To compare endovascular (EVR) to open repair (OR) of abdominal aortic aneurysm (AAA) for cytokine activation, changes in the intestinal mucosal barrier, and renal dysfunction.
Methods:
In a prospective nonrandomized study, 15 patients admitted to a university hospital for elective infrarenal AAA repair (8 OR and 7 EVR) were recruited. Intestinal permeability was assessed preoperatively (PO), at day 1 (D1), and at day 3 (D3) after surgery using the lactulose/mannitol differential excretion (LMR) test. Renal damage was assessed from measurements of the urinary albumin:creatinine ratio (ACR); cytokine activation was based on the urinary concentration of tumor necrosis factor receptor p55 (TNF-Rp55) at the same time points. Serum creatinine and urea concentrations were measured preoperatively and daily for 5 days postoperatively.
Results:
A significant increase in LMR was found in the OR group at D1 and D3 compared to PO (p<0.05). The LMR increase at D3 was significantly greater in the OR group (p<0.01). A significant difference was observed in the percentage rise in ACR on D1 in the OR group compared to the EVR group (p<0.005). The urinary TNF-Rp55 concentration was significantly elevated in the OR group at D1 (p<0.05) and D3 (p<0.05) compared to baseline; in the EVR group, it was elevated at D1 (p<0.05) compared to PO. The difference was also significant for this marker between the 2 groups at D1 (p<0.01). No significant change was observed in the serum creatinine or urea concentrations in either group perioperatively
Conclusions:
Endovascular AAA repair is associated with less cytokine production and less intestinal and renal dysfunction compared to the open approach.
ThomasSMGainesPABeardJD. Short-term (30-day) outcome of endovascular treatment of abdominal aortic aneurism: Results from the prospective Registry of Endovascular Treatment of Abdominal Aortic Aneurism (RETA). Eur J Vasc Endovasc Surg.2001; 21: 57–64.
2.
BecqueminJPBourriezAd'AudiffretA. Mid-term results of endovascular versus open repair of abdominal aortic aneurysm in patients anatomically suitable for endovascular repair. Eur J Vasc Endovasc Surg.2000; 19: 656–661.
3.
CuypersPButhJHarrisPL. Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms. Results of a European multicenter registry. Eur J Vasc Endovasc Surg.1999; 17: 507–516.
4.
TreharneGDThompsonMMWhiteleyMS. Physiological comparison of open and endovascular aneurysm repair. Br J Surg.1999; 86: 760–764.
5.
GalleCDe MaertelaerVMotteS. Early inflammatory response after elective abdominal aortic aneurysm repair: A comparison between endovascular procedure and conventional surgery. J Vasc Surg.2000; 32: 234–246.
6.
ParodiJCFerreiraMFornariC. Neutrophil respiratory burst activity and pro- and anti-inflammatory cytokines in AAA surgery: Conventional versus endoluminal treatment. J Endovasc Ther.2001; 8: 114–124.
7.
OdegardALundbomJMyhreHO. The inflammatory response following treatment of abdominal aortic aneurysms: A comparison between open surgery and endovascular repair. Eur J Vasc Endovasc Surg.2000; 19: 536–544.
8.
SwartbolPNorgrenLAlbrechtssonU. Biological responses differ considerably between endovascular and conventional aortic aneurysm surgery. Eur J Vasc Endovasc Surg.1996; 12: 18–25.
9.
NorgrenLSwartbolP. Biological responses to endovascular treatment of abdominal aortic aneurysms. J Endovasc Surg.1997; 4: 169–173.
10.
ThompsonMMNasimASayersRD. Oxygen free radical and cytokine generation during endovascular and conventional aneurysm repair. Eur J Vasc Endovasc Surg.1996; 12: 70–75.
11.
CarraroMMalalanFAntonioneR. Effects of a dimeric vs a monomeric nonionic contrast medium on renal function in patients with mild to moderate renal insufficiency: A double-blind, randomized clinical trial. Eur Radiol.1998; 8: 144–147.
12.
WesthuyzenJCrossDBCoxSV. Urinary protein excretion following coronary angiography using non-ionic radiocontrast agent. Ann Clin Biochem. 1996; 33: 349–351.
13.
WijnenMHWACuypersPButhJ. Differences in renal response between endovascular and open repair of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg.2001; 21: 171–174.
14.
LiabakkNSundanAWaageA. Development of immunoassays for the detection of soluble tumour necrosis factor receptors. J Immunol Methods. 1991; 141: 237–243.
