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Swartbol, H. Parsson,L, Truedsson*,A. Sjoholm* and L. Norgren Depatiments of Surgery and *MedicalMicrobiologyLund UniversityS-221 85 Lund, Sweden The aim of the present study was to determinethe inflammatoryresponseby an extended analysisof complementin 16 patientsundergoingaortobifemoralbypasssurgery.The patients were randomizedto recieveeither a bifurcatedexpandedpolytetrafluoroethylene graft (n = 8: group1)or a collagen-impregnated knitted Dacrongraft (n = 8; groupII) to determinewhether differencesin graft surfacepropertiesmight influencethe inflammatoryresponseduring and after the procedure.The followingcomponentsof complement:Cl q, C4, C3, C3d, C5a and terminal complementcomplexeswere all analyses.,,, C-reactiveprotein and interleukin-6were alsodeterminedto assessthe acutephaseresponse\i,The complementdata were correctedfor haemodilution,which was assessedfrom &-mac~globulin concentrations.A significant decreaseof Clq (P < 0.0001) and an increasein C5a (P e 0.0005) was observedin both groups. C4 and C3 levelsshowed slight fluctuationsin group 1, whereas in group II these proteinsincreasedsignificantly(P< 0.05, P <0.005, respectively)between2 and 7 daysafter surgery.Terminalcomplementcomplexesremainedunchangedin both groups. Interleukin-6 levelspeakedat 12-24 h and the C-reactiveproteinat 24-72 h. Higherinterleukin-6levels (P e 0.05) were found II 6 h after surgerycomparedwith group1;no releaseof tumour necrosisfactor-alphawas identified.An earlyinflammatoryresponsewas foundin all patients. The patterns of the complementproteinsvaried with a Clq depletionand a C5a increase, interpretedas complementactivation.Whether the variationsbetweenthe two graft groups representany differencesin graft surfacepropertieshas to be further elucidated.CopyrightG 1996 The InternationalSocietyfor Cardiovascular Surgery. Keywords:complement,cytokines,vascularsurgery

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tissue ischaemia and reperfusion is unclear. A possible control group would be open aortic thromboendarterectomy, where the magnitudeof ischaemia and reperfusion injury might be comparable with aortofemoral graft surgery.These procedures are, however,extremely rare nowadays. Procedures in general surgery are not comparable as they cause different types of injury or involve bowel surgery, which may induce cytokine release for other reasons. Aortobifemoral surgery in patients with occlusive vascular disease causes complement activation, with Clq depletion and C.5a increase. It seemsimportant to correct for haemodilutionin order not to misinterpret results of complement activation. The authors found evidence of an early and generalized inflammatory response, demonstrated by a release of interleukin-6, but not tumour necrosis factoralpha, followed by an increase of C-reactive protein. In this group of patients, it is likely that ischaemia and reperfusion are less important than the surgical trauma itself, as collaterals supply the legs also during aortic clamping. Variations between the results of the two graft groups were not found. In vitro studies of the blood-graft interface utilising human blood cells might be helpful to elucidate this further; such studies are currently being conducted in the authors’ laboratory.

interaction. Br J Atzaestb 1983; 55: 1149–53.

10 Siegel J, Rent R, Gewurz H. Interactions of C-reactive protein

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Acknowledgements The authors thank T. Jonung, E. Ribbe and J. Thorne for surgical assistance. This study was supported by research grants from Lund University, W. L Gore & Associates Inc., USA, The SwedishMedical Association and Salus.

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