Abdominal Aortic Aneurysm Surgery and Thrombosis

Study Overview
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Brief Summary
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The aim of our study is to evaluate the incidence of post-operative thrombotic complications after abdominal aortic aneurysm surgery in the context of atherosclerosis or infectious aneurysm and its links with preoperative inflammation and hemostasis.

Detailed Description
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Abdominal aortic aneurysm (AAA) develops in the context of atherosclerosis or infection (aortitis or mycotic aneurysm). AAA and its surgery are associated with pro-thrombotic modifications of hemostasis, which persists in the post-operative period. Pro-thrombotic reactions occur in the intraluminal thrombus. Inflammatory cells recruitment is mediated by adhesion molecules from the activated endothelium, such as vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), P-selectin and E-selectin. In the setting of infection, neutrophil death process occurs, the NETosis, with the liberation of Neutrophil Extracellular Traps (NETs), containing DNA and histones. NETs are associated with thrombosis and various studies have already quantified NETosis biomarkers in plasma from patients with thrombotic disease, such as MPO-DNA (DNA coupled myeloperoxidase). In the clinical perioperative setting, patients with aortitis scheduled for AAA surgery shwoed exhibit thrombotic events. The hypothesize was that patients with aortitis have an inflammatory and hemostatic activation different from patients who develop AAA in atherosclerotic condition, and that inflammation is a risk factor of postoperative thrombotic events.

Official Title
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Study of Thrombotic Complications After Abdominal Aortic Aneurysm Surgery With or Without Infection: AAA-IT

Conditions
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Abdominal Aortic Aneurysm

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patient >18 years-old; patient scheduled for AAA surgery by laparotomy in the vascular surgical unit at Bordeaux University Hospital; patient who gave his/her authorization for the use of its medical data and results of blood analyses performed on residual plasma and results of aortic material analyses Exclusion Criteria: patient who do not understand the study (not fluently French speaking or unable to give his/her consent); patient with a pre-existing hemostatic disorder; patient scheduled for an endovascular surgery and benefiting from a secondary laparotomy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| thrombotic events | Incidence of thrombotic events | first 7 postoperative days after AAA surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| white blood cells | white blood cells (G/L), | baseline | 
| hemoglobin | hemoglobin (g/dL), | baseline | 
| platelets | platelets (G/L), | baseline | 
| prothrombin time ratio | prothrombin time ratio (%), | baseline | 
| INR | INR | baseline | 
| aPTT ratio | aPTT ratio | baseline | 
| fibrinogen | fibrinogen (g/L), | baseline | 
| CRP | CRP (ng/mL), | baseline | 
| interleukin-6 | interleukin-6 (pg/mL), | baseline | 
| thrombin generation test | thrombin generation test (lag time (min), | baseline | 
| peak | peak (nM), | baseline | 
| time to peak | time to peak (min), | baseline | 
| ETP | ETP (nM.min), | baseline | 
| velocity index | velocity index | baseline | 
| von Willebrand factor | von Willebrand factor (%), | baseline | 
| soluble P-selectin | soluble P-selectin (ng/mL), | baseline | 
| MPO-AND | MPO-AND (% standard) | baseline | 
| atherosclerosis | % of patients with preoperative atherosclerosis (number) | baseline | 
| Aspirin treatment | % of patients with preoperative treatment by Aspirin (number) | baseline | 
| clamping duration | clamping duration (min), | baseline | 
| bleeding | bleeding (min), | baseline | 
| vascular filling | vascular filling (ml), | baseline | 
| tranexamic acid administration | tranexamic acid administration (g), | baseline | 
| transfusion | transfusion (pack of red blood cells, plasma volume (ml), | baseline | 
| amount of fibrinogen | amount of fibrinogen (g), | baseline | 
| amount of heparin | amount of heparin (UI) | baseline | 
| Type of postoperative anticoagulation | Type of postoperative anticoagulation: % of patients with unfractionated heparin or low-molecular-weight heparin | baseline | 
| Administration way of postoperative anticoagulation | Administration way of postoperative anticoagulation: % of administration intra-venous or subcutaneously | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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abdominal aortic aneurysm, NETosis, thrombosis