Ischemia-reperfusion injury significantly contributes to abdominal aortic aneurysm (AAA)— related mortality and morbidity; therefore, we measured oxidative stress during open AAA repair and investigated any potential associations with intraoperative or perioperative events (aortic clamping time, blood loss, and the need to transfer to the intensive care unit). Blood samples were collected at specific time points from 53 patients undergoing open AAA repair: (1) before induction of anesthesia; (2) 15, 30, 60, and 120 minutes after aortic clamping; (3) 15 and 60 minutes after clamp removal; and (4) 24 hours postoperatively. Malondialdehyde (MDA) levels were measured by a spectrophotometric method. Baseline MDA values in patients with AAA were significantly higher than in controls (P < .0001). A positive correlation was found between preoperative MDA levels and the size of AAAs (Pearson correlation = 0.578, P < .001). No difference was observed in MDA levels between ruptured and nonruptured AAAs; however, when all symptomatic patients (ruptured and elective symptomatic AAAs, n = 18) were considered, there was a significant elevation in MDA levels (P < .001). There was also a significant increase in MDA values in patients transferred postoperatively to the intensive care unit (P < .001). Finally, a positive association was found between the duration of aortic clamping with MDA values at 15 and 60 minutes after declamping, but not after 24 hours (Pearson correlation = 0.467, P < .001). MDA levels may predict the postoperative course of elective and ruptured AAAs.
Filipovic M. , Goldacre MJ, Roberts SE, et al: Trends in mortality and hospital admission rates for abdominal aortic aneurysm in England and Wales, 1979-1999. Br J Surg92:968-975, 2005.
3.
Hua HT, Cambria RP, Chuang SK, et al: Early outcomes of endovascular versus open abdominal aortic aneurysm repair in the National Surgical Quality improvement Program-Private Sector (NSQIP-PS). J Vasc Surg41:382-389, 2005.
4.
Forbes TL, Steiner SH, Lawlor DK, et al: Risk-adjusted analysis of outcomes following elective open abdominal aortic aneurysm repair. Ann Vasc Surg19:142-148, 2005.
Bown MJ, Nicholson ML, Bell PR, et al: The systemic inflammatory response syndrome, organ failure, and mortality after abdominal aortic aneurysm repair. J Vasc Surg37:600-606, 2003.
7.
Sullivan GW, Sarembock IJ, Linden J.: The role of inflammation in vascular diseases. J Leukoc Biol67:591-602, 2000.
8.
Matheus WR, Guido DM, Fisher MA, et al: Lipid peroxidation as molecular mechanism of liver cell injury during reperfusion after ischemia. Free Radic Biol Med16:763-770, 1994.
9.
Miller FJ Jr, Sharp WJ, Fang X., et al: Oxidative stress in human abdominal aortic aneurysms: A potential mediator of aneurysmal remodeling. Arterioscler Thromb Vasc Biol22:560-565, 2002.
10.
Lindsay TF, Luo XP, Lehotay DC, et al: Ruptured abdominal aortic aneurysm, a “two-hit” ischemia/ reperfusion injury: Evidence from an analysis of oxidative products . J Vasc Surg30:219-228, 1999.
11.
Requena JR, Fu MX, Ahmed MU, et al: Lipoxidation products as biomarkers of oxidative damage to proteins during lipid peroxidation reactions. Nephrol Dial Transplant11:48-53, 1996.
12.
Andreadou I. , Tasouli A., Iliodromitis E., et al: Reduction of myocardial infarct size in rabbits by a novel indole derivative with antioxidant and free radical scavenging properties. Eur J Pharmacol453:271-277, 2002.
13.
Miwa K., Igawa A., Nakagawa K., et al: Consumption of vitamin E in coronary circulation in patients with variant angina. Cardiovasc Res41:291-298, 1999.
14.
Kugiyama K. , Miyao Y., Sakamoto T., et al: Glutathione attenuates coronary constriction to acetylcholine in patients with coronary spastic angina. Am J Physiol Heart Circ Physiol280:H264-H271, 2001.
15.
Andreadou I. , Iliodromitis EK, Mikros E., et al: Melatonin does not prevent the protection of ischemic preconditioning in vivo despite its antioxidant effect against oxidative stress. Free Radic Biol Med237:500-510, 2004.
16.
Cavalca V., Cighetti G., Bamonti F., et al: Oxidative stress and homocysteine in coronary artery disease . Clin Chem47:887-892, 2001.
17.
Bastounis E. , Filis K., Georgopoulos A., et al: Selective use of the intensive care unit after elective infrarenal abdominal aortic aneurysm repair. Int Angiol22:308-316, 2003.
18.
Shah PK: Inflammation, metalloproteinases, and increased proteolysis: an emerging pathophysiological paradigm in aortic aneurysm. Circulation96:2115-2117, 1997.
19.
Freestone T., Turner RJ, Coady A., et al: Inflammation and matrix metalloproteinases in the enlarging abdominal aortic aneurysm. Arterioscler Thromb Vasc Biol15:1145-1151, 1995.
20.
Dubick MA, Keen CL, DiSilvestro RA, et al: Antioxidant enzyme activity in human abdominal aortic aneurysmal and occlusive disease. Proc Soc Exp Biol Med220:39-45, 1999.
