Early inflammatory response following elective abdominal aortic aneurysm repair: A comparison between endovascular procedure and conventional, open surgery
Authors: Marjanovic Ivan , Jevtic Miodrag , Misovic Sidor , Vojvodic Danilo , Zoranovic Uros , Rusovic Sinisa , Sarac Momir , Stanojevic Ivan 
Published: November 2011

Background/Aim. Abdominal aorta aneurysm (AAA) represents a pathological
enlargment of infrarenal portion of aorta for over 50% of its lumen. The only
treatment of AAA is a surgical reconstruction of the affected segment. Until
the late XX century, surgical reconstruction implied explicit, open repair
(OR) of AAA, which was accompanied by a significant morbidity and mortality
of the treated patients. Development of endovascular repair of (EVAR) AAA,
especially in the last decade, offered another possibility of surgical
reconstruction of AAA. The preliminary results of world studies show that
complications of such a procedure, as well as morbidity and mortality of
patients, are significantly lower than with OR of AAA. The aim of this paper
was to present results of comparative clinical prospective study of early
inflammatory response after reconstruction of AAA between endovascular and
open, conventional surgical technique. Methods. A comparative clinical
prospective study included 39 patients, electively operated on for AAA within
the period of December 2008 - February 2010, divided into two groups. The
group I counted 21 (54%) of the patients, 58-87 years old (mean 74.3 years),
who had been submited to EVAR by the use of excluder stent graft. The group
II consisted of 18 (46%) of the patients, 49-82 (mean 66.8) years, operated
on using OR technique. All of the treated patients in both groups had AAA
larager than 50 mm. The study did not include patients who have been treated
as urgent cases, due to the rupture or with simptomatic AAA. Clinical,
biochemical and inflamatory parameters in early postoperative period were
analyzed, in direct postoperative course (number of leucocytes, thrombocytes,
serum circulating levels of cytokine - interleukine (IL)-2, IL-4, IL-6 and
IL-10). Parameters were monitored on the zero, first, second, third and
seventh postoperative days. The study was approved by the Ethics Commitee of
the Military Medical Academy. Results. The study showed a statistically
significantly shorter time of treatment in the EVAR group (average 90 min)
compared to the OR group (average 136 min). Also, there was a statistically
significantly less blood loss in the patients operated on by the use of EVAR
surgery (average 60 mL) as compared to the patients treated with OR
techinique (average 495 mL), as well as a shorter postoperative
hospitalization of patients in the EVAR group (average 4 days) compared to
the OR group (average 8 days). The OR group was detected with a statistically
significant increase of leucocytes and statistically significant fall of the
number of thrombocytes in comparison with the EVAR group in all the
investigated terms. A significant concentration rise of IL-2 in the OR group
and concentration rise of IL-6 in the EVAR group was shown 24 hours after the
procedure, whereas on the second postoperative day there was detected a
significant fall of IL-6 in the EVAR group. IL-4 concentration in the OR
group was significantly higher as of the third postoperative day in
comparison to the EVAR group. There was no significant difference in IL-10
concentration between the groups. Conclusion. The EVAR techinique is a safer
and less invasive and less traumatic procedure for patients than the OR of
AAA. Following the EVAR, there are less inflammatory reactions in the early
postoperative periodas compared to the OR and therefore less possibility of
the development of systemic inflammatory respons syndrome in patients
treated.