PERIOPERATIVE CHANGES IN COAGULATIVE AND FIBRINOLYTIC FUNCTION DURING SURGICAL-TREATMENT OF ABDOMINAL AORTIC-ANEURYSM AND ARTERIOSCLEROSIS OBLITERANS

To determine the factors which influence perioperative coagulative and fibrinolytic function, we studied 41 patients who underwent surgical repair of unruptured abdominal aortic aneurysm (AAA) and 30 patients who underwent arterial reconstruction for arteriosclerosis obliterans (ASO). In patients with AAA, the levels of fibrin/fibrinogen degradation products (FDP) (11.4 +/- 20.1 mu g/ml), thrombin-antithrombin III complex (TAT) (22.0 +/- 21.8 mu g/l), plasmin-alpha(2) plasmin inhibitor complex (PIC) (2.6 +/- 2.9 mu g/ml) and d-dimer of cross-linked fibrin degradation products (D-D) (8.4 +/- 10.8 mu g/ml) were elevated, particularly when the AAAs had a large mural thrombus surface area or were accompanied by aneurysm of the iliac or femoral artery. In arterial aneurysms, blood coagulability and secondary fibrinolytic activity were believed to be enhanced. In patients with ASO, the level of TAT (17.2 +/- 24.8 mu g/l) was so elevated that they were considered to show chronic hypercoagulability. Among the ASO patients with aorto-iliac lesions, those with concomitant graft occlusion or anastomotic aneurysm had significantly elevated levels of TAT. Proximal arterial occlusion or accompanying aneurysm in the ASO patients was associated with increased levels of PIC and D-D. Postoperative fluctuations in conventional hematological variables did not differ significantly among the surgical procedures. Conventional markers showed a transient decrease due to consumption during surgery, and a subsequent recovery or an actual increase within several days after surgery. Changes in the molecular markers of the coagulative and fibrinolytic systems were affected by the extent of the surgical procedure. These changes revealed that the enhanced coagulative state and the depressed fibrinolytic state increased within 3 days after surgery, and the secondary fibrinolytic state rose subsequently.