Platelet activation after endovascular repair of abdominal aortic aneurysm

Abstract

Aim

To investigate the effect of endovascular aneurysm repair (EVAR) on platelet (PLT) function and reveal possible associated factors.

Methods

Fifty consecutive patients were included. PLT count and activation (CD62P-CD36), white blood cell (WBC) count, and high sensitivity C-reactive protein (hs-CRP) were measured preoperatively, at the first and third postoperative day.

Results

EVAR elicited a significant reduction in PLT count from baseline to first day after EVAR (p < 0.001), while no significant difference was noted between the first and third day. Furthermore, CD62P expression was markedly elevated at the first day after EVAR (median % positive PLTs from 13.7 at baseline to 22.1, p = 0.05), but returned to baseline levels by the third day. Maximum abdominal aortic aneurysm diameter was the only factor that significantly affected the CD62P values (p = 0.005). Postoperative CD36 values were significantly correlated with total aneurysm volume (p = 0.05) and were higher in endografts made from polyester (p = 0.01). There were no correlation between PLT activation and hs-CRP, WBC, maximum temperature, and 30-day morbidity.

Conclusion

EVAR has elucidated a significant reduction in PLT count and increase in PLT activation at the immediate postoperative period. The type of the endograft material and the aneurysm maximum diameter and volume appear to play an important role in PLT activation.

Keywords

Platelets activation endovascular aneurysm repair endovascular aneurysm

Get full access to this article

View all access options for this article.

References

Arnaoutoglou

Kouvelos

Milionis

. Post implantation syndrome following endovascular abdominal aortic aneurysm repair: preliminary data. Interact Cardiovasc Thorac Surg 2011; 12: 609–614.

Abdelhamid

Davies

Adam

. Changes in thrombin generation, fibrinolysis, platelet and endothelial cell activity, and inflammation following endovascular abdominal aortic aneurysm repair. J Vasc Surg 2012; 55: 41–46.

Englberger

Savolainen

Jandus

. Activated coagulation during open and endovascular abdominal aortic aneurysm repair. J Vasc Surg 2006; 43: 1124–1129.

Davies

Abdelhamid

Vohra

. Perioperative myocardial injury and hemostasis in patients undergoing endovascular aneurysm repair for asymptomatic infrarenal abdominal aortic aneurysm. Vasc Endovasc Surg 2011; 45: 712–716.

Moulakakis

Alepaki

Sfyroeras

. The impact of endograft type on inflammatory response after endovascular treatment of abdominal aortic aneurysm. J Vasc Surg 2013; 57: 668–677.

Boyle

Goodall

Thompson

. Endovascular AAA repair attenuates the inflammatory and renal responses associated with conventional surgery. J Endovasc Ther 2000; 7: 359–371.

Moll

Powell

Fraedrich

European Society for Vascular Surgery . Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 2011; 41: S1–S58.

Thygesen

Alpert

Jaffe

. Joint ESC/ACCF/AHA/WHF Task Force for Universal definition of myocardial infarction; third universal definition of myocardial infarction. J Am Coll Cardiol 2012; 60: 1581–1598.

Sacco

Kasner

Broderick

. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44: 2064–2089.

10.

Easton

Saver

Albers

. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 2009; 40: 2276–2293.

11.

Fliser

Laville

Covic

. Ad-hoc Working Group of ERBP. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast induced nephropathy. Nephrol Dial Transpl 2012; 27: 4263–4272.

12.

Davì

Patrono

. Platelet activation and atherothrombosis. N Engl J Med 2007; 357: 2482–2494.

13.

Kamath

Blann

Lip

. Platelet activation: assessment and quantification. Eur Heart J 2001; 22: 1561–1571.

14.

Matzdorff

. Platelet function tests and flow cytometry to monitor antiplatelet therapy. Semin Thromb Hemost 2005; 31: 393–399.

15.

Silverstein

. Platelet CD36 links not only α-granule derived proteins to thrombus stability but also metabolic and oxidant stress to a prothrombotic phenotype. Arterioscler Thromb Vasc Biol 2014; 34: 1120–1121.

16.

Tschoepe

Schultheiss

Kolarov

. Platelet membrane activation markers are predictive for increased risk of acute ischemic events after PTCA. Circulation 1993; 88: 37–42.

17.

Wallinder

Bergqvist

Henriksson

. Haemostatic markers in patients with abdominal aortic aneurysm and the impact of aneurysm size. Thromb Res 2009; 124: 423–426.

18.

Davies

Abdelhamid

Wall

. Coagulation, fibrinolysis, and platelet activation in patients undergoing open and endovascular repair of abdominal aortic aneurysm. J Vasc Surg 2011; 54: 865–878.

19.

Aho

Niemi

Piilonen

. Interplay between coagulation and inflammation in open and endovascular abdominal aortic aneurysm repair–impact of intra-aneurysmal thrombus. Scand J Surg 2007; 96: 229–235.

20.

Voûte

Bastos Gonçalves

van de Luijtgaarden

. Stent graft composition plays a material role in the postimplantation syndrome. J Vasc Surg 2012; 56: 1503–1509.

21.

Stokes

Granger

. Platelets: a critical link between inflammation and microvascular dysfunction. J Physiol 2012; 590: 1023–1034.

22.

Winkel

Schouten

van Kuijk

. Perioperative asymptomatic cardiac damage after endovascular abdominal aneurysm repair is associated with poor long-term outcome. J Vasc Surg 2009; 50: 749–754.

23.

Janssen

ten Berg

. Platelet function testing and tailored antiplatelet therapy. J Cardiovasc Transl Res 2013; 6: 316–328.