Comparison of open transabdominal AAA repair with endovascular AAA repair in reduction of postoperative stress response

Abstract

Operative intervention causes a necessary biologic response known as the hypermetabolic stress response. Less invasive operative procedures may cause fewer metabolic and endocrine derangements. To evaluate the metabolic and endocrine differences between endovascular and transperitoneal abdominal aortic aneurysm (AAA) repair, 10 patients underwent standard open repair (open group) and 10 patients underwent endovascular repair of AAA (endovascular group) with a modular bifurcated endograft. Blood samples were obtained prior to general anesthesia (baseline) and every 6 hr for a 24-hr period. Assays for hormones related to the postoperative stress response as well as retinol-binding protein were performed. Peak hormonal values are presented in relation to the baseline. Demographic analysis of the two groups showed that there were no significant differences in age or ASA classification. The open group had a 9.6-fold increase in epinephrine release, which was significantly higher than the 1.6-fold increase in the endovascular group (P < 0.05). Elevations in cortisol were also significantly higher in the open group. Early postoperative nutritional derangements, as reflected by the levels of retinol-binding protein, were far less in the endovascular group than in the open group. Endovascular AAA repair appears to be associated with a marked reduction in the hypermetabolic stress response and nutritional deterioration, compared to traditional open repair. This reduction in physiologic stress may have salutary effects on the incidence of postoperative medical morbidity.