Rowlands Timothy E, Homer-Vanniasinkam Shervanthi
Vascular Surgical Unit, The General Infirmary at Leeds, Great George Street, Leeds, United Kingdom.
Vasc Endovascular Surg. 2007 Feb-Mar;41(1):48-54. doi: 10.1177/1538574406294070.
Endovascular repair of abdominal aortic aneurysm potentially avoids problems associated with prolonged aortic cross-clamping that occurs with open repair, but it appears to have its own biologic consequences, which may relate to neutrophil elastase release. Blood samples of consecutive patients undergoing open or endovascular abdominal aneurysm repair were analyzed for neutrophil elastase/alpha(1)-antitrypsin complex and free elastase. Free elastase rose from baseline and fell quickly in open repair patients, returning to baseline by 144 hours. In the endovascular repair group, it continued to increase for up to 144 hours. Bound elastase increased to 24 hours, returning to baseline in endovascular repair patients by 72 hours, but remaining elevated in open repair patients at 144 hours. Open repair patients showed raised elastase/alpha(1)-antitrypsin complex and initial raised free elastase levels. High free elastase levels in endovascular repair patients may reflect less bound elastase and may paradoxically lead to a prolonged inflammatory postoperative response.
腹主动脉瘤的血管内修复术有可能避免与开放修复术中长时间主动脉交叉钳夹相关的问题，但它似乎有其自身的生物学后果，这可能与中性粒细胞弹性蛋白酶的释放有关。对接受开放或血管内腹主动脉瘤修复术的连续患者的血样进行中性粒细胞弹性蛋白酶/α1-抗胰蛋白酶复合物和游离弹性蛋白酶分析。游离弹性蛋白酶在开放修复患者中从基线上升并迅速下降，在144小时时恢复到基线。在血管内修复组中，它持续增加长达144小时。结合弹性蛋白酶增加至24小时，血管内修复患者在72小时时恢复到基线，但开放修复患者在144小时时仍保持升高。开放修复患者显示弹性蛋白酶/α1-抗胰蛋白酶复合物升高且初始游离弹性蛋白酶水平升高。血管内修复患者中高游离弹性蛋白酶水平可能反映结合弹性蛋白酶较少，并且可能反常地导致术后炎症反应延长。
