Early inflammatory response after elective abdominal aortic aneurysm repair: A comparison between endovascular procedure and conventional surgery

Objective: To determine the nature of and to compare the inflammatory respo nses induced by (1) endovascular and (2) conventional abdominal aortic aneu rysm (AAA) repair. Material and methods: Twelve consecutive patients undergoing elective infra renal AAA repair were prospectively studied. Seven patients were selected f or endovascular procedures (the EAAA group); five patients underwent open s urgery (the OAAA group). Three control patients undergoing carotid thromboe ndarterectomy were also included. Serial peripheral venous blood samples we re collected preoperatively, immediately after declamping or placement of t he endograft, and at hours 1, 3, 6, 12, 24, 48, and 72. Acute phase respons e expression of peripheral T lymphocyte and monocyte activation markers and adhesion molecules (flow cytometry), soluble levels of cell adhesion molec ules (enzyme-linked immunosorbent assay), cytokine (tumor necrosis factor a lpha, interleukin-6, and interleukin-8) release (enzyme-linked immunosorben t assay), and liberation of complement products (nephelometry) were measure d. Results: Regarding acute phase response, the EAAA and OAAA groups showed si gnificant increases in C-reactive protein (P < .001 and P = .001), body tem perature (P = .035 and P = .048), and leukocyte count (P < .001 and P < .00 1). Similar time course patterns were observed with respect to body tempera ture (P = .372). Statistically significant different patterns were demonstr ated for C-reactive protein (P = .032) and leukocyte count (P = .002). Rega rding leukocyte activation, a significant upregulation of peripheral T lymp hocyte CD38 expression was observed in the OAAA group only (P = .001). Anal ysis of markers such as CD69, CD40L, CD25, and CD54 revealed no perioperati ve fluctuations in any group. Regarding circulating cell adhesion molecules , the EAAA and OAAA groups displayed significant increases in soluble inter cellular adhesion molecule-1 (P = .003 and P = .001); there was no intergro up difference (P = .193). All groups demonstrated high soluble von Willebra nd factor levels (P = .018, P = .007, and P = .027), there being no differe nces in the patterns (P = .772). Otherwise, soluble vascular cell adhesion molecule-1, soluble E-selectin, and soluble P-selectin did not appear to va ry in any group. Regarding cytokine release, although a tendency toward hig h tumor necrosis factor a and interleukin-8 levels was noticed in the EAAA group, global time course effects failed to reach statistical significance (P = .543 and P = .080). In contrast, interleukin-6 showed elevations in al l groups (P = .058, P < .001, and P = .004). Time course patterns did not d iffer between the EAAA and OAAA groups (P = .840). Regarding complement act ivation, the C3d/C3 ratio disclosed significant postoperative elevations in the EAAA and OAAA groups (P = .013 and P = .009). This complement product release was reduced in the EAAA group (P < .001).