Endothelium injury and inflammatory state during abdominal aortic aneurysm surgery: scrutinizing the very early and minute injurious effects using endothelial markers – a pilot study

Abstract

IntroductionOne of the most severe complications of repair surgery for abdominal aortic aneurysms (AAA) is acute kidney injury (AKI). Acute kidney injury is an inflammatory process whose pathogenesis involves endothelial cells (EC). The aim of this study was to assess the dynamics of endothelium injury markers measured during elective AAA surgery which might confirm the inflammatory character of AKI.Material and methodsThe study group consisted of 14 patients with AAA. We measured plasma soluble forms of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, P-selectin as well as the levels of von Willebrand factor (vWF) before, during (including intra-abdominal vein levels before and after aortic clamp removal) and within 2 days after surgery.ResultsWe have found a biphasic response of ICAM-1, VCAM-1 and P-selectin with an initial fall and subsequent rise. However, only VCAM-1 changes were significant compared to its baseline value. The maximum decrease of VCAM-1 was observed in the renal vein 5 min after aortic clamp removal (335.42 ±129.63 ng/ml vs. 488.90 ±169.80 ng/ml baseline value, p < 0.05), and the highest rise 48 h after aortic clamp removal (721.46 ±333.99 vs. baseline, p < 0.05).ConclusionsVascular cell adhesion molecule-1 turned out to be the most sensitive indicator of EC injury and inflammatory status after AAA surgery. During AAA surgery, soluble forms of P-selectin, ICAM-1 and VCAM-1 demonstrate a biphasic response with an initial fall and subsequent rise. These soluble forms could have a modulatory effect on the development of inflammation.

Biomarkers of inflammation in major vascular surgery: a prospective randomised trial

“…Desflurane has also been shown to inhibit VCAM‐1 expression . In accordance with our findings, Kokot et al . found the same biphasic pattern in VCAM‐1 levels perioperatively.…”

“…After a transiently decline 30 min after arrival ICU, the levels increased 1st post‐operative day. The intermediate decrease might be due to saturation of soluble VCAM‐1 on upregulated receptors, but in the second phase, a further intensively release of VCAM‐1 leads to increased concentration of the soluble form …”

“…Samples were separated within 1 h after collection by centrifugation at 2200 g force for 10 min. To detect changes in concentrations of biomarkers, we choose one blood sample shortly after surgery (30 min) and one later (1st post‐operative day) because some biomarkers have peak values after a few hours (IL‐6, IL‐8, MCP‐1 and the early stages of VCAM‐1) and others after 1 or 2 days (MMP‐9, CRP and late phase of the VCAM‐1) after surgery . Serum and citrated plasma were kept frozen at –80°C until analysed.…”

Prognostic value of tissue factor in patients with abdominal aortic and iliac arterial aneurysms – preliminary study

“…To improve the clinical course and to follow up the results of AAA surgery, studies are conducted in search of biological markers that evaluate the risk of postoperative complications [25, 26] and predict the aneurysmal size progression [27]. …”

Treatment of denture-related stomatitis improves endothelial function assessed by flow-mediated vascular dilation

“…We monitored the most reliable indicator of endothelial function – flow-mediated dilatation [40]. In future it would be valuable to address some other biomarkers of endothelial health with all the limitations of these, including soluble adhesion molecules, ADMA and von Willebrand factor, as well as others [9, 41–44]. Predominance of women in the study group could also be a limitation to the generalizability of the study findings; however, the study population is consistent with the epidemiology of DRS.…”