Cholesterol microcrystals and neutrophil extracellular traps detection during open aortic surgery

Abstract

Objective

Improved aortic surgery outcomes are linked to a broader comprehension of the pathogenesis of thromboembolic complications. This study aims to evaluate the involvement of cholesterol microcrystals and neutrophil extracellular traps (NETs) in postoperative thrombotic complications following open aortic surgery.

Methods

Aortic blood smears were examined precisely to identify the presence of cholesterol microcrystals (CMs) using polarized light microscopy, Coherent Anti-Stokes Raman spectroscopy (CARS), and fluorescence microscopy to detect NETs. The data obtained, including CMs quantity, perimeter, and NETs quantity, were evaluated as possible predictors of the postoperative complication rate.

Results

Fifty-five patients (85%) had an uneventful postoperative period, while 10 patients (15%) experienced early postoperative complications, there was a statistically significant positive correlation between the average perimeter of the CMs and the number of NETs in the blood smears in patients who experienced a complicated postoperative period (rho = 0.67; p = .03).

Conclusion

In some cases, complications in the early postoperative period after aortae surgery may be caused by CMs embolism (CE) of the distal vascular bed, accompanied by NETs-mediated thrombosis. The protocol for assessing arterial blood allows for the identification and evaluation of CMs and NETs characteristics as predictors of perioperative thromboembolic complications.