Paradoxical neutrophil elastase release in endovascular abdominal aortic aneurysm repair.
Endovascular repair of abdominal aortic aneurysm potentially avoids problems associated with prolonged aortic cross-clamping that occurs with open repair, but it appears to have its own biologic consequences, which may relate to neutrophil elastase release. Blood samples of consecutive patients undergoing open or endovascular abdominal aneurysm repair were analyzed for neutrophil elastase/alpha(1)-antitrypsin complex and free elastase. Free elastase rose from baseline and fell quickly in open repair patients, returning to baseline by 144 hours. In the endovascular repair group, it continued to increase for up to 144 hours. Bound elastase increased to 24 hours, returning to baseline in endovascular repair patients by 72 hours, but remaining elevated in open repair patients at 144 hours. Open repair patients showed raised elastase/alpha(1)-antitrypsin complex and initial raised free elastase levels. High free elastase levels in endovascular repair patients may reflect less bound elastase and may paradoxically lead to a prolonged inflammatory postoperative response.
Rowlands
Timothy E
TE
Vascular Surgical Unit, The General Infirmary at Leeds, Great George Street, Leeds, United Kingdom. timrowlands@hotmail.com
Homer-Vanniasinkam
Shervanthi
S
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000201:enzymology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D005260:Female; D005334:Fever / Q000097:blood / Q000201:enzymology / Q000209:etiology; D006801:Humans; D007958:Leukocyte Count; D019272:Leukocyte Elastase / Q000097:blood*; D007964:Leukocytosis / Q000097:blood / Q000201:enzymology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000201:enzymology*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D000515:alpha 1-Antitrypsin / Q000097:blood*
D000515:alpha 1-Antitrypsin; C037741:alpha 1-antitrypsin-leukocyte elastase complex; D019272:Leukocyte Elastase