Contribution to the study of malondialdehyde (MDA) as indicator of oxidative stress variation during infarenal abdominal aortic aneurysm open repair

Objective: Ischaemia – reperfusion injury through the activation of inflammatory pathways contributes to mortality and morbidity of Αbdominal Aortic Aneurysm (AAA). The aim of this study was to measure the grade and time-course of oxidative stress in AAA repair and to investigate any potential relationship with intra- or perioperative events (aortic clamping time, blood loss, and need for Intensive Care Unit (ICU) transfer)Methods: Blood samples were taken from 53 patients undergoing AAA open repair before induction of anesthesia, at 15, 30, 60, 120 min after aortic clamping, at 15 min and 60 min after clamp removal, and 24 h postoperatively. Malondialdehyde (MDA) levels were measured by a spectrophotometric method. Results: A positive correlation was found between MDA preoperative levels and the size of aneurysms (Pearson correlation= 0.578, P<0.001). No difference was observed in the MDA level between ruptured and non-ruptured aneurysms. However, considering all symptomatic patients (n=18), there was a significant elevation in the MDA levels (P<0.001) There was also a statistical significant increase in MDA values in patients transferred into the ICU and a positive correlation of aortic clamping time and MDA values at 15 and 60 min after declamping (Pearson correlation= 0,323 and 0,467 respectively, P<0.001), but not after 24 hours. Conclusions: There is a high-grade oxidative stress during AAA repair. MDA levels may identify the time intervals where the oxidative stress reach its peak and potentially predict which patients might develop systemic complications.Σκοπός: Η ιστική ισχαιμία και η επαναιμάτωση κατά τη διάρκεια της χειρουργικής αποκατάστασης των ανευρυσμάτων της κοιλιακής αορτής (ΑΚΑ) συμμετέχουν στην ενεργοποίηση των φλεγμονωδών μηχανισμών που συμβάλλουν στη μετεγχειρητική νοσηρότητα και θνησιμότητα της νόσου. Σκοπός της μελέτης ήταν η μέτρηση του βαθμού και της διάρκειας του οξειδωτικού stress κατά την αποκατάσταση των ανευρυσμάτων της κοιλιακής αορτής και η διερεύνηση της πιθανής συσχέτισης με διε- ή περιεγχειρητικά γεγονότα (χρόνος αορτικού αποκλεισμού, απώλεια αίματος, ανάγκη για μεταφορά σε Μονάδα Εντατικής Θεραπείας - ΜΕΘ).Υλικά και Μέθοδοι: Δείγματα αίματος λήφθηκαν από 53 ασθενείς που υποβλήθηκαν σε ανοικτή χειρουργική αποκατάσταση ΑΚΑ πριν την εισαγωγή στην αναισθησία, στα 15, 30, 60, 120 λεπτά μετά τον αορτικό αποκλεισμό, στα 15 και 60 λεπτά μετά την άρση του αποκλεισμού καθώς και 24 ώρες μετεγχειρητικά. Τα επίπεδα της μαλονδιαλδεΰδης (malondialdehyde-MDA) μετρήθηκαν με μία φασματοφωτομετρική μέθοδο.Αποτελέσματα: Θετική συσχέτιση διαπιστώθηκε μεταξύ των επιπέδων της MDA προεγχειρητικά και του μεγέθους του ανευρύσματος (Pearson correlation= 0.578, P<0.001). Καμία διαφορά δεν παρατηρήθηκε στα επίπεδα της MDA μεταξύ των ραγέντων και μη ανευρυσμάτων. Ωστόσο, όσον αφορά τους συμπτωματικούς ασθενείς (n=18), υπήρχε μία σημαντική αύξηση των επιπέδων της MDA (P<0.001) σε σχέση με τους ασυμπτωματικούς. Υπήρχε επίσης μία στατιστικά σημαντική αύξηση των τιμών της MDA στους ασθενείς που μεταφέρθηκαν στη ΜΕΘ και θετική συσχέτιση του συνολικού χρόνου αορτικού αποκλεισμού και των επιπέδων της MDA στα 15 και 60 λεπτά μετά το «declamping» (Pearson correlation= 0.323 και 0.467 αντίστοιχα, P<0.001), αλλά όχι και μετά από 24 ώρες.Συμπέρασμα: Παρατηρείται ένα υψηλού βαθμού οξειδωτικό stress κατά τη διάρκεια της χειρουργικής αποκατάστασης των ανευρυσμάτων της κοιλιακής αορτής. Τα επίπεδα της ΜDA πιθανότατα χαρακτηρίζουν τα χρονικά μεσοδιαστήματα που το οξειδωτικό stress κορυφώνεται και δυνητικά καθορίζουν ποιοι από τους ασθενείς θα εμφανίσουν συστηματικές επιπλοκές

