scholarly journals Association of Neutrophil–Lymphocyte and Platelet–Lymphocyte Ratio with Adverse Events in Endovascular Repair for Abdominal Aortic Aneurysm

2021 ◽  
Vol 10 (5) ◽  
pp. 1083
Author(s):  
Maria P. Ntalouka ◽  
Petroula Nana ◽  
George N. Kouvelos ◽  
Konstantinos Stamoulis ◽  
Konstantinos Spanos ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Adverse Events ◽  
Characteristic Curve ◽  
Endovascular Aneurysm Repair ◽  
Adverse Cardiovascular Event ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Platelet Lymphocyte Ratio ◽  
Abdominal Aortic

The association of chronic inflammatory markers with the clinical outcome after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) was investigated. We included 230 patients, treated electively with EVAR. The values of neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) were measured pre- and postoperatively. Any major adverse cardiovascular event (MACE) and acute kidney injury (AKI) were recorded. Adverse events occurred in 12 patients (5.2%). Seven patients suffered from MACE and five from AKI. Median NLR and PLR values were significantly increased after the procedure (NLR: from 3.34 to 8.64, p < 0.001 and PLR: from 11.37 to 17.21, p < 0.001). None of the patients or procedure characteristics were associated with the occurrence of either a MACE or AKI. Receiver operating characteristic curve analysis showed that postoperative NLR and PLR were strongly associated with AKI. A threshold postoperative NLR value of 9.9 was associated with the occurrence of AKI, with a sensitivity of 80% and specificity of 81%. A threshold postoperative PLR value of 22.8 was associated with the occurrence of AKI, with a sensitivity of 80% and specificity of 83%. Postoperative NLR and PLR have been associated with the occurrence of AKI after EVAR for AAA.

scholarly journals Neutrophil to Lymphocyte Ratio Reflects the Proteolytic Activity of the Abdominal Aortic Aneurysm Wall

2021 ◽  
Vol 2 (5) ◽  
pp. 339-342
Author(s):  
VA Sasarman ◽  
O Andercou ◽  
S Bruno ◽  
M Chira ◽  
A Oprea ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Proteolytic Activity ◽  
Statistical Significance ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Aneurysmal Wall ◽  
Aneurysm Wall ◽  
Abdominal Aortic ◽  
Significant Difference

Background: This study aims to evaluate the local proteolytic activity from the level of Abdominal Aortic Aneurysm (AAA) wall and correlate the obtained values with the preoperative values of NLRs (Neutrophil-Lymphocyte Ratio), evaluating a possible association between the two variables and, implicitly, between the local proteolysis process and the systemic inflammatory response of those patients diagnosed with AAA. Methods: The current study is monocentric, observational, and prospective, taking place at the Department of Cardiovascular Surgery, Cluj-Napoca, Romania. Patients undergoing elective or emergency classical surgery for unruptured AAA or ruptured AAA were included in the study. During classical surgery, samples from the infrarenal aortic aneurysmal wall were collected in a standardized manner, from the central part of the anterior wall from uAAA and rAAA and were analyzed by gel zymography. Results: The concentration of MMP2 was similar in the ruptured/non-ruptured group, without any statistical significance. In the MMP-9 case, we obtained a mean of 821.35 U arb/µg at the level of unruptured aneurysmal wall and 1411.57 U arb/µg at the level of the ruptured aneurysmal wall. According to the ANOVA test, there is a significant difference between the two categories of aneurysms. The same correlation was observed regarding both the zymogen category, pro-MMP-2, as well as pro-MMP-9: they expressed significant higher quantities of inactive enzymes in rAAA. We splitted the study population into two categories: patients who presented preoperative NLR values < 5 and > 5. MMP-2 collagenase levels did not register statistical differences between the two groups, p = 0.3236. High levels of MMP-9 are positively associated with increased values of NLR, the NLR<5 group had an MMP-9 mean of 902.41(473.71) U arb/µg, statistically lower than the MMP-9 mean indicated in the NLR>5 group, 1474(521.21) U arb/µg. Similarly, MMP-2 and MMP-9 zymogens were found in statistically higher quantities (p < 0.05) in the NLR>5 group of patients. Conclusions: This is the first study that analyzes a possible correlation between the local proteolytic activity at the site of the dilated aneurysmal aortic wall and circulating levels of NLR. Following the results obtained, we conclude that the group of patients presenting with NLR>5 preoperatively, as in the rAAA group, significantly greater levels of MMP-9 and inactive proenzymes were identified. Local metalloproteinase MM9 activity is proportional to the systemic inflammatory activity. Concomitantly, we hypothesize that the increased sensitivity of NLR as a prognostic marker in AAA pathology, which is ensured and confirmed by its strong association with local proteolytic activity, directly implied in the evolution of the disease.

EVAR in Patients With Abdominal Aortic Aneurysm and Horseshoe Kidney: A Systematic Review

2021 ◽  
pp. 152660282110594
Author(s):  
Mauricio Gonzalez-Urquijo ◽  
Diana Paola Padilla-Armendariz ◽  
David Eugenio Hinojosa-Gonzalez ◽  
Gerardo Lozano-Balderas ◽  
Eduardo Flores-Villalba ◽  
...  
Keyword(s):  
Systematic Review ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Operative Time ◽  
Endovascular Aneurysm Repair ◽  
Horseshoe Kidney ◽  
Complication Rates ◽  
Abdominal Aortic ◽  
Endovascular Approach ◽  
Aneurysm Repair

Purpose: A systematic review of all patients that have been reported in the literature with abdominal aortic aneurysm (AAA) concomitant with horseshoe kidney (HSK) treated electively by endovascular aneurysm repair (EVAR) is presented. A new grouping system for describing HSK vasculature is implemented. Materials and Methods: We searched for published manuscripts using the Medical Subject Headings terms “abdominal aortic aneurysm,” “AAA,” “EVAR,” “endovascular aneurysm repair,” and “horseshoe kidney” in PubMed, Google Scholar, Scopus, and National Center for Biotechnology Information databases. Inclusion criteria include all published material of patients with AAA with HSK treated electively by an endovascular approach. We excluded patients who were treated by a hybrid or open repair or patients with ruptured AAA. Statistical analysis was carried out using SPSS Statistics version 25 (IBM Corp, Armonk, New York) software. Results: A total of 50 patients from 30 studies were included for analysis. Males made up 88% (n=44) of the population. The median age for this cohort was 70 years (range: 47–86 years). Median aneurysmal diameter was 6.0 cm (range: 4.0–10.3 cm). The median operative time for endovascular repair was 84 minutes (range: 40–332 minutes). The most common graft used was Zenith, used in 40% (n=20) of the cases, followed by Endurant in 14% (n=7). The overall complication rate was 14% (n=7). The median follow-up was 19 months (range: 1–108 months). While comorbidities did not appear to impact outcomes significantly, median operative times for smokers were higher than those in nonsmokers, 84 versus 118 minutes, respectively (p=0.048). Univariate linear regression modeling of aneurysmal size with age, operative time, and length of stay revealed a significant coefficient association between aneurysmal size and operative times. After adjusting for comorbidities and aneurysmal size, prior history of chronic kidney disease significantly increased odds for renal infarction. Conclusion: This review presents the most complete data set possible of patients with concomitant HSK and AAA treated by an endovascular approach. Furthermore, the A + B + C classification for grouping the HSK vasculature is implemented. This systematic review suggests EVAR to be an excellent option with low complication rates for the treatment of AAA in patients with HSK.

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