Coagulation, fibrinolysis and inflammation in open surgery for infrarenal abdominal aortic aneurysm
1999 (English)Doctoral thesis, comprehensive summary (Other academic)
Elective repair of infrarenal abdominal aortic aneurysm (AAA) carries a mortality of 4-8% and there is a substantial incidence of serious non-lethal complications. During surgery there is a situation of relative ischaemia and subsequent reperfusion of the lower part of the body. Since most complications may have a thromboembolic aetiology and there are strong evidences for links between inflammation and haemostasis as well as ischaemia/reperfusion and inflammation, increased understanding of disturbances of the haemostatic and inflammatory systems are of importance. Twenty-three patients operated on for AAA according to open standard procedure were studied and compared with an operated control group (OC) undergoing nonvascular surgery of similar magnitude.
- In AAA patients prothrombin fragment 1+2 (F1+2), thrombin antithrombin complex (TAT) andsoluble fibrin were elevated preoperatively, increased intraoperatively, especially during reperfusion, and were not normalised one week postoperatively. - Tissue plasminogen activator (tPA) decreased, plasminogen activator inhibitor-1 increased and cross linked fibrin degradation product (D-dimer) had a slight increase in spite of strong coagulation activation intraoperatively. One week postoperatively tPA and D-dimer were significantly increased.
- Intraoperatively there were significant increases in the proinflammatory cytokines interleukin-6 (I1-6), monocyte chemoattractant protein - 1 (MCP-1) and the anti-inflammatory interleukin-10 (I1-10). MCP-1 is also a procoagulant and I1-10 an anticoagulant cytokine. Soluble interleukin-2 receptor (SI1-2R) and fibrinogen decreased intraoperatively and were significantly increased one week postoperatively.
- Intraoperatively neutrophil L-selectin expression was upregulated, CD11b/CD18 unchanged, neutrophil chemotaxis decreased, and lactoferrin and myeloperoxidase increased. White blood cell and neutrophil cell counts also increased.
- In a long-term perspective F1+2, TAT and D-dimer decreased after AAA surgery compared to preoperative levels. However, TAT and D-dimer were still higher than in healthy age matched controls.
Conclusions: Preoperatively AAA patients were in a state of coagulation activation. Intraoperatively they were in a strong prothrombotic and proinflammatory state. One week postoperatively the coagulation was still as activated as preoperatively. There were indications for a decline in the coagulation activation in a long-term perspective after AAA surgery. These haemostatic and inflammatory alterations may be due to ischaemia and reperfusion and may contribute to the high complication rate.
Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 1999. , 50 p.
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 851
Surgery, Abdominal aortic aneurysm, blood coagulation, fibrinolysis, cytokines, leucocytes, flow cytometry, chemotaxis, lactoferrin, myeloperoxidase
Research subject Surgery
IdentifiersURN: urn:nbn:se:uu:diva-341ISBN: 91-554-4489-XOAI: oai:DiVA.org:uu-341DiVA: diva2:162705
1999-05-26, Grönwallsalen,University Hospital, Entrance 70, Uppsala, Uppsala, 09:15