Influence of open surgical and endovascular abdominal aortic aneurysm repair on clot quality assessed by ROTEM® test
Introduction/Aim. The disturbances in hemostasis are often in open surgical repair (OR) and endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA). These changes may influence the perioperative and early postoperative period inducing serious complications. The aim of this study wa...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Military Health Department, Ministry of Defance, Serbia
2016-01-01
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| Series: | Vojnosanitetski Pregled |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2016/0042-84501500123S.pdf |
| Summary: | Introduction/Aim. The disturbances in hemostasis are often in open surgical
repair (OR) and endovascular repair (EVAR) of an abdominal aortic aneurysm
(AAA). These changes may influence the perioperative and early postoperative
period inducing serious complications. The aim of this study was to compare
the impact of OR and EVAR of AAA on clot quality assessed by rotational
thromboelastometry (ROTEM®) tests. Methods. The study included 40 patients
who underwent elective AAA surgery and were devided into two groups (the OR
and the EVAR group - 20 patients in each group). The ROTEM ® test was
performed in 4 points: point 1 - 10 min before starting anesthesia in both
groups; point 2 - 10 min after aortic clapming in the OR group and 10 min
after the stent-graft trunk release in the EVAR group; point 3 - 10 min after
the releasing of aortic clamp in the OR group and 10 min after stentgraft
placement and releasing the femoral clamp in the EVAR group; point 4 - one
hour after the procedure in both groups. Three ROTEM® tests were performed
as: extrinsically activated assay with tissue factor (EXTEM), intrinsically
activated test using kaolin (INTEM), and extrinsically activated test with
tissue factor and the platelet inhibitor cytochalasin D (FIBTEM). All tests
included the assessment of the maximum clot firmness (MCF) and the platelet
component of clot strength was presented as maximal clot elasticity (MCE).
Results. No significant difference in age, gender and diameter of AAA between
groups was found. The time required for the procedure was significantly
longer and loss of blood was greater in the OR group than in the EVAR group
(p < 0.001). The significant deviation of MCF values in EXTEM test was found
mainly in the point 3 (p ≤ 0.004) with significant difference between groups
(p < 0.001). A significant difference of MCF values in INTEM test between
groups was found in the points 3 and 4 (p < 0.001), which were dose-dependent
by heparin sulfate. The MCF values in FIBTEM test were more prominent in the
OR group than in the EVAR group without significant difference. The
significant changes of MCF values in the FIBTEM test were found during time
in both groups (p < 0.001). The values of MCE were lower in both groups, but
without significant changes and difference between groups (p = 0.105).
Conclusion. The disorders of hemostatic parameters assessed by ROTEM® tests
are present in both the OR and the EVAR groups being more prominent in OR of
AAA. Vigilant monitoring of hemostatic parameters evaluated by ROTEM® tests
could help in administration of the adequate and target therapy in patients
who underwent EVAR or OR of AAA. |
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| ISSN: | 0042-8450 2406-0720 |