Primary fibrinolysis during supraceliac aortic clamping

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Presentation transcript:

Primary fibrinolysis during supraceliac aortic clamping K.A. Illig, MD, R.M. Green, MD, K. Ouriel, MD, P.N. Riggs, MD, S. Bartos, MD, R. Whorf, BS, J.A. DeWeese, MD, A. Chhibber, MD, V.J. Marder, MD, C.W. Francis, MD Journal of Vascular Surgery Volume 25, Issue 2, Pages 244-254 (February 1997) DOI: 10.1016/S0741-5214(97)70346-X Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Study protocol: Mean time after induction of anesthesia for all 18 patients is indicated on the abscissa. Blood samples were obtained at eight points: before induction of anesthesia (T1), just before heparinization and proximal clamping (T2), just before proximal clamp was removed (T3), 10 minutes after clamp was shifted to graft for performance of distal anastomosis (T4), 30 (T5) and 60 (T6) minutes after all clamps were removed and lower extremities perfused, and 180 (3 hours, T7) and 720 (12 hours, T8) minutes after operation was completed. Duration of proximal and distal clamping is indicated by dark and light shading, respectively. Journal of Vascular Surgery 1997 25, 244-254DOI: (10.1016/S0741-5214(97)70346-X) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Schematic version of fibrinolytic system. t-PA is major enzyme responsible for cleavage of plasminogen, and PAI-1 is its major inhibitor. α2-AP binds to and inactivates plasmin. Plasmin degrades fibrinogen, fibrin, and formed clot, yielding FDP and D-dimers. Journal of Vascular Surgery 1997 25, 244-254DOI: (10.1016/S0741-5214(97)70346-X) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 AST (left) and LDH (right) during study protocol. Data presented as mean ± standard error. Overall significance assessed by repeated measures ANOVA, and each point in time is analyzed using t tests. *Significance at p < 0.025 (because of multiple comparisons). Journal of Vascular Surgery 1997 25, 244-254DOI: (10.1016/S0741-5214(97)70346-X) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 AST (left) and LDH (right) during study protocol. Data presented as mean ± standard error. Overall significance assessed by repeated measures ANOVA, and each point in time is analyzed using t tests. *Significance at p < 0.025 (because of multiple comparisons). Journal of Vascular Surgery 1997 25, 244-254DOI: (10.1016/S0741-5214(97)70346-X) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 ECLT (left) and t-PA levels (right) during study protocol. Data presented as mean ± standard error. Overall significance assessed by repeated measures ANOVA, and each point in time is analyzed using t tests. *Significance at p < 0.025 (because of multiple comparisons). Journal of Vascular Surgery 1997 25, 244-254DOI: (10.1016/S0741-5214(97)70346-X) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 ECLT (left) and t-PA levels (right) during study protocol. Data presented as mean ± standard error. Overall significance assessed by repeated measures ANOVA, and each point in time is analyzed using t tests. *Significance at p < 0.025 (because of multiple comparisons). Journal of Vascular Surgery 1997 25, 244-254DOI: (10.1016/S0741-5214(97)70346-X) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Individual data points for ECLT, fibrinogen, and t-PA after proximal clamping (sample T3) in patients who underwent SCC and IRC. Normal values are shown by the shaded areas, and mean value for each group is shown by dotted line. Journal of Vascular Surgery 1997 25, 244-254DOI: (10.1016/S0741-5214(97)70346-X) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 PAI-1 (left) and α2-AP levels (right) during study protocol. Data presented as mean ± standard error. Overall significance assessed by repeated measures ANOVA, and each point in time is analyzed using t tests. *Significance at p < 0.025 (because of multiple comparisons). Journal of Vascular Surgery 1997 25, 244-254DOI: (10.1016/S0741-5214(97)70346-X) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 PAI-1 (left) and α2-AP levels (right) during study protocol. Data presented as mean ± standard error. Overall significance assessed by repeated measures ANOVA, and each point in time is analyzed using t tests. *Significance at p < 0.025 (because of multiple comparisons). Journal of Vascular Surgery 1997 25, 244-254DOI: (10.1016/S0741-5214(97)70346-X) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 t-PA to PAI-1 ratios during study protocol. Data presented as mean ± standard error. Overall significance assessed by repeated measures ANOVA, and each point in time is analyzed using t tests. *Significance at p < 0.025 (because of multiple comparisons). Journal of Vascular Surgery 1997 25, 244-254DOI: (10.1016/S0741-5214(97)70346-X) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Schematic summary of hypothesized changes occurring after SCC leading to primary fibrinolytic state. Journal of Vascular Surgery 1997 25, 244-254DOI: (10.1016/S0741-5214(97)70346-X) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions