Oxygen free radical and cytokine generation during endovascular and conventional aneurysm repair

Objectives: Endovascular aneurysm repair has been proposed as a ''minimally invasive'' alternative to conventional aneurysm resection. One of the most important potential benefits of endoluminal surgery is the avoidance of aortic cross clamping, which may attenuate the ischaemia - reperfusion injury that complicates open aneurysm repair This study aimed to quantify the metabolic response to both conventional and endovascular aortic surgery. Design: Prospective clinical study. Setting: University hospital. Methods: Femoral vein blood samples (pre-clamp, during aneurysm repair and 5 and 30 min post reperfusion) were obtained from 12 patients undergoing aortoaortic aneurysm repair, six by conventional transperitoneal inlay replacement (median age 71 years, median aneurysm diameter 5.8 cm), and six by endoluminal deployment of a straight endograft (median age 73 years, median aneurysm diameter 5.5 cm). All endovascular procedures were completed satisfactorily with no conversions to conventional surgery. Outcome measures: Venous blood samples were analysed for oxygen free radical (OFR) production using the quantifiable oxidation of IgG in plasma, and cytokine (IL-1 beta and TNF-alpha) generation by radioimmunoassay. Results: The results are given as median values with interquartile ranges: [GRAPHICS] Conclusions: These results suggest that the ischaemia - reperfusion response associated with conventional aneurysm surgery may be largely negated by endovascular techniques. This may have significant consequences as the generation of oxygen free radicals and cytokines have been implicated in the development of systemic organ failure following aortic surgery.