Concept of the aortic aneurysm repair-related surgical stress: a review of the literature

Abdominal aorta aneurysm (AAA) is a serious threat for human life. AAA repair is a high-risk procedure which results in a severe surgical stress response. We aim to give a conceptual description of the underlying pathophysiology of stress after surgical repair of AAA. The MEDLINE/PubMed database was searched for publications with the medical subject heading "surgical stress" and keywords "abdominal aortic aneurysms (AAA)", or "cytokines" or "hormones" or "open repair (OR)" or "endovascular repair (EVAR)". We restricted our search to English till 2012 and only in cases of abdominal and thoracoabdominal aneurysms (TAAA). We identified 93 articles that were available in English as abstracts or/and full-text articles that were deemed appropriate for our review. Literature highlights no statistical significance for early acute TNF-α production in EVAR and no TNF-α production in OR. IL-6 and IL-8 levels are higher after OR especially when compared with those of EVAR. IL-10 peak was observed during ischemic phase in aneurysm surgical repair. Cortisol and epinephrine levels are higher in OR patients in comparison to EVAR patients. Finally, the incidence of systemic inflammatory response syndrome was significantly higher in OR than EVAR patients.