Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.640190
Title: Coagulation, fibrinolysis and endothelial cell activation in abdominal aortic aneurysm repair
Author: Adam, Donald John
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2003
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Abstract:
The hypothesis of this thesis is that deranged coagulation, fibrinolysis and endothelial cell activation contribute to the thrombotic and haemorrhagic complications associated with AAA repair. In a retrospective study, 83% of 741 patients with ruptured AAA admitted to a regional vascular unit were operated upon and the operative mortality rate was 37%. Thrombotic and haemorrhagic complications including cardiac events, renal and respiratory failure, coagulopathy, lower limb ischaemia, stroke and pulmonary embolism were the major factors contributing to peri-operative mortality. Only 35% of patients diagnosed as ruptured AAA within the catchment area were operated upon and the overall community-based mortality rate was 79%. In patients with ruptured AAA who survived to 24 hours post-operatively, there was evidence of intense thrombin generation and inhibition of systemic fibrinolysis. In ruptured AAA, prolonged duration of symptoms was associated with increased thrombin generation; and increased operative blood loss was associated with reduced fibrinogen and PC, prolonged clotting times and reduced intra-operative vWF. In non-ruptured AAA, increased blood loss and prolonged clamp times were associated with reduced fibrinogen and PC, prolonged clotting times, reduced vWF and inhibition of systemic fibrinolysis. Non-survivors if ruptured AAA repair had significantly prolonged clotting times, reduced PC and increased systemic fibrinolysis. Intra-operative coagulopathy was associated with reduced PC and increased systemic fibrinolysis. Increased intra-operative inhibition of systemic fibrinolysis was associated with post-operative clinical and biochemical evidence of myocardial injury. Post-operative acute renal failure and fatal organ dysfunction were associated with significantly reduced peri-operative levels of the endothelial vasopressor, endothelin. In survivors, increased endothelin levels were associated with reduced thrombin generation.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.640190  DOI: Not available
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