Ces radiol. 2011, 65(2):102-111

Dynamics of the inflammatory markers after uncomplicated bifurcated stent graft implantation in abdominal aortic aneurysm - a comparison with the situation complicated by the embolization to the visceral arteriesOriginal article

Petr Šedivý1, Khaled El Samman1, Helena Přindišová2, Tomáš Mach2, Vladimír Borůvka2, Miloslav Loučka3, Iva Zemanová4
1 Oddělení cévní chirurgie, Nemocnice Na Homolce, Praha
2 Radiodiagnostické oddělení, Nemocnice Na Homolce, Praha
3 Ústav matematiky, Vysoká škola chemicko-technologická, Praha
4 Patologie, Nemocnice Na Homolce, Praha

Aim: In about 30% of patients with abdominal aortic aneurysm (AAA) it is necessary to extend bifurcated stent graft (SG) into external iliac arteries (EIA). It is unclear whether it can be done without clinical risk and how intensive will be the biochemical reaction.

Method: We implanted bifurcated SG to 320 patients with AAA. They were divided into four groups according to perioperative IIA occlusion: group A (right IIA occluded); B (left IIA occluded); C (both IIA occluded) and group D (neither IIA occluded). In all groups we collected blood samples during 7 post-operative days and we investigated the values of C-reactive protein (CRP), myoglobine, lactate and leucocytes. We also followed the symptoms of colonic ischemia. We compared the elevation of laboratory markers among the experimental groups.

Results: The maximum myoglobin levels were reached on the 2nd post-operative day; in groups A, B and D the values were 224, 261 and 120 ng/l resp., while in group C the value was 621 ng/ml. The maximum CRP levels were reached on the 3rd post-operative day; in groups A, B, C and D they were 125, 122, 141 and 130 mg/ml, resp. The only case of colonic ischemia was caused by multiple cholesterol plaque embolisation which was proved by histology.

Conclusion: The elevations of CRP, lactate and leucocytes in groups A, B and C were not statistically different in comparison with group D. Myoglobin was the most sensitive marker of subclinical temporary ischemia after bilateral IIA occlusion (group C).