21.
Briede JJ, De Kok TM, Hogervorst JG, et al: Development and application of an electron spin resonance spectrometry method for the determination of the oxygen free radical formation by particulate matter. Environ Sci Technol39:8420-8426, 2005.
22.
Templar J., Kon SP, Milligan TP, et al: Increased plasma malondialdehyde levels in glomerular disease as determined by a fully validated HPLC method. Nephrol Dial Transplant14:946-951, 1999.
23.
Vainas T., Lubbers T., Stassen FR, et al: Serum C-reactive protein level is associated with abdominal aortic aneurysm size and may be produced by aneurysmal tissue. Circulation107:1103-1110, 2003.
24.
Lawrence DM , Singh RS, Franklin DP, et al: Rapamycin suppresses experimental aortic aneurysm growth. J Vasc Surg40:334-338, 2004.
25.
Pan JH, Lindholt JS, Sukhova GK, et al: Macrophage migration inhibitory factor is associated with aneurysmal expansion. J Vasc Surg237:628-635, 2003.
26.
Adembri C., Kastamoniti E., Bertolozzi I., et al: Pulmonary injury follows systemic inflammatory reaction in infrarenal aortic surgery. Crit Care Med32:1170-1177, 2004.
27.
Fantini GA, Conte MS: Pulmonary failure following lower torso ischemia: Clinical evidence for a remote effect of reperfusion injury. Am Surg61:316-319, 1995.
28.
Roumen RM, Hendriks T., de Man BM, et al: Serum lipofuscin as a prognostic indicator of adult respiratory distress syndrome and multiple organ failure. Br J Surg81:1300-1305, 1994.
29.
Wijnen MH, Roumen Rmh, Vader HL, et al: A multi-antioxidant supplementation reduces damage from ischaemia reperfusion in patients after lower torso ischaemia: A randomised trial. Eur J Vasc Endovasc Surg23:486-490, 2002.
30.
Poder P., Pulges A., Kals J., et al: Is elective abdominal aortic aneurysm repair accompanied by high grade oxidative stress? ScandJ Surg92:206-209, 2003.
31.
Pararajasingam R., Wieght SC, Bell PR, et al: Pulmonary nitric oxide metabolism following infrarenal aortic cross-clamp-induced ischemia-reperfusion injury . Eur J Vasc Endovasc Surg19:47-51, 2000.
32.
Liu SX, Hou FF, Guo ZJ, et al: Advanced oxidation protein products accelerate atherosclerosis through promoting oxidative stress and inflammation. Arterioscler Thromb Vasc Biol26:1156-1162, 2006.
33.
Barry MC, Kelly CJ, Abdih H., et al: Differential effects of lower limb revascularisation on organ injury and the role of the amino acid taurine. Eur J Vasc Endovasc Surg13:193-201, 1997.
34.
Athyros VG, Mikhailidis DP, Didangelos, et al: Effect of multifactorial treatment on non-alcoholic fatty liver disease in metabolic syndrome: A randomised study. Curr Med Res Opin22:873-883, 2006.
35.
Tsiara S., Elisaf M., Mikhailidis DP: Early vascular benefits of statins. Curr Med Res Opin19:540-546, 2003.
36.
Alnaeb ME, Youssef M., Mikhailidis DP, et al: Short-term lipid-lowering treatment with atorvastatin improves renal function but not renal blood flow indices in patients with peripheral arterial disease. Angiology57:65-71, 2006.
37.
Lee JD, Morrissey JR, Mikhailidis DP, et al: CARDS on the table: Should everybody with type 2 diabetes take a statin?Curr Med Res Opin21:357-362, 2005.
38.
Liberopoulos EN, Daskalopoulou SS, Mikhailidis DP, et al: A review of the lipid related effects of fluvastatin. Curr Med Res Opin21:231-244, 2005.
39.
Suzuki M., Saito M., Nagai T., et al: Prevention of positive coronary artery remodelling with statin therapy in patients with coronary artery disease. Angiology57:259-265, 2006.
40.
Reddy R., Chahoud G., Mehta JL: Modulation of cardiovascular remodelling with statins: fact or fiction?Curr Vasc Pharmacol3:67-79, 2005.
41.
Paraskevas KI, Liapis CD, Hamilton G., et al: Can statins reduce perioperative morbidity and mortality in patients undergoing non-cardiac vascular surgery?Eur J Vasc Endovasc Surg32:286-293, 2006.
42.
Leurs LJ, Visser P., Laheij RJ, et al: Statin use is associated with reduced all-cause mortality after endovascular abdominal aortic aneurysm repair. Vascular14:1-8, 2006.
43.
Lloyd GM, Newton JD, Norwood MG, et al: Patients with abdominal aortic aneurysms: Are we missing the opportunity for cardiovascular risk reduction?J Vasc Surg40:691-697, 2004.
44.
Kertai MD, Boersma E., Westerhout CM, et al: A combination of statins and beta-blockers is independently associated with a reduction in the incidence of perioperative mortality and nonfatal myocardial infarction in patients undergoing abdominal aortic aneurysm surgery. Eur J Vasc Endovasc Surg28:343-352, 2004.
