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Coagulation changes during thoracoabdominal aneurysm repair

J P Gertler1, R P Cambria, D C Brewster

  • 1Department of Surgery, Massachusetts General Hospital, Boston 02114, USA.

Journal of Vascular Surgery
|December 1, 1996
PubMed
Summary
This summary is machine-generated.

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Thoracoabdominal aneurysm repair causes reduced clotting factors and increased fibrinolysis after supraceliac clamping. Early blood replacement and monitoring can mitigate bleeding risks during TAA surgery.

Area of Science:

  • Cardiovascular Surgery
  • Hematology
  • Vascular Surgery

Background:

  • Coagulopathic hemorrhage is a significant complication during thoracoabdominal aneurysm (TAA) repair.
  • The precise mechanisms underlying coagulation changes in TAA repair remain incompletely understood.
  • Investigating these changes is crucial for improving patient outcomes and surgical safety.

Purpose of the Study:

  • To define the cause of coagulopathic hemorrhage during TAA repair.
  • To investigate coagulation system alterations associated with supraceliac versus infrarenal aortic cross-clamping.
  • To identify factors contributing to bleeding complications in TAA surgery.

Main Methods:

  • Analyzed blood levels of fibrinogen, prothrombin fragment F1.2, D-dimer, and coagulation factors II, V, VII, VIII, IX, X, XI, and XII.

Related Experiment Videos

  • Collected data from 19 TAA patients and 4 abdominal aortic aneurysm (AAA) patients at four time points: induction, during clamping, after clamp release, and post-surgery.
  • Utilized analysis of variance, Student's t test, and univariate linear regression to determine significance.

    • Main Results:

    • Clotting factor levels (fibrinogen, II, V, VII, VIII, IX, X, XI, XII) decreased significantly after supraceliac clamping (p < 0.05).
    • D-dimer and prothrombin fragment F1.2 levels increased significantly by the end of surgery (p < 0.05).
    • TAA repair showed more pronounced coagulation changes compared to AAA repair; blood replacement correlated with factor reduction and fibrinolysis.

    Conclusions:

    • TAA repair is linked to reduced clotting factor activity and increased fibrinolytic function post-supraceliac clamping.
    • Visceral ischemia or a larger ischemic tissue burden likely causes these coagulation alterations.
    • Aggressive early blood component replacement and coagulation monitoring may reduce blood loss and prevent severe bleeding during TAA repair.