Endovascular reconstruction of iliac artery bifurcation atherosclerotic disease with the kissing technique

A 71-year-old male patient with severe left buttock and lower-extremity claudication due to iliac artery bifurcation stenoses was referred to our institution for endovascular treatment. A kissing’ technique was used in order to dilate the proximal parts of both internal and external iliac arteries and avoid compromization of the internal iliac artery during proximal external iliac artery stenting. A balloon expandable stent was inserted via a left ipsilateral retrograde access to the narrowed origin of the left external iliacartery and a balloon catheter via a right contralateral access inside the origin of the left internal iliac artery. Simultaneous balloons inflation restored full patency of both vessels. Twelve months later the patient is doing well, free of buttock or lower-extremity claudication symptoms. For iliac artery bifurcation atherosclerotic disease, endovascular repair with the kissing’ technique can achieve a complete bifurcation reconstruction offering significant clinical benefit in selected patients

The effect of fluoxetine on ischemia–reperfusion after aortic surgery in a rat model

Background: Aortic ischemia-reperfusion (IR) is an important factor in the development of postoperative acute lung injury after abdominal aortic surgery. The aim of the present study was to examine the effect of fluoxetine (Flx), a selective serotonin reuptake inhibitor widely used as a preoperative anxiolytic, on lung injury induced by abdominal aortic IR in rats

Fluoxetine ameliorates imbalance of redox homeostasis and inflammation in an acute kidney injury model

Ischemia-reperfusion (IR) has been reported to be associated with augmented reactive oxygen radicals and cytokines. Currently, we aimed to examine the influence of fluoxetine, which is already used as a preoperative anxiolytic, in the context of IR induced by occlusion of infrarenal abdominal aorta (60 min of ischemia) and its effects on renal oxidative status, inflammation, renal function, and cellular integrity in reperfusion (120 min post-ischemia). Male rats were randomly assigned as control, IR, and pretreated groups. The pretreated group animals received fluoxetine (20 mg/kg, i.p.) once daily for 3 days. Renal tissue oxidative stress, myeloperoxidase activity, proinflammatory cytokines (tumor necrosis factor-alpha, interleukin-1 beta, interleukin-6), histology, and function were assessed. As an anti-inflammatory cytokine, interleukin-10 was also assessed. IR led to a significant increase in lipid hydroperoxide, malondialdehyde, and pro-oxidant antioxidant balance and decrease in superoxide dismutase activity and ferric reducing/antioxidant power level (p < 0.05), but fluoxetine was able to restore these parameters. High concentrations of tumor necrosis factor-alpha, interleukin-1 beta, interleukin-6, and myeloperoxidase activity caused by IR were significantly decreased in kidney tissue with fluoxetine. In addition, interleukin-10 levels were high in fluoxetine pretreated group. IR resulted in disrupted cellular integrity, infiltration of tissue with leukocytes, and decreased serum creatinine-urea levels (p < 0.05). Fluoxetine significantly restored impaired redox balance and inflammation parameters of rats subjected to IR to baseline values. This beneficial effect of fluoxetine on redox balance might be addressed to an improvement in renal function