Systemic endotoxaemia and fibrinolysis during aortic surgery.

Abstract

To determine whether endotoxaemia and activation of the systemic fibrinolytic system occurs during and after aortic surgery. Prospective clinical study. University Hospital. 31 patients undergoing aortic surgery. 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. 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). Endotoxaemia does occur during aortic surgery and appears to be associated with activation of the systemic fibrinolytic system.