Is Endovascular Treatment of Abdominal Aortic Aneurysms Less Invasive Regarding the Biological Responses?

Abstract

To compare the biological responses following an endoluminal repair and a conventional open repair of abdominal aortic aneurysm (AAA), 14 patients who underwent an endoluminal repair (endograft group) and 26 who underwent an open repair (open group) were investigated. As markers of biological responses, interleukin-6 (IL-6) and -8 (IL-8), granulocyte elastase (GEL), white blood cell count (WBC), and serum C-reactive protein (CRP) were all measured preoperatively as well as on postoperative days (POD) 1, 3, and 6. In addition, the blood loss, duration of surgery, initial oral intake the day after surgery, and length of hospital stay were compared between both groups. The plasma levels of IL-6, GEL, CRP, and WBC were higher in the endograft group than in the open group, while the CRP, WBC, and GEL levels all peaked on POD 3. The plasma level of IL-6 remained high in the endograft group, compared with that in the open group throughout the study period. Conversely, blood loss, initial oral intake the day after surgery, and the length of hospital stay were all significantly greater in the open group than in the endograft group, although there was no significant difference in the duration of surgery between the two groups. These findings indicate that although the endoluminal repair of AAA is supposed to be less invasive, the biological responses tend to be greater because of the manipulation related to the insertion of the stent graft.

Prospective Evaluation of Post-implantation Inflammatory Response After EVAR for AAA: Influence on Patients' 30 Day Outcome

“…Some authors recommended aggressive routine use of anti-inflammatory drugs while most others prefer a more conservative approach. 15,25 Akin et al 26 did not observe any clinical benefit of prolonging antibiotic treatment beyond the day of endovascular intervention in PIS patients. Bischoff et al 17 in a recent survey of vascular surgery departments in Germany reported that 71% of the vascular centers treated PIS with non-steroidal anti-inflammatory agents (NSAIDs).…”

Role of Leukocyte Elastase in Preventing Cellular Re-Colonization of the Mural Thrombus

“…Recently, reduced plasma protease inhibitory activities have been reported in patients with abdominal aortic aneurysms. 53 Nevertheless, these studies focused on circulating blood markers 54 rather than on a role for leukocyte elastase released by PMNs trapped within the mural thrombus.…”

Inflammatory mediators after endovascular aortic aneurysm repair

“…Our findings should therefore be interpreted with caution. However, each patient was his or her own control within each group improving the statistical strength of this study, and the long follow-up adds new data to previous literature [28][29][30][31] in the field of inflammation after EVAR.…”

“…The reported incidence of PIS after EVAR varies widely between 14% and 60% [28], and both underestimation and lack of explicit criteria for this syndrome may account for this large variation [29]. Plasma levels of IL-6 have been shown to increase already on the first postoperative day, culminate at 24 h, and remain increased for at least 6 days [28][29][30][31]. The full duration of this postoperative increase in inflammatory mediators has to our knowledge not been fully established, however.…”