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Project Nr 16 Tissue factor, tissue factor pathway inhibitor, and thrombin-antithrombin complexes in patients with abdominal aortic aneurysm undergoing.

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Presentation on theme: "Project Nr 16 Tissue factor, tissue factor pathway inhibitor, and thrombin-antithrombin complexes in patients with abdominal aortic aneurysm undergoing."— Presentation transcript:

1 Project Nr 16 Tissue factor, tissue factor pathway inhibitor, and thrombin-antithrombin complexes in patients with abdominal aortic aneurysm undergoing endovascular and open repair. Kotschy M. 1, Witkiewicz W. 1,2, Grendziak R. 2, Zapotoczny N. 2, Dubis J. 1, Żuk N. 1, Pfanhauser M. 2, Kotschy D. 3 1 Regional Specialized Hospital in Wrocław, Research & Development Centre Departments: 2 of Vascular Surgery, 3 of Angiology

2 The aim of the study was to determine the concentrations of TF, TFPI, VEGF-A and TAT complexes in blood plasma of patients with abdominal aortic aneurysm undergoing endovascular aortic repair (EVAR) and open aortic repair (OAR)

3 Background Source:

4 EndoVascular Aortic Repair Source:

5 Open Aortic Repair Source:

6 The presence of tissue factor (TF), tissue factor pathway inhibitor (TFPI), vascular endothelial growth factor-A (VAEGF-A) in patients with damaged aortic wall, with thrombin-antithrombin complexes (TAT) indicating thrombin-generation and appearance of intraluminal thrombin in aortic aneurysm suggests that haemostatic processes can enhance proteolysis of aortic wall.

7 Haemostatic factors: TF, TFPI TAT complex

8 HaemostasisVEGF

9 VEGF - A as angiogenic factor Source:

10 Materials and methods The studies enrolled 42 patients (38 males and females) in mean age 71 (range 59-86) years in whom presurgery ultrasound and computer tomography revealed presence of abdominal aortic aneurysm (AAA). Blood was drawn 3 times: before, directly after surgery and 24 hours after EVAR and OAR. The concentrations of TF, TFPI, VEGF-A and TAT complexes was measured in plasma using enzyme immuno-assay with commercial tests.

11 Kind of repairEVAR n (n = 26 %) OAR n (n=16%) Genger male/ female 24/2 92,3/7,714/2 87,5 / 12,5 Age (years) mean-range 68 (59-83)75 (64-86) Coronary heart diseases Previous Myocardial Infarction Cerebrovascular disease ,5 Preipheral vascular diseases 2 60 Hypertension ,5 Pulmonary diseases ,25 Renal, prostate diseases Diabetes mellutis3 9,31 6,25 Smoking20 62, Aneurysm diameter cm range 5,4 3,5-7,7 8,1 4,5-10,0 Tab. 1 Some demographic data of examined patients with AAA

12 Fig.1

13 Examined parameters Controls n = 50 M; SD (range) Me, Q1, Q3 Patients with AAA n = 42 M; SD (range) Me, Q1, Q3 p-value TF pg/ml 133+/- 79 (18-290) 230 +/- 139 (81-912) 0,03 TFPI ng/ml 84+/- 19 (52-124) 90+/-23 (51-174) NS VEGF-A pg/ml 24+/- 14 (8-44) 34+/-23 (14-144) NS TAT complex ng/ml 2,2+/-3,5 (0,5 – 4,9) Me; Q1, Q3 1,4; 0,7; 2,2 7,6+/-8,2 (1,1 - 33) Me; Q1, Q3 5,24;2,7;8,8 0,0003 Tab. 2 Haemostatic factors in plasma of patients with AAA and in controls

14 Examined parameters EVAR n=26 2 Preoperative M; SD 3 End of surgery M; SD 4 24 h postoperative M; SD p-value TF pg/ml 229+/- 162 (98-912) 131+/-89 (60-443) 203+/-112 (70-483) 2/3 0,0001 3/4 0,01 TFPI ng/ml 101+/-18 (66-134) 114+/-29 (65-169) 125+/-30 (77-194) 2/3 0,006 VEGF pg/ml 25+/-9 (13-42) 21+/-12 (6-43) 33+/-16 (14-62 NS TAT complexes ng/ml 9,9+/-9,8 Me, Q1, Q3 7,8 2,9 12,9 37,9+/-21,6 Me, Q1, Q3 31,6 25,6 52,0 18,9+/-31,6 Me, Q1, Q3 9,9 5,9 13,6 2/3 0,0003 3/4 0,034 Tab. 3 Haemostatic factors during endovascular aortic repair

15 1 – control 2 – preoperative 3 – immediatelly postoperative 4 – postoperative (24 h) EVAR - endovascular aortic repair Concentration of TF in Medians during EVAR Fig. 2

16 Tab. 4 Haemostatic factors during open aortic repair (OAR) Examined parameters OAR n=16 2 Preoperative M; SD 3 End of surgery M; SD 4 24 h postoperative M; SD p-value TF pg/ml 223+/- 96 (75-397) 161+/-88 (53-390) 218+/-75 ( ) 2/3, 3/4 <0,02 TFPI ng/ml 88+/-24 (51-137) 97+/-38 (63-174) 87+/-23 (62-122) SN VEGF pg/ml 38+/-19 (13-61) 36+/-30 (7-118) 50+/-21 (8-84) SN TAT complexes ng/ml 4,7+/-3,7 (0,7 – 14,1) Me, Q1, Q3 4,3 1,6 14,1 34,5+/-27,2 (6,5 – 90,2) Me, Q1, Q3 24,9 11,2 50,4 51,3+/-42,2 (6,4 – 104,8) Me, Q1, Q3 62 8,2 70,5 2/3 0,0053 3/4 0,000005

17 TAT complexes in Medians and Quartiles 1 – control 2 – preoperative 3 – immediatelly postoperative 4 – postoperative (24 h) Fig. 3

18 TAT complexes during OAR The relation of its preoperative concentration 1 – control 2 – preoperative 3 – immediatelly postoperative 4 – postoperative (24 h) Fig. 4

19 Conclusions: 1.Significantly higher [TF] & [TAT] in AAA patients than in controls. 2.EVAR & OAR activates thrombin-generation in AAA patients 3.The degree of clotting activation after aortic aneurysm repair depends on preoperative clotting status of patients with AAA.

20 References: 1.Yamazumi K., Ojro M., Okumura H., Aikon T. An activated state of blood coagulation and fibrynolysis in patients withb abdominal aortic aneurysm. Am. J. Surg. 1998; 775: Hobbs S.D., Haggart P., Fegan Ch., Bradburry A.W., Adam D.J. The role of tissue factor in patients undergoing open repair of raptured and nonraptured abdominal aortic aneurysm. J. Vasc. Surg. 2007; 46:


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