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Postoperative Evolution of Inflammatory Response in a Model of Suprarenal Aortic Cross-clamping with and without Hemorrhagic Shock. Systemic and Local Reactions

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Abstract

Surgery of the abdominal aorta generates a systemic inflammatory response (SIR), a source of operative morbidity-mortality. In the present work we attempted to evaluate the evolution of SIR in an experimental model that simulates elective and urgent surgery on the abdominal aorta. Fifteen mini-pigs divided into three groups were used. The animals were subjected to suprarenal aortic/iliac clamping and bypass with a Dacron-collagen prosthetic graft. Groups were as follows: (1) sham (only aortic dissection); (2) clamping and bypass; (3) hemorrhage of 40%, pre-clamping, and bypass. Determinations included (1) tumor necrosis factor-alpha (TNF-α) interleukin (IL)-1β, IL-6, IL-10, interferon-gamma; (2) myeloperoxidase (MPO), superoxide anion (SOA), superoxide dismutase (SOD), and malondialdehyde (MDA); (3) nitrites; (4) iNOS, (5) cell adhesion molecules (ICAM-1, VCAM-1) at 24 hours, 48 hours, and on day 7; and (6) NFκB at 48 hours. Our results point to an increase in all inflammatory variables, corroborated by their molecular regulators such as the expression of CAMs, iNOS, and NFκB. The alterations tended to normalize by day 7, after reperfusion. The results point to the great importance of SIR at all levels (molecular, nuclear, cellular, and systemic) in situations such as elective and urgent abdominal aorta surgery and the role that control of this response could represent for the future of vascular surgery.

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References

  1. Alkharfy KM, Kellum JA, Matzke GR. Unintended immunomodulation: Part I. Effect of common clinical conditions on cytokine biosynthesis. Shock 2000;13:333–345

    CAS  PubMed  Google Scholar 

  2. Sayers RD. Aortic aneurysms, inflammatory pathways and nitric oxide. Ann. R. Coll. Surg. Engl. 2002;84:239–246

    CAS  PubMed  Google Scholar 

  3. Alkharfy KM, Kellum JA, Matzke GR. Unintended immunomodulation: Part II. Effect of pharmacological agents on cytokine activity. Shock 2000;13:346–360

    CAS  PubMed  Google Scholar 

  4. Bown MJ, Nicholson ML, Bell R, et al. Cytokines and inflammatory pathways in the pathogenesis of multiple organ failure following abdominal aortic aneurysm repair. Eur. J. Vasc. Surg. 2001;22:485–495

    CAS  Google Scholar 

  5. Swartbol P, Truedsson L, Norgren L. The inflammatory response and its consequence for the clinical outcome following aortic aneurysm repair. Eur. J. Vasc. Endovasc. Surg. 2001;21:393–400

    Article  CAS  PubMed  Google Scholar 

  6. Zatelli A, Bonfanti U, Santilli R, et al. Echo-assisted percutaneous renal biopsy in dogs. A retrospective study of 229 cases. Vet. J. 2003;166:257–264

    Article  PubMed  Google Scholar 

  7. Lozano FS, Garcia-Criado FJ, Fresnadillo MJ, et al. Systemic inflammatory response induced by Dacron and modulation by antimicrobial agents: experimental study. J. Surg. Res. 2002;107:7–13

    CAS  PubMed  Google Scholar 

  8. Garcia-Criado FJ, Eleno N, Santos F, et al. Protective effect of exogenous nitric oxide on the renal function and inflammatory response in a model of ischemia-reperfusion. Transplantation 1998;66:982–990

    CAS  PubMed  Google Scholar 

  9. Ernst CB. Abdominal aortic aneurysm. N. Engl. J. Med. 1993;328:l167–1172

    Article  Google Scholar 

  10. Katz DJ, Stanley JC, Zelenock GB. Operative mortality rate for intact and ruptured abdominal aortic aneurisms in Michigan: an eleven year statewide experience. J. Vasc. Surg. 1994;19:804–815

    CAS  PubMed  Google Scholar 

  11. Swartbol P, Norgren L, Albrechtsson U, et al. Biological responses differ considerably between endovascular and conventional aortic aneurysms surgery. Eur. J. Vasc. Endovasc. Surg. 1996;12:18–25

    Article  CAS  PubMed  Google Scholar 

  12. Thompson MM, Nasim A, Sayers RD, et al. Oxygen free radical and cytokine generation during endovascular and conventional aneurysm repair. Eur. J. Vasc. Endovasc. Surg. 1996;12:70–75

