RT info:eu-repo/semantics/doctoralThesis
T1 Estudio de biomarcadores y modelos predictivos de complicaciones después de la reparación endoluminal del aneurisma de aorta abdominal
A1 Saiz Villoria, Laura
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Corazón - Cirugía
K1 Endovascular aortic repair
K1 Aneurisma
K1 Endofuga
K1 Biomarcador
K1 32 Ciencias Médicas
AB Abdominal aortic anuerym (AAA) is a multifactorial pathology with a prevalence near 5% of men older than 65 years. Proteolysis of the structure of the aortic wall, inflammatory changes as well as, biomechanics forces are the main phisiopathologic alterations that take place.The surgical treatment aims to prevent the aneurