Cardiovascular and Catecholamine Responses During Endovascular and Conventional Abdominal Aortic Aneurysm Repair

Objectives: To compare changes in plasma catecholamines, acid-base status and cardiovascular dynamics in patients undergoing endovascular or conventional infrarenal abdominal aortic aneurysm (AAA) repair under standard general anaesthesia.

Design: Prospective cohort study.

Materials: 30 patients scheduled for elective infrarenal AAA repair.

Methods: Plasma epinephrine and norepinephrine concentrations, acid-base status and cardiovascular measurement were compared before surgery, and 5 min after aortic clamping and clamp release (conventional group) or occlusion and release (endovascular group) in patients undergoing endovascular (n = 15) or conventional AAA repair (n = 15).

Results: Arterial pH (p < 0.005) and base deficit (p < 0.05) increased, and plasma bicarbonate decreased (p < 0.005) during aortic cross-clamping in the conventional group. pH decreased further (p < 0.005), and base deficit and pCO2 increased (both p < 0.005) after clamp release. These changes were significantly greater than during endovascular repair, in whom within-group changes were not statistically significant. Values were similar in the two groups 30 min after reperfusion. Plasma epinephrine concentrations increased during conventional surgery (p < 0.05) and were greater than in the endovascular group (p < 0.05). Plasma norepinephrine concentrations increased during surgery in both groups but the changes were not statistically significant.

Conclusions: Plasma catecholamine concentrations, changes in cardiovascular variables and acid-base status were increased during conventional compared with endovascular AAA repair.