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Perioperative assessment of changes in tissue factor and its inhibitor in patients with abdominal aortic aneurysm treated using classical and intravascular methods

Norbert Zapotoczny, Maria Kotschy, Ryszard Grendziak, Natalia Zuk, Joanna Dubis and Wojciech Witkiewicz

Objectives: We examined plasma concentrations of essential regulators of coagulation cascade, tissue factor (TF) and tissue factor inhibitor pathway (TFPI) in patients with abdominal aortic aneurysm (AAA) during two types of surgical repair , open (OAR) and endovascular repair (EVAR). Background: The interplay between TF and TFPI is important for the proper functioning of coagulation cascade. Although abnormal coagulation is known to contribute to the formation of AAA, little is known about the prognostic value of TF and TFPI levels in the perioperative stage of AAA repair. Methods: We have selected the reference group of 53 healthy, first-time blood donors and 66 patients scheduled for AAA repair using EVAR or OAR and measured TF and TFPI in their blood plasma using ELISA (enzyme-linked immunosorbent assay) before surgery, immediately after and 24 hours after surgery. Results: Patients with AAA had elevated levels of TF (219.242 pg/ml) compared to the reference group (149.170 pg/ml). TF levels were higher in AAA patients with limb ischemia (p=0.0026) and mural thrombi >30 mm (p=0.0015) but decreased in patient with BMI >25 (p=0.027). No differences were observed in TF and TFPI levels during EVAR and OAR or de-pending on the stent graft type. However, there was a correlation between the TF level and occurrence of post-surgical complications in OAR type of surgery Conclusions: Our results suggest that monitoring levels of TF and TFPI in perioperative period would be useful in risk assessment of surgery complications, especially in AAA patients with ischemic disorders undergoing OAR surgery.