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

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-alpha) interleukin (IL)-1beta, 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) NFkappaB 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 NFkappaB. 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.

Endothelium injury and inflammatory state during abdominal aortic aneurysm surgery: scrutinizing the very early and minute injurious effects using endothelial markers – a pilot study

“…Abdominal aortic aneurysm surgery induces a systemic inflammatory response (SIR) [9, 10]. Inflammatory status along with toxic metabolic waste products inflow to the vena cava inferior from ischemic lower extremities as well as oxidative stress associated with surgical trauma might contribute to AKI development following AAA surgery.…”

“…The peak expression of sP-selectin during acute coronary syndromes only has a 2-hour delay in relation to its peak expression on platelets [25–27]. But another experiment has shown that, following aorta surgery, serum levels of sVCAM-1 and sICAM-1 might remain unchanged despite a significant increase of their tissue counterparts in kidneys [9]. This indicates that the relationship between membrane-bound and soluble forms might be quite complex.…”

“…Abdominal aortic aneurysm surgery is regarded as a trigger of potent inflammatory responses [9, 10]. …”

“…Pathological processes occurring in the endothelium of intrarenal blood vessels are important constituents of AKI pathogenesis [12]. Von Willebrand factor (vWF) and cell adhesion molecules (CAMs), i.e., intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin and P-selectin, are important indicators of endothelial cell (EC) function and injury [9, 13–15]. …”

Respuesta inflamatoria y cirugía protésica. Su control con donadores de óxido nítrico

“…En la actualidad se han descrito más de 20; detallaremos a continuación las más importantes relacionadas con el proceso inflamatorio en la reperfusión (182,259,264,184,40,132) .…”