Biological responses differ considerably between endovascular and conventional aortic aneurysm surgery

Area of Science:

• Vascular Surgery
• Immunology
• Inflammatory Response

Background:

• Abdominal aortic aneurysm (AAA) repair involves complex procedures with potential for systemic inflammatory responses.
• Understanding the distinct inflammatory profiles of endovascular (AAA-E) versus conventional open repair (AAA-C) is crucial for patient management.

Purpose of the Study:

• To investigate and compare the inflammatory responses following endovascular AAA repair (AAA-E) and conventional open AAA repair (AAA-C).
• To correlate these inflammatory markers with clinical findings during and after the procedures.

Main Methods:

• A prospective, non-randomized study involving seven patients in the AAA-E group and seven in the AAA-C group.
• Assessment of inflammatory parameters including cytokines (IL-1 beta, IL-6, IL-8, TNF-alpha), complement proteins (C1q, C4, C3, C5a, TCC), hematologic parameters, and C-reactive protein (CRP).

Main Results:

• Endovascular AAA repair (AAA-E) was associated with significant decreases in blood pressure during device introduction in most patients.
• Higher levels of Interleukin-6 (IL-6) and C-reactive protein (CRP) were observed in the conventional AAA repair (AAA-C) group compared to AAA-E.
• Endovascular AAA repair (AAA-E) showed elevated Tumor Necrosis Factor-alpha (TNF-alpha) and less consumption of early complement proteins (C1q, C4, C3) compared to AAA-C.

Conclusions:

• Endovascular AAA repair elicits a distinct inflammatory response, characterized by TNF-alpha elevation, possibly linked to blood pressure fluctuations.
• Conventional AAA repair is associated with a more pronounced inflammatory response, indicated by higher IL-6 and CRP levels, likely due to surgical trauma and reperfusion.
• The study highlights differing inflammatory pathways activated by endovascular versus conventional AAA repair strategies.