    CAS  PubMed  Google Scholar 

  13. Galle D, De Maertelaer V, Motte S, et al. Early inflammatory response after elective abdominal aortic aneurysm repair: a comparison between endovascular procedures and conventional surgery. J. Vasc. Surg. 2000;32:234–246

    Article  CAS  PubMed  Google Scholar 

  14. Odergard A, Lundbom J, Myhre HO, et al. The inflammatory response following treatment of abdominal aortic aneurysms: a comparison between open surgery and endovascular repair. Eur. J. Vasc. Endovasc. Surg. 2000;19:536–544

    Google Scholar 

  15. Lau LL, Halliday MI, Smye MG, et al. Extraperitoneal approach reduces intestinal and renal dysfunction in elective abdominal aortic aneurysm repair. Int. Angiol. 2001;20:282–287

    CAS  PubMed  Google Scholar 

  16. Fiane AE, Videm V, Lingaas PS, et al. Mechanism of complement activation and its role in the inflammatory response after thoracoabdominal aortic aneurysm repair. Circulation 2003;108:849–856

    Article  CAS  PubMed  Google Scholar 

  17. Roumen RM, Hendriks T, van der Ven-Jongekrijg J, et al. Cytokine patterns in patients after major vascular surgery, hemorrhagic shock and severe blunt trauma. Relation with subsequent adult respiratory distress syndrome and multiple organ failure. Ann. Surg. 1993;218:769–776

    CAS  PubMed  Google Scholar 

  18. Froon AH, Greve JW, Van der Linden CJ, et al. Increased concentrations of cytokines and adhesion molecule patients after repair of abdominal aortic aneurysm. Eur. J. Surg. 1996;162:287–296

    CAS  PubMed  Google Scholar 

  19. Lindsay T, Lou X, Lehotay D, et al. Ruptured abdominal aortic aneurysm, a “two-hit” ischemia/reperfusion injury: evidence from an analysis of oxidative products. J. Vase. Surg. 1999;30:219–228

    CAS  Google Scholar 

  20. Adam D, Lee AJ, Bradbury AW, et al. Elevated levels of soluble tumor necrosis factor receptors are associated with increased mortality rates in patients who undergo operation for ruptured abdominal aortic aneurysm. J. Vasc. Surg. 2000;31:514–519

    Article  CAS  PubMed  Google Scholar 

  21. Lee WA, Hirneise CM, Tayyarah M, et al. Impact of endovascular repair on early outcomes of ruptured abdominal aortic aneurysms. J. Vasc. Surg. 2004;40:211–215

    Article  PubMed  Google Scholar 

  22. Barry MC, Kelly C, Burke P, et al. Immunological and physiological responses to aortic surgery: effect of reperfusion on neutrophil and monocyte activation and pulmonary function. Br. J. Surg. 1997;84:513–519

    Article  CAS  PubMed  Google Scholar 

  23. Barry MC, Wang JH, Nelly CJ, et al. Plasma factors augment neutrophil and endothelial cell activation during aortic surgery. Eur. J. Vasc. Endovasc. Surg. 1997;13:381–387

    CAS  PubMed  Google Scholar 

  24. Holmberg A, Bergqvist D, Westman B, et al. Cytokine and fibrinogen response in patients undergoing open abdominal aortic aneurysm surgery. Eur. J. Vasc. Surg. 1999;17:294–300

    CAS  Google Scholar 

  25. Holzheimer RG, Gross J, Schein M. Pro and anti-inflammatory cytokine response in abdominal aortic aneurysm repair: a clinical model of ischemia-reperfusion. Shock 1999;1:305–310

    Google Scholar 

  26. Adembri C, Kastamoniti E, Bertolozzi L, et al. Pulmonary injury follows systemic inflammatory reaction in infrarenal aortic surgery. Crit. Care Med. 2004;32:1170–1177

    PubMed  Google Scholar 

  27. Jedynak M, Siemiatkowski A, Gacho M, et al. Serum concentrations of MCP-1 and RANTES in patients due aortic surgery: the relationship with ischemia-reperfusion. Arch Immunol Ther. Exp. (Warsz) 2004;53:201–207

    Google Scholar 

  28. Paterson IS, Smith FC, Tsang GM, et al. Reperfusion plasma contains a neutrophil activator. Ann. Vasc. Surg. 1993;7:68–75

    Article  CAS  PubMed  Google Scholar 

  29. Tassiopoulos A, Carlin R, Gao Y, et al. Role of nitric oxide and tumor necrosis factor on lung injury caused by ischemia/reperfusion of the lower extremities. J. Vasc. Surg. 1997;26:647–656

