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[Fibrinolysis and complement-system profiles during aorto-femoral bypass implantation]
Insights
Aortofemoral bypass surgery significantly alters fibrinolytic and complement systems, decreasing plasminogen and complement factors. Saphenous bypass showed minimal changes, indicating surgery type impacts these crucial biological systems.
Area of Science:
- Vascular Surgery
- Hemostasis
- Immunology
Background:
- Fibrinolytic and complement systems play vital roles in hemostasis and immune response.
- Surgical procedures, particularly those involving vascular grafts, can potentially impact these systems.
Purpose of the Study:
- To investigate the effects of aortofemoral and saphenous bypass surgery on the fibrinolytic and complement systems.
- To determine if anesthesia type or hemodynamic changes influence these systems during surgery.
Main Methods:
- Analysis of fibrinolytic and complement system profiles in 51 patients undergoing bypass surgery.
- Comparison of pre- and post-operative levels of plasminogen, alpha 2-macroglobulin, C3c, C4, antithrombin III, and alpha 1-antitrypsin.
Main Results:
- Aortofemoral bypass led to significant decreases in plasminogen (40%), alpha 2-macroglobulin (25%), C3c (20%), and C4 (40%).
- Saphenous bypass showed minimal changes in these factors, except for a 20% intraoperative decrease in C3c and a 30% postoperative increase in alpha 1-antitrypsin.
- Anesthesia type and intraoperative hemodynamic changes did not affect fibrinolytic or complement system profiles.
Conclusions:
- Aortofemoral bypass significantly impacts the fibrinolytic and complement systems, suggesting a potential role in post-operative complications.
- Saphenous bypass has a less pronounced effect on these systems.
- Anesthesia and hemodynamic stability do not appear to be confounding factors in these observed changes.
Abstract:
In 51 patients undergoing either implantation of an aortofemoral bypass (38 patients) or of an saphenous bypass (13 patients) the fibrinolytic and complement system profiles were determined. During the course of an aortofemoral bypass the plasminogen concentration decreased by 40%, alpha 2-macroglobulin by 25%, the complement factor C3c by 20% and the complement factor C4 by 40%. Antithrombin III concentration remained stable until the third postoperative day. The alpha 1-antitrypsin concentration increased postoperatively by 40% compared to the preoperative control. The concentrations of plasminogen, antithrombin III, alpha 2-macroglobulin and complement factor C4 did not change in the patients undergoing saphenous bypass operation. Intraoperatively the complement factor C3c decreased by 20%, while alpha 1-antitrypsin showed postoperatively an increase by 30%. Anaesthesia (neuroleptanaesthesia, halothane- or continuous thoracal epidural anaesthesia) had no influence on the fibrinolytic and complement system profiles. Neither could a correlation be shown between the intraoperative haemodynamic changes and the concentrations of the factors of the fibrinolytic and complement system.