BIOLOGICAL RESPONSES DIFFER CONSIDERABLY BETWEEN ENDOVASCULAR AND CONVENTIONAL AORTIC-ANEURYSM SURGERY

Objectives: To determine the inflammatory responses in endovascular ab dominal aortic aneurysm (AAA) repair and their relation to clinical fi ndings. Design: Prospective non-randomised study. Setting: University Hospital, Department of Surgery. Patients and methods: Seven patients treated with an endoluminal procedure (AAA-E) and seven patients under going conventional surgery (AAA-C) were included. Inflammatory paramet ers were assessed by measurements of the cytokines interleukin (IL)-1 beta, IL-6, IL-8 and Tumour Necrosis Factor-alpha (TNF-alpha); analyse s of complement proteins C1q, C4, C3, C5a and Terminal Complement Comp exes (TCC); haematologic parameters and determination of C-reactive pr otein (CRP). Results: In six of seven patients in the AAA-E group bloo d pressure decreases were recorded during introduction of the device. IL-6 and CRP levels were found to be significantly higher in AAA-C pat ients compared to the AAA-E group. On the other hand, high TNF-alpha l evels were recorded in the AAA-E group. Less consumption of the comple ment proteins C1q, C4 and C3 was observed in AAA-E compared to AAA-C p atients. Increased C5a levels were recorded in the AAA-C group, wherea s only slight fluctuations were noticed in the AAA-E group. TCC levels were unchanged in both groups. Conclusion: Endovascular aortic aneury sm repair induced a significant inflammatory response, mainly involvin g TNF-alpha and differing from the findings during open AAA repair The se inflammatory responses were probably related to blood pressure decr eases during the procedures. On the other hand, conventional repair in duced responses related to the more extensive surgical trauma and repe rfusion injury.