Activated coagulation during open and endovascular abdominal aortic aneurysm repair.
OBJECTIVE
The study was conducted to determine activation of coagulation in patients undergoing open and endovascular infrarenal abdominal aortic aneurysm repair (EVAR).


METHODS
In a prospective, comparative study, 30 consecutive patients undergoing open repair (n = 15) or EVAR (n = 15) were investigated. Blood samples to determine fibrinopeptide A, fibrin monomer, thrombin-antithrombin complex, and D-dimer were taken up to 5 days postoperatively. Routine hematologic and hematochemical parameters as well as clinical data were collected.


RESULTS
Both groups showed comparable demographic variables. Operating time was longer in open repair (249 +/- 77 minutes vs 186 +/- 69 minutes, P < .05). Perioperatively elevated markers of coagulation were measured in both groups. Fibrinopeptide A levels did not differ significantly between the groups (P = .55). The levels of fibrin monomer and thrombin-antithrombin complex were significantly higher in patients undergoing EVAR (P < .0001), reflecting increased thrombin activity and thrombin formation compared with open surgery. The D-dimer level did not differ significantly between the groups. These results were also valid after correction for hemodilution.


CONCLUSIONS
These data suggest increased procoagulant activity in EVAR compared with open surgery. A procoagulant state may favor possible morbidity derived from micro- and macrovascular thrombosis, such as in myocardial infarction, multiple organ dysfunction, venous thrombosis and thromboembolism, or disseminated intravascular coagulation.
Englberger
Lars
L
Department of Cardiovascular Surgery, Inselspital, University Hospital Berne, Freiburgstrasse, 3010 Berne, Switzerland. lars.englberger@insel.ch
Savolainen
Hannu
H
Jandus
Peter
P
Widmer
Matthias
M
Do
Do Dai
do D
Haeberli
Andre
A
Baumgartner
Iris
I
Carrel
Thierry P
TP
Schmidli
Juerg
J
D000368:Aged; D000704:Analysis of Variance; D000990:Antithrombin III; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001777:Blood Coagulation / Q000502:physiology*; D001780:Blood Coagulation Tests; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010447:Peptide Hydrolases / Q000097:blood; D011446:Prospective Studies; D018709:Statistics, Nonparametric
D005338:Fibrin Fibrinogen Degradation Products; C046193:antithrombin III-protease complex; C011468:fibrinmonomer; D000990:Antithrombin III; D010447:Peptide Hydrolases