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Systemic endotoxaemia and fibrinolysis during aortic surgery
M Welch1, J T Douglas, J V Smyth
1Department of Vascular Surgery, Manchester Royal Infirmary & Medical School, U.K.
Objective:
To determine whether endotoxaemia and activation of the systemic fibrinolytic system occurs during and after aortic surgery.
Design:
Prospective clinical study.
Setting:
University Hospital.
Materials:
31 patients undergoing aortic surgery.
Chief Outcome Measures:
Venous blood assay for endotoxin and plasminogen activator inhibitor-1 (PAI-1). Samples were obtained preoperatively, immediately before and 5 minutes after cross-clamp application and removal, and at 2, 4, 6 and 24 hours postoperatively. Tonometric sigmoid intramural pH was monitored throughout this period as a means of detecting colonic mucosal ischaemia.
Main Results:
Endotoxin levels increased after clamping of the aorta, peaking immediately before clamp removal, mean value 34.5 pg/ml, p < 0.01, but returning to preoperative levels by 24 hours. PAI-1 levels progressively increased after surgery, with persistently high levels remaining at 24 hours (p < 0.01).
Conclusions:
Endotoxaemia does occur during aortic surgery and appears to be associated with activation of the systemic fibrinolytic system.