University Hospital Birmingham NHS Foundation Trust, Department of Vascular Surgery Heart of England NHS Foundation Trust, Netherwood House, Birmingham B91 2JL, United Kingdom.
J Vasc Surg. 2011 Sep;54(3):865-78. doi: 10.1016/j.jvs.2011.04.010.
Endovascular aneurysm repair (EVAR) is associated with an improved perioperative mortality compared to open surgical repair. This benefit may reflect reduced incidence of microvascular and macrovascular thrombotic complications after EVAR.
The purpose of this study was to review and compare the effects of abdominal aortic aneurysm (AAA), open surgical repair, and EVAR on coagulation, fibrinolysis, and platelet activation.
A MEDLINE (1966-2010) and Cochrane library search for articles relating to the effects of AAA, open surgical repair, and EVAR on hemostasis was performed utilizing and cross-linking terms such as clotting, fibrinolysis, AAA, EVAR, and open surgical repair. Studies with a small cohort of patients (less than 7) or in which values of assessed biomarkers were not included were rejected.
AAA is associated with increased thrombin generation, activity, and fibrin turnover as evidenced by increased plasma levels of thrombin-antithrombin III-complex (TAT), activated protein C-protein C inhibitor (APC-PCI), fibrin-monomer-fibrinogen (FM-F), F1+2, fibrinogen, and D-dimer. The extent of hemostatic derangement correlates with the volume of intraluminal thrombus. This procoagulant state is exaggerated in the immediate perioperative period after both open surgical repair and EVAR, but is attenuated at medium-term follow-up although not normalized.
The resultant prothrombotic diathesis after open surgical repair and EVAR may account for the high level of perioperative thrombotic complications.
与开放手术修复相比，血管内动脉瘤修复（EVAR）与围手术期死亡率降低相关。这种益处可能反映了 EVAR 后微血管和大血管血栓形成并发症发生率的降低。
本研究旨在回顾和比较腹主动脉瘤（AAA）、开放手术修复和 EVAR 对凝血、纤溶和血小板激活的影响。
使用和交叉链接诸如凝血、纤溶、AAA、EVAR 和开放手术修复等术语，对涉及 AAA、开放手术修复和 EVAR 对止血影响的 MEDLINE（1966-2010 年）和 Cochrane 图书馆文献进行了检索。拒绝了具有小患者队列（少于 7 个）或未包含评估生物标志物值的研究。
AAA 与凝血酶生成、活性和纤维蛋白周转增加相关，这表现为血浆中凝血酶-抗凝血酶 III 复合物（TAT）、活化蛋白 C-蛋白 C 抑制剂（APC-PCI）、纤维蛋白单体-纤维蛋白原（FM-F）、F1+2、纤维蛋白原和 D-二聚体水平增加。止血失调的程度与管腔内血栓的体积相关。这种促凝状态在开放手术修复和 EVAR 后的即刻围手术期被夸大，但在中期随访时被减弱，尽管没有恢复正常。
开放手术修复和 EVAR 后的促血栓形成倾向可能解释了围手术期血栓形成并发症的高发生率。
