Interplay between coagulation and inflammation in open and endovascular abdominal aortic aneurysm repair--impact of intra-aneurysmal thrombus.
OBJECTIVE
Our aim was to compare hemostatic and inflammatory mechanisms in abdominal aortic aneurysm (AAA) patients after open surgery (OPEN) and endovascular AAA repair (ENDO).


METHODS
From the 32 consecutive AAA patients recruited, 17 represented ENDO and 15 OPEN. The intra-aneurysmal thrombus was removed during OPEN, but stayed intact after ENDO. The preoperative volume of the intra-aneurysmal thrombus was calculated from computed tomography images. Markers of coagulation and inflammation were studied preoperatively, at one, two, three, four and seven days and at three months postoperatively.


RESULTS
Preoperative upregulation of F 1+2, TAT and D-dimer was evident in both groups. The volume of intra-aneurysmal thrombus correlated with CRP (beta = 0.62, p = 0.001), IL-6 (beta = 0.60, p = 0.001) and PAI-1 ag (beta = 0.51, p = 0.007). Surgery further enhanced inflammation, coagulation and fibrinolysis. IL-6 increased in both groups, but the increases of CRP and PIIINP were higher in the OPEN group. Postoperative CRP correlated with the intra-aneurysmal thrombus volume in the ENDO group. At three months D-dimer (p < 0.05) was higher than preoperatively in the ENDO, in contrast to the OPEN group.


CONCLUSIONS
Preoperatively both prothrombotic and fibrinolytic mechanisms are activated in patients with AAA. Intraluminal thrombus induces prothrombotic and inflammatory interactions, which persist after endovascular aortic aneurysm repair.
Aho
P-S
PS
Department of Vascular Surgery, Helsinki University Central Hospital, Finland. pekka.aho@hus.fi
Niemi
T
T
Piilonen
A
A
Lassila
R
R
Renkonen
R
R
Lepäntalo
M
M
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D001777:Blood Coagulation / Q000502:physiology*; D002097:C-Reactive Protein / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000473:pathology*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D005338:Fibrin Fibrinogen Degradation Products; D015850:Interleukin-6; C036309:fibrin fragment D; D002097:C-Reactive Protein