    Article  CAS  PubMed  Google Scholar 

  30. Pararajasingam R, Weight SC, Bell PR, et al. Endogenous renal nitric oxide metabolism following experimental infrarenal aortic cross clamp induced ischemia reperfusion injury. Br. J. Surg. 1999;86:795–799

    Article  CAS  PubMed  Google Scholar 

  31. Pararajasingam R, Weight SC, Bell PR, et al. Pulmonary nitric oxide metabolism following infrarenal aortic cross-clamp-induced ischaemia-reperfusion injury. Eur. J. Vasc. Endovasc. Surg. 2000;19:47–51

    CAS  PubMed  Google Scholar 

  32. Sirham M, Moochhala SM, Kerwin SY, et al. Influence of selective nitric oxide synthetase inhibitor for treatment of refractory haemorrhagic shock. Resucitation 2004;61:221–229

    Google Scholar 

  33. Harkin DW, Rubin BB, Romaschin A, et al. Selective inducible nitric oxide synthase (iNOS) inhibition attenuates remote acute lung injury in a model of ruptured abdominal aortic aneurysm. J. Surg. Res. 2004;120:230–241

    Article  CAS  PubMed  Google Scholar 

  34. Albelda SM, Smith CW, Ward PA. Adhesion molecules and inflammatory injury. FASEB J. 1994;8:504–512

    CAS  PubMed  Google Scholar 

  35. Takada M, Nadeau KC, Shaw GD, et al. The cytokuine-adhesion molecule cascade in ischaemia/reperfusion injury of the rat kidney. Inhibition by soluble P-selectin ligand. J. Clin. Invest. 1997;99:2682–2690

    CAS  Google Scholar 

  36. Weight SC, Bell PRF, Nicholson ML. Renal ischaemia-reperfusion injury. Br. J. Surg. 1996;83:162–170

    Article  CAS  PubMed  Google Scholar 

  37. Foulds S, Galustian C, Mansfield AO, et al. Transcription factor NF kappa B expression and postsurgical organ dysfuncion. Ann. Surg. 2001;233:70–78

    CAS  PubMed  Google Scholar 

  38. Kanwar S, Kubes P. Nitric oxide is antiadhesive molecule for leukocytes. New Horiz. 1995;3:93–104

    CAS  PubMed  Google Scholar 

Download references

Acknowledgement

This work was supported by the Institute de Salud Carlos III. Grant FISS 00/1093 from the Ministerio de Sanidad, Spain. Marcello B. Barros was sponsored by the Carolina Foundation, Madrid, Spain

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Authors and Affiliations

  1. Service of Angiology and Vascular Surgery, University Hospital of Salamanca, Avda, Alfonso X elsabio s/n, E-37007, Salamanca, Spain

    Francisco S. Lozano M.D. Ph.D. & Marcello B. Barros M.D.

  2. Service of Anesthesiology, University Hospital of Salamanca, Avda. Alfonso X el Sabio s/n, E-37007, Salamanca, Spain

    José M. Rodriguez M.D., Ph.D. & Pilar S. Conde M.D. Ph.D.

  3. Experimental Surgery Unit, University Hospital of Salamanca, University of Salamanca, Campus Miguel de Unamuno, Avda. Alfonso X el Sabio s/n, E-37007, Salamanca, Spain

    Francisco S. Lozano M.D. Ph.D., Francisco J. Garcia-Criado M.D., Ph.D., Luis M. Gonzalez M.D., Manuel Rodriguez M.D. & Alberto Gomez-Alonso M.D. Ph.D.

  4. Carolina Foundation, Calle General Rodrigo 6,4a planta, Edificio Germania, E-28003, Madrid, Spain

    Marcello B. Barros M.D.

Authors
  1. Francisco S. Lozano M.D. Ph.D.
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  2. José M. Rodriguez M.D., Ph.D.
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  3. Francisco J. Garcia-Criado M.D., Ph.D.
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  6. Luis M. Gonzalez M.D.
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  8. Alberto Gomez-Alonso M.D. Ph.D.
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Correspondence to Francisco S. Lozano M.D. Ph.D..

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Lozano, F.S., Rodriguez, J.M., Garcia-Criado, F.J. et al. Postoperative Evolution of Inflammatory Response in a Model of Suprarenal Aortic Cross-clamping with and without Hemorrhagic Shock. Systemic and Local Reactions. World J. Surg. 29, 1248–1258 (2005). https://doi.org/10.1007/s00268-005-7877-y

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  • DOI: https://doi.org/10.1007/s00268-005-7877-y

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