Abdominal Aortic Aneurysm
Conditions
Keywords
abdominal aortic aneurysm, NETosis, thrombosis
Brief summary
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
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.
Interventions
None listed
Sponsors
University Hospital, Bordeaux
Study design
Observational model
CASE_ONLY
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| thrombotic events | first 7 postoperative days after AAA surgery | Incidence of thrombotic events |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| hemoglobin | baseline | hemoglobin (g/dL), |
| platelets | baseline | platelets (G/L), |
| prothrombin time ratio | baseline | prothrombin time ratio (%), |
| INR | baseline | INR |
| aPTT ratio | baseline | aPTT ratio |
| fibrinogen | baseline | fibrinogen (g/L), |
| CRP | baseline | CRP (ng/mL), |
| interleukin-6 | baseline | interleukin-6 (pg/mL), |
| thrombin generation test | baseline | thrombin generation test (lag time (min), |
| peak | baseline | peak (nM), |
| time to peak | baseline | time to peak (min), |
| ETP | baseline | ETP (nM.min), |
| velocity index | baseline | velocity index |
| white blood cells | baseline | white blood cells (G/L), |
| soluble P-selectin | baseline | soluble P-selectin (ng/mL), |
| MPO-AND | baseline | MPO-AND (% standard) |
| atherosclerosis | baseline | % of patients with preoperative atherosclerosis (number) |
| Aspirin treatment | baseline | % of patients with preoperative treatment by Aspirin (number) |
| clamping duration | baseline | clamping duration (min), |
| bleeding | baseline | bleeding (min), |
| vascular filling | baseline | vascular filling (ml), |
| tranexamic acid administration | baseline | tranexamic acid administration (g), |
| transfusion | baseline | transfusion (pack of red blood cells, plasma volume (ml), |
| amount of fibrinogen | baseline | amount of fibrinogen (g), |
| amount of heparin | baseline | amount of heparin (UI) |
| Type of postoperative anticoagulation | baseline | Type of postoperative anticoagulation: % of patients with unfractionated heparin or low-molecular-weight heparin |
| Administration way of postoperative anticoagulation | Baseline | Administration way of postoperative anticoagulation: % of administration intra-venous or subcutaneously |
| von Willebrand factor | baseline | von Willebrand factor (%), |
Countries
France
Outcome results
None listed