Keywords: stent graft, internal iliac artery, ischemic colitis, ischemic marker

Accepted: March 31, 2011; Published: June 1, 2011  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Šedivý P, El Samman K, Přindišová H, Mach T, Borůvka V, Loučka M, Zemanová I. Dynamics of the inflammatory markers after uncomplicated bifurcated stent graft implantation in abdominal aortic aneurysm - a comparison with the situation complicated by the embolization to the visceral arteries. Ces radiol. 2011;65(2):102-111.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Ferko A, Krajina A. Arteriální aneuryzmata. Hradec Králové: ATD 1999.
    2. Kritpracha B, Pigott JP, Russell TE, Corbey MJ, Whalen RC, DiSalle RS, Price CL, Sproat IA, Beebe HG. Bell-bottom aortoiliac endografts: an alternative that preserves pelvic blood flow. J Vasc Surg 2002; 35: 874-881. Go to original source... Go to PubMed...
    3. Armon MP, Wenham PW, Whitaker SC, Gregson RH, Hopkinson BR. Common iliac artery aneurysms in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 1998; 15: 255-257. Go to original source... Go to PubMed...
    4. Hobo R, Sybrandy JE, Harris PL, Buth J; EUROSTAR Collaborators Endovascular repair of abdominal aortic aneurysms with concomitant common iliac artery aneurysm: outcome analysis of the EUROSTAR Experience. J Endovasc Ther 2008; 15: 12-22. Go to original source... Go to PubMed...
    5. Farahmand P, Becquemin JP, Desgranges P, Allaire E, Marzelle J, Roudot-Thoraval F. Is hypogastric artery embolization during endovascular aortoiliac aneurysm repair (EVAR) innocuous and useful? Eur J Vasc Endovasc Surg 2008; 35: 429-435. Go to original source... Go to PubMed...
    6. Cil B, Peynircioglu B, Canyigit M, Geyik S, Ciftci T. Peripheral vascular applications of the Amplatzer vascular plug. Diagn Interv Radiol 2008; 14: 35-39.
    7. Vandy F, Criado E, Upchurch GR Jr, Williams DM, Rectenwald J, Eliason J. Transluminal hypogastric artery occlusion with an Amplatzer vascular plug during endovascular aortic aneurysm repair. J Vasc Surg 2008; 48: 1121-1124. Go to original source... Go to PubMed...
    8. Gabrielli L, Baudo A, Molinari A, Domanin M. Early complications in endovascular treatment of abdominal aortic aneurysm. Acta Chir Belg 2004; 104: 519-526. Go to original source... Go to PubMed...
    9. Yano OJ, Morrissey N, Eisen L, Faries PL, Soundararajen K, Wan S, Teodorescu V, Kerstein M, Hollier LH, Marin ML. Intentional internal iliac artery occlusion to facilitate endovascular repair of aortoiliac aneurysms. J Vasc Surg 2001; 34: 204-211. Go to original source... Go to PubMed...
    10. Lee CW, Kaufman JA, Fan CM, Geller SC, Brewster DC, Cambria RP, Lamuraglia GM, Gertler JP, Abbott WM, Waltman AC. Clinical outcome of internal iliac artery occlusions during endovascular treatment of aortoiliac aneurysmal diseases. J Vasc Interv Radiol 2000; 11: 567-571. Go to original source... Go to PubMed...
    11. Razavi MK, DeGroot M, Olcott C 3rd, Sze D, Kee S, Semba CP, Dake MD. Internal iliac artery embolization in the stent-graft treatment of aortoiliac aneurysms: analysis of outcomes and complications. J Vasc Interv Radiol 2000; 11: 561-566. Go to original source... Go to PubMed...
    12. Wolpert LM, Dittrich KP, Hallisey MJ, Allmendinger PP, Gallagher JJ, Heydt K, Lowe R, Windels M, Drezner AD. Hypogastric artery embolization in endovascular abdominal aortic aneurysm repair. J Vasc Surg 2001; 33: 1193-1198. Go to original source... Go to PubMed...
    13. Tefera G, Turnipseed WD, Carr SC, Pulfer KA, Hoch JR, Acher CW. Is coil embolization of hypogastric artery necessary during endovascular treatment of aortoiliac aneurysms? Ann Vasc Surg 2004; 18: 143-146. Go to original source... Go to PubMed...
    14. Jaquinandi V, Picquet J, Bouyé P, Saumet JL, Leftheriotis G, Abraham P. High prevalence of proximal claudication among patients with patent aortobifemoral bypasses. J Vasc Surg 2007; 45: 312-318. Go to original source... Go to PubMed...
    15. Iliopoulos JI. Hemodynamics of the hypogastric arterial circulation. J Vasc Surg 1989; 9: 637-641. Go to original source... Go to PubMed...
    16. Singhal R, Coghill JE, Guy A, Bradbury AW, Adam DJ, Scriven JM. Serum lactate and base deficit as predictors of mortality after ruptured abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2005; 30: 263-266. Go to original source... Go to PubMed...
    17. Hussain FA, Martin MJ, Mullenix PS, Steele SR, Elliott DC. Serum lactate and base deficit as predictors of mortality and morbidity. Am J Surg 2003; 185: 485-491. Go to original source... Go to PubMed...
