Neutrophil respiratory burst activity and pro- and anti-inflammatory cytokines in AAA surgery: Conventional versus endoluminal treatment

Purpose: To examine the inflammatory impact of endovascular and conventiona l surgery of abdominal aortic aneurysm (AAA) as assessed by the activation of neutrophils and serum levels of pro- and anti-inflammatory cytokines. Methods: Twenty-four patients undergoing AAA exclusion were treated with ei ther endovascular (n = 14) or conventional (n=10) techniques. Clinical and hematological data, respiratory burst of neutrophils, and the expression of adhesion and activation molecules (CD18, CD11b, CD69, and HLA-DR) were ana lyzed by flow cytometry. The enzyme-linked immunosorbent assay technique wa s used to measure proinflammatory cytokine interleukin (IL)-8 and anti-infl ammatory cytokines IL-l receptor antagonist (IL-1RA) and transforming growt h factor beta1 (TGF-beta1). Results: All patients, most of whom had normal cytokine values before surge ry, were successfully treated. No significant changes were found in surface antigens. Basal respiratory burst was quite heterogeneous; in all cases re spiratory burst activity decreased after surgery and remained low throughou t the observation period. Despite marked interpatient differences, IL-1RA a nd IL-8 increased after surgery, whereas TGF-beta1 decreased, although the variation achieved statistical significance only in the conventional group. Elevated IL-1RA returned to normal within 48 hours in the endoluminal grou p, whereas the level remained high in the conventional group in the last sa mple. Conclusions: Despite heterogeneity before surgery, the respiratory burst de creased for most of the patients regardless of the approach, and both techn iques increased IL-1RA. Although both procedures seemed to decrease TGF-bet a1, the difference was significant only with the conventional approach. IL- 1RA levels fell toward basal values quicker in the endograft patients, sugg esting that the endoluminal approach was less aggressive.