The short and medium term effects of Endovascular Aneurysm Repair (EVAR) on coagulation, fibrinolysis and renal function in patients with Abdominal Aortic Aneurysms

Abdelhamid, Mohamed Farouk Aly (2017). The short and medium term effects of Endovascular Aneurysm Repair (EVAR) on coagulation, fibrinolysis and renal function in patients with Abdominal Aortic Aneurysms. University of Birmingham. M.D.

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Abstract

Background:

Previous reports described activation of the haemostatic mechanism in patients with abdominal aortic aneurysm (AAA). Both open and endovascular repair of AAA affect the haemostatic markers. Cystatin C is sensitive endogenous marker of renal function that is strongly associated with cardiovascular outcomes.

Aim:

To establish the medium-term effects of endovascular and open aneurysm repair on coagulation, fibrinolysis and renal function.

Patients and Methods:

Twenty-nine patients completed twelve months follow-up after EVAR, eleven patients were recruited after they had open aneurysm repair and eight age-matched control were recruited. Patients were tested for markers of coagulation, fibrinolysis and renal function pre-operatively and at 1, 6 and 12 months post-operatively.

Results:

Pre-operatively, PF1+2 levels were significantly higher in patients with AAA. PF1+2 levels post-EVAR and post-OAR were significantly lower than pre-operative values and similar to AMC. There was no significant difference in TAT, PAI, or t-PA between AMC, AAA preoperatively, and post-EVAR. Post-OAR, PAI activity was significantly higher than pre-operatively.
24 hours after procedure, a significant increase in Cystatin C and serum creatinine (sCr) and significant decrease in eGFR were seen. Cystatin C increased significantly at 1, 6 and 12 months.

Conclusion:

AAA is associated with increased thrombin generation without up-regulation of fibrinolysis. The pro-thrombotic, hypo-fibrinolytic diathesis returns toward normal in the medium term after EVAR and OAR.
EVAR is associated with a significant increase in Cystatin C 24 hours after the procedure and is maintained for 12 months. sCr and eGFR show significant change at 24 hours.

Type of Work:

Thesis (Higher Doctorates > M.D.)

Award Type:

Higher Doctorates > M.D.

Supervisor(s):