OXYGEN-FREE RADICAL AND CYTOKINE GENERATION DURING ENDOVASCULAR AND CONVENTIONAL ANEURYSM REPAIR

Objectives: Endovascular aneurysm repair has been proposed as a ''mini mally invasive'' alternative to conventional aneurysm resection. One o f the most important potential benefits of endoluminal surgery is the avoidance of aortic cross clamping, which may attenuate the ischaemia - reperfusion injury that complicates open aneurysm repair This study aimed to quantify the metabolic response to both conventional and endo vascular aortic surgery. Design: Prospective clinical study. Setting: University hospital. Methods: Femoral vein blood samples (pre-clamp, d uring aneurysm repair and 5 and 30 min post reperfusion) were obtained from 12 patients undergoing aortoaortic aneurysm repair, six by conve ntional transperitoneal inlay replacement (median age 71 years, median aneurysm diameter 5.8 cm), and six by endoluminal deployment of a str aight endograft (median age 73 years, median aneurysm diameter 5.5 cm) . All endovascular procedures were completed satisfactorily with no co nversions to conventional surgery. Outcome measures: Venous blood samp les were analysed for oxygen free radical (OFR) production using the q uantifiable oxidation of IgG in plasma, and cytokine (IL-1 beta and TN F-alpha) generation by radioimmunoassay. Results: The results are give n as median values with interquartile ranges: [GRAPHICS] Conclusions: These results suggest that the ischaemia - reperfusion response associ ated with conventional aneurysm surgery may be largely negated by endo vascular techniques. This may have significant consequences as the gen eration of oxygen free radicals and cytokines have been implicated in the development of systemic organ failure following aortic surgery.