Measurement of Free Radicals Using Electron Paramagnetic Resonance Spectroscopy During Open Aorto-Iliac Arterial Reconstruction

Abstract

BackgroundAortic cross-clamping during abdominal aortic aneurysm (AAA) open repair leads to development of ischemia-reperfusion injury. Electron paramagnetic resonance spectroscopy (EPR) spin-trapping is a valuable method of direct measurement of free radicals.The objective of the study was to evaluate the results of EPR as a direct method of free radical measurement and degree of inflammatory response in open operative treatment of patients with AAA and aorto-iliac occlusive disease (AIOD).Material/MethodsThe study was performed on a group of 32 patients with AAA and 25 patients with AIOD scheduled for open repair. Peripheral venous blood for EPR spectroscopy and for SOD, GPx, ox-LDL, Il-6, TNF-alfa, CRP, and HO-1 were harvested. Selected parameters were established accordingly to specified EPR and immunohistochemical methods and analyzed between groups by Mann-Whitney U test and Wilcoxon matched-pairs signed-ranks test with Bonferroni correction.ResultsFree radicals level was correlated with the time of the aortic cross-clamping after the reperfusion of he first and second leg in AAA (r=0.7; r=0.47). ox-LDL in AAA decreased 5 min after reperfusion of the first leg (32.99 U/L, range: 14.09–77.12) and 5 min after reperfusion of the second leg (26.75 U/L, range: 11.56–82.12) and 24 h after the operation (25.85 U/L, range: 14.29–49.70). HO-1concentration increased to above the level before intervention 24 h after surgery. The activities of GPx and SOD decreased 5 min after the first-leg reperfusion in AAA. Twenty-four hours after surgery, inflammatory markers increased in AAA to CRP was 14.76 ml/l (0.23–38.55), IL-6 was 141.22 pg/ml (84.3–591.03), TNF-alfa was 6.82 pg/ml (1.76–80.01) and AIOD: CRP was 18.44 mg/l (2.56–33.14), IL-6: 184.1 pg/ml (128.46–448.03), TNF-alfa was 7.74 pg/ml (1.74–74.74).ConclusionsEPR spin-trapping demonstrates temporarily elevated level of free radicals in early phase of reperfusion, leading to decrease antioxidants in AAA. Elevated free radical levels decreased 24 h after surgery due to various endogenous antioxidants and therapies.

Advanced Oxidation Protein Products and Carbonylated Proteins Levels in Endovascular and Open Repair of an Abdominal Aortic Aneurysm: The Effect of Pre-, Intra-, and Postoperative Treatment

“…Literature data shows that surgery exerts its influence on plasma prooxidant-antioxidant balance in AAA patients [21, 22]. An inflammatory response as well as an intensified generation of FR results from the reperfusion of ischemic tissue due to cross-clamping of the aorta following OR [16, 17]. In contrast, in EVAR patients, another research demonstrated lower production of FR and ROS due to lack of intra-abdominal manipulation and a relatively brief period of aortic occlusion [21, 23].…”

“…Furthermore, based on the study of Majewski and coworkers, who suggested that MDA is a final product of lipid peroxidation derived from polyunsaturated fatty acids and that oxidized low density lipoproteins (ox-LDL) are probably formed earlier, the kinetics of oxidative modification of proteins seem to be worth similar consideration [17]. Therefore, we may suggest that different types of oxidatively modified proteins are formed in different stages of oxidative stress.…”

“…Aivatidi and coworkers noticed that almost all oxidative stress parameters returned to their normal values within 24 hours [18]. Majewski and coworkers demonstrated that FR levels, measured by electron paramagnetic resonance spectroscopy spin-trapping at the beginning of reperfusion, decreased 24 hours after AAA surgery due to various endogenous antioxidants and antioxidant therapies [17]. On the other hand, Lindsay and coworkers demonstrated a significantly elevated F 2 -isoprostane level through the perioperative period and further significant increases on the third and fifth day after surgery in patients with raptured AAA [30].…”

“…It is well documented that the reperfusion of ischemic tissue due to cross-clamping of the aorta following AAA surgery generates free radicals (FR) and ROS and, therefore, intensifies oxidative stress [15–17]. In contrast, no cross-clamping as well as a relatively brief period of aortic occlusion during EVAR surgery is associated with a lower induction of oxidative stress [17, 18].…”

“…It is well documented that the reperfusion of ischemic tissue due to cross-clamping of the aorta following AAA surgery generates free radicals (FR) and ROS and, therefore, intensifies oxidative stress [15–17]. In contrast, no cross-clamping as well as a relatively brief period of aortic occlusion during EVAR surgery is associated with a lower induction of oxidative stress [17, 18]. Some studies have indicated that preoperative oxidative stress markers' levels, such as malondialdehyde (MDA), the most frequently analyzed product of oxidative modifications of lipids, are higher in EVAR patients, as compared to OR patients [8, 19].…”