OBJECTIVE: To determine whether endotoxaemia and activation of the systemic fibrinolytic system occurs during and after aortic surgery. DESIGN: Prospective clinical study. SETTING: University Hospital. MATERIALS: 31 patients undergoing aortic surgery. CHIEF OUTCOME MEASURES: Venous blood assay for endotoxin and plasminogen activator inhibitor-1 (PAI-1). Samples were obtained preoperatively, immediately before and 5 minutes after cross-clamp application and removal, and at 2, 4, 6 and 24 hours postoperatively. Tonometric sigmoid intramural pH was monitored throughout this period as a means of detecting colonic mucosal ischaemia. MAIN RESULTS: Endotoxin levels increased after clamping of the aorta, peaking immediately before clamp removal, mean value 34.5 pg/ml, p < 0.01, but returning to preoperative levels by 24 hours. PAI-1 levels progressively increased after surgery, with persistently high levels remaining at 24 hours (p < 0.01). CONCLUSIONS: Endotoxaemia does occur during aortic surgery and appears to be associated with activation of the systemic fibrinolytic system.
OBJECTIVE: To determine whether endotoxaemia and activation of the systemic fibrinolytic system occurs during and after aortic surgery. DESIGN: Prospective clinical study. SETTING: University Hospital. MATERIALS: 31 patients undergoing aortic surgery. CHIEF OUTCOME MEASURES: Venous blood assay for endotoxin and plasminogen activator inhibitor-1 (PAI-1). Samples were obtained preoperatively, immediately before and 5 minutes after cross-clamp application and removal, and at 2, 4, 6 and 24 hours postoperatively. Tonometric sigmoid intramural pH was monitored throughout this period as a means of detecting colonic mucosal ischaemia. MAIN RESULTS: Endotoxin levels increased after clamping of the aorta, peaking immediately before clamp removal, mean value 34.5 pg/ml, p < 0.01, but returning to preoperative levels by 24 hours. PAI-1 levels progressively increased after surgery, with persistently high levels remaining at 24 hours (p < 0.01). CONCLUSIONS: Endotoxaemia does occur during aortic surgery and appears to be associated with activation of the systemic fibrinolytic system.