Cytokine and fibrinogen response in patients undergoing open abdominal aortic aneurysm surgery

Objectives: to assess whether open abdominal aortic aneurysm (AAA) surgery influences cytokines and fibrinogen. Methods: twenty-three consecutive patients operated on for AAA were compared to 11 operated controls and 20 age-matched controls. Cubital blood ions sampled pre-, intra- and postoperatively and femoral blood also sampled intraoperatively. Results: preoperatively, interleukin (Il)-6 was elevated in AAA patients. During aortic clamping, Il-6, Il-10 and monocyte chemoattractant protein-1 (MCP-1) increased significantly (p<0.001, p<0.01 and p<0.05 respectively) while soluble interleukin-2 receptor (sIl-2R) and fibrinogen decreased significantly (p<0.001 for both). After aortic declamping, Il-6, Il-10 and MCP-1. had further significant increases compared with levels during aortic clamping while sIl-2R had a further non-significant and fibrinogen a significant decrease (p<0.05 in cubital and p<0.001 in femoral blood). One week postoperatively Il-6, IL-10 and MCP-1 had all decreased but were still significantly elevated compared with baseline values while sIl-2R and fibrinogen showed an increase in comparison with baseline (p<0.001 for both). Intraoperative levels of Il-6 and Il-10 showed It significant co-variation with the magnitude of operative trauma. Conclusions: these data indicate that open AAA surgery induces a profound inflammatory and coagulative response which persists at one week postoperatively.