15.
SoongCVBlairPHBHallidayMI. Endo-toxaemia, the generation of the cytokines and their relationship to intramucosal acidosis of the sigmoid colon in elective abdominal aortic aneurysm repair. Eur J Vasc Surg.1993; 7: 534–539.
16.
SoongCVBlairPHHallidayMI. Bowel ischaemia and organ impairment in elective abdominal aortic aneurysm repair. Br J Surg.1994; 81: 965–968.
17.
BaigrieRJLamontPMKwiatkowskiD. Systemic cytokine response after major surgery. Br J Surg.1992; 79: 757–760.
18.
LauLLGardinerKRMartinL. Extraperitoneal approach reduces neutrophil activation, systemic inflammatory response and organ dysfunction in aortic aneurysm surgery. Eur J Vasc Endovasc Surg.2001; 21: 326–333.
19.
LauLLHallidayMILeeB. Intestinal manipulation during elective aortic aneurysm surgery leads to portal endotoxaemia and mucosal barrier dysfunction. Eur J Vasc Endovasc Surg.2000; 19: 619–624.
20.
BarryMCWangJHKellyCJ. Plasma factors augment neutrophil and endothelial cell activation during aortic surgery. Eur J Vasc Endovasc Surg.1997; 13: 381–387.
21.
HolzheimerRGGrossJScheinM. Pro- and anti-inflammatory cytokine-response in abdominal aortic aneurysm repair: A clinical model of ischemia-reperfusion. Shock. 1999; 11: 305–310.
22.
SykIBrunkwallJIvancevK. Postoperative fever, bowel ischaemia and cytokine response to abdominal aortic aneurysm repair a comparison between endovascular and open surgery. Eur J Vasc Endovasc Surg.1998; 15: 398–405.
23.
SwartbolPTruedssonLNorgrenL. The inflammatory response and its consequence for the clinical outcome following aortic aneurysm repair. Eur J Vasc Endovasc Surg.2001; 21: 393–400.
ReberPUPeterMPatelAG. Ischaemia/reperfusion contributes to colonic injury following experimental aortic surgery. Eur J Vasc Endovasc Surg.2001; 21: 35–39.
26.
RowlandsTEHomer-VanniasinkamS. Pro- and anti-inflammatory cytokine release in open versus endovascular repair of abdominal aortic aneurysm. Br J Surg.2001; 88: 1335–1340.
27.
SpinasGAKellerUBrockhausM. Release of soluble receptors for tumor necrosis factor (TNF) in relation to circulating TNF during experimental endotoxinemia. J Clin Invest. 1992; 90: 533–536.
28.
SoongCVHallidayMIBarclayGR. Intra-mucosal acidosis and systemic host responses in abdominal aortic aneurysm surgery. Crit Care Med.1997; 25: 1472–1479.
29.
HadziselimovicFEmmonsLRGallatiH. Soluble tumour necrosis factor receptors p55 and p75 in the urine monitor disease activity and the efficacy of treatment of inflammatory bowel disease. Gut. 1995; 37: 260–263.
30.
SkovgaardNHolmJHemmingsenL. Urinary protein excretion following intravenously administered ionic and non-ionic contrast media in man. Acta Radiol.1989; 30: 517–519.
31.
ThompsonMMSmithJNaylorAR. Miroembolization during endovascular and conventional aneurysm repair. J Vasc Surg.1997; 25: 179–186.
32.
TepelMvan der GietMSchwarzfeldC. Prevention of radiographic-contrast-agent-in-duced reduction in renal function by acetylcysteine. N Engl J Med.2000; 343: 180–184.
33.
SmithFCGoslingPSangheraK. Micro-proteinuria predicts the severity of systemic effects of reperfusion injury following infrarenal aortic aneurysm surgery. Ann Vasc Surg.1994; 8: 1–5.
34.
GrabowskiEFJangIKGoldH. Platelet degranulation induced by some contrast media is independent of their nonionic vs ionic nature. Acta Radilogica. 1995; 36(Suppl 399): 182–184.
35.
ChronosNAGoodallAHWilsonDJ. Profound platelet degranulation is an important side effect of some types of contrast media used in interventional cardiology. Circulation. 1993; 88: 2035–2044.
36.
AbeyamaKOhSKawanoK. Nonionic contrast agents produce thrombotic effect by inducing adhesion of leukocytes on human endothelium. Biochem Biophys Res Commun. 1995; 212: 776–783.
