SUPRACELIAC, BUT NOT INFRARENAL, AORTIC CROSS-CLAMPING UP-REGULATES NEUTROPHIL INTEGRIN CD11B

Objective: To evaluate the effects of supraceliac and infrarenal aortic cross-clamping on the expression of neutrophil integrin CD11b (a marker of systemic cytokine release). Design: Two groups, determined by anatomic placement of aortic cross-clamp. Laboratory personnel were blinded as to group assignment. Setting: University teaching and community hospitals. Laboratory facilities used were university and Veteran's Affairs medical centers. Participants: Patients scheduled for aortic surgery. Interventions: Blood sampling was performed at baseline, after 30 minutes of aortic cross-clamp duration, 30 and 90 minutes after reperfusion (for tumor necrosis factor-alpha plasma levels in infrarenal cross-clamp group), and at baseline and 90 minutes reperfusion (for neutrophil CD11b expression quantification) in both groups. Measurements and Main Results: Tumor necrosis factor-alpha measured by ELISA technique did not change at any time period in the infrarenal clamping group. Neutrophil CD11b expression, measured by double antibody staining and FACScan analysis, did not change significantly at 90 minutes of reperfusion in the infrarenal group, but increased significantly (p < 0.05) in the supraceliac aortic cross clamp group. Conclusions: Neutrophil integrin CD11b has been demonstrated to be the primary adhesive glycoprotein responsible for neutrophil organ entrapment and subsequent neutrophil-mediated reperfusion injury. These results suggest that upregulation of neutrophil integrin CD11b after supraceliac aortic clamping may in part be responsible for the higher incidence of acute lung injury after thoracic aortic aneurysm repair requiring supraceliac cramping when compared with infrarenal aneurysm surgery. (C) 1995 by WB. Saunders Company