise in ACR on D1 in the OR group compared to the EVR group (p<0.005). The urinary TNF-Rp55 concentration was significantly elevated in the OR group at D1 (p<0.05) and D3 (p<0.05) compared to baseline; in the EVR group, it was elevated at D1 (p<0.05) compared to PO. The difference was also significant for this marker between the 2 groups at D1 (p<0.01). No significant change was observed in the serum creatinine or urea concentrations in either group perioperatively.


CONCLUSIONS
Endovascular AAA repair is associated with less cytokine production and less intestinal and renal dysfunction compared to the open approach.
Junnarkar
Sameer
S
Vascular Surgery Unit, Belfast City Hospital, Northern Ireland, UK. sameer@junnarkar.freeserve.co.uk
Lau
Luk Louis
LL
Edrees
Waleed K
WK
Underwood
David
D
Smye
Michael G
MG
Lee
Bernard
B
Hannon
Raymond J
RJ
Soong
Chee V
CV
D000368:Aged; D017130:Angioplasty / Q000009:adverse effects*; D015703:Antigens, CD / Q000652:urine*; D017544:Aortic Aneurysm, Abdominal / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology*; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor; D047888:Receptors, Tumor Necrosis Factor, Type I; D015607:Stents; D016896:Treatment Outcome
D015703:Antigens, CD; D018124:Receptors, Tumor Necrosis Factor; D047888:Receptors, Tumor Necrosis Factor, Type I