The inflammatory response following treatment of abdominal aortic aneurysms: a comparison between open surgery and endovascular repair

Objectives: to compare the inflammatory response following endovascular and conventional AAA repair. Design: prospective study. Patients and methods: ten patients were selected for open surgery (OPEN) an d ten for endovascular (ENDO) AAA repair. Leukocytes, platelets, myeloperox idase, lactoferrin, beta-thromboglobulin, C-reactive protein (CRP), interle ukin 6 (IL-6), tumour necrosis factor alpha (TNF-alpha) and complement acti vation products were measured before, during and after surgery. Results: in the OPEN group the median hospital stay was longer (6 vs. 12 da ys, p=0.001) and more patients required transfusion (p=0.02). IL-6 and CRP increased postoperatively, most in OPEN (p<0.01). Platelet counts decreased after the first angiography in ENDO (p<0.01) and before aortic cross-clamp ing in OPEN (p<0.05). The decrease was larger in OPEN (p=0.02). Leukocyte c ounts decreased after the first angiography in ENDO, and thereafter increas ed (p=0.001). An equivalent increase was observed in OPEN after declamping (p=0.001). Leukocyte and platelet degranulation products increased after th e first angiography in ENDO and after declamping in OPEN. Changes in comple ment activation products were small. TNF-alpha did not change significantly . Conclusion: endovascular AAA repair caused significant leukocyte and platel et activation. Based on the timing of activation this could be caused by ra diographic contrast media.