    18. Szalay L, Umar F, Khadem A, Jafarmadar M, Fürst W, Ohlinger W, Redl H, Bahrami S. Increased plasma D-lactate is associated with the severity of hemorrhagic/traumatic shock in v rats. Shock 2003; 20: 245-250. Go to original source... Go to PubMed...
    19. Bashar AH, Suzuki K, Kazui T, Okada MY, Suzuki T, Washiyama N, Terada H, Yamashita K. Changes in cerebrospinal fluid and blood lactate concentrations after stent-graft implantation at critical aortic segment: a preliminary study. Interact Cardiovasc Thorac Surg 2008; 7: 262-266. Go to original source... Go to PubMed...
    20. Belle GH, Fischer LD, Heagerty PJ, Lumley TS. Biostatistics. A methodology for health science. Sec. Ed. John Willey and Sons, inc. 2004.
    21. Picone AL, Green RM, Ricotta JR, May AG, DeWeese JA. Spinal cord ischemia following operations on the abdominal aorta. J Vasc Surg 1986; 3: 94-103. Go to original source...
    22. Gloviczki P, Cross SA, Stanson AW, Carmichael SW, Bower TC, Pairolero PC, Hallett JW Jr, Toomey BJ, Cherry KJ Jr. Ischemic injury to the spinal cord or lumbosacral plexus after aorto-iliac reconstruction. Am J Surg 1991; 162: 131-136. Go to original source... Go to PubMed...
    23. Plecha EJ, Seabrook GR, Freischlag JA, Towne JB. Neurologic complications of reoperative and emergent abdominal aortic reconstruction. Ann Vasc Surg 1995; 9: 95-101. Go to original source... Go to PubMed...
    24. Criado FJ, Wilson EP, Velasquez OC, Carpenter JP, Barker C, Wellons E, Abul-Khoudoud O, Fairman RM. Safety of coil embolization of the internal iliac artery in endovascular grafting of abdominal aortic aneurysms. J Vasc Surg 2000; 32: 684-688. Go to original source... Go to PubMed...
    25. Mehta M, Veith FJ, Ohki T, Cynamon J, Goldstein K, Suggs WD, Wain RA, Chang DW, Friedman SG, Scher LA, Lipsitz EC. Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients: a relatively innocuous procedure. J Vasc Surg 2001; 33(2 Suppl): S27-S32. Go to original source... Go to PubMed...
    26. Sandison AJ, Edmondson RA, Panayiotopoulos YP, Ready JF, Adam A, Taylor PR. Fatal colonic ischemia after stent graft for aortic aneurysm. Eur J Vasc Endovasc Surg 1997; 13: 219-220. Go to original source... Go to PubMed...
    27. Wires MC, Schermerhorn ML, Fillinger MF, Powell RJ, Rzucidlo EM, Walsh DB, Zwolak RM, Cronenwett JT. Internal iliac occlusion without coil embolization during endovascular abdominal aortic aneurysm repair. J Vasc Surg 2002; 36: 1138-1145. Go to original source... Go to PubMed...
    28. Su WT, Stone DH, Lamparello PJ, Rockman CB. Gluteal compartment syndrome following elective unilateral internal iliac artery embolization before endovascular abdominal aortic aneurysm repair. J Vasc Surg 2004; 39: 672-675. Go to original source... Go to PubMed...
    29. Kwok PC, Chung TK, Chong LC, Chan SC, Wong WK, Chan MK, Chu WS. Neurologic injury after endovascular stent-graft and bilateral internal iliac artery embolization for infrarenal abdominal aortic aneurysm. J Vasc Interv Radiol 2001; 12: 761-763. Go to original source... Go to PubMed...
    30. Unno N, Inuzuka K, Yamamoto N, Sagara D, Suzuki M, Konno H. Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. J Vasc Surg 2006; 44: 1170-1175. Go to original source... Go to PubMed...
    31. Inuzuka K, Unno N, Mitsuoka H, Yamamoto N, Ishimaru K, Sagara D, Suzuki M, Konno H. Intraoperative monitoring of penile and buttock blood flow during endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2006; 31: 359-365. Go to original source... Go to PubMed...
    32. Gerasimidis T, Sfyroeras G, Trellopoulos G, Skoura L, Papazoglou K, Konstantinidis K, Karamanos D, Filaktou A, Parapanisiou E. Impact of endograft material on the inflammatory response after elective endovascular abdominal aortic aneurysm repair. Angiology 2005; 56: 743-753. Go to original source... Go to PubMed...
    33. Storck M, Scharrer-Pamler R, Kapfer X, Gallmeier U, Görich J, Sunder-Plassmann L, Brückner U, Mickley V. Does a postimplantation syndrome following endovascular treatment of aortic aneurysms exist? Vasc Surg 2001; 35: 23-29. Go to original source... Go to PubMed...
    34. Eggebrecht H, Metozounve H, Huptas S, Herold U, Jakob H, Erbel R. Clinical implications of systemic inflammatory response syndrome following thoracic aortic stent-graft placement. Clin Res Cardiol. 2007; 96(Suppl 1): V 1875.
    35. Köcher M, Utíkal P, Koutná J, Bachleda P, Buriánková E, Heřman M, Bučil J, Benýšek V, Černá M, Kojecký Z. Endovascular treatment of abdominal aortic aneurysms - six years of experience with Ella Stent-graft System. Eur J Radiol 2004; 51: 181-188. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content