POSTOPERATIVE FEVER, BOWEL ISCHEMIA AND CYTOKINE RESPONSE TO ABDOMINAL AORTIC-ANEURYSM REPAIR - A COMPARISON BETWEEN ENDOVASCULAR AND OPEN SURGERY

Objectives: To study bowel ischaemia in transfemorally placed endolumi nal grafting (TPEG) for abdominal aortic aneurysms, and any relation t o cytokine response or postoperative fever. Design: Prospective not ra ndomised. University hospital setting. Material: Fourteen cases of con ventional surgery and 23 cases of endovascular technique for infrarena l abdominal aortic aneurysm repair. Methods: Tonometry was used for si gmoid colon pH, and ELISAs for serum IL-6. Results: Mucosal pH in the sigmoid colon fell significantly during clamping and reperfusion in bo th groups. Lowest measured sigmoid colon pH was 7.10 in the open group , compared to 7.22 in the TPEG group (p < 0.05). The IL-6 levels in se rum peaked after 4 h of reperfusion; 249 pg/ml in the open group, comp ared to 89 pg/ml in the TPEG group (p < 0.05). High levels of IL-6 in the postoperative period and persisting low sigmoidal pH were associat ed with serious complications. Postoperative temperature did not diffe r significantly between the groups, and no significant correlation cou ld be found with sigmoid colon pH or IL-6. Conclusions: The less prono unced perioperative bowel ischaemia in TPEG patients indicates an adva ntage of the TPEG technique. Splanchnic ischaemia was not related to p ostoperative fever, nor the IL-6 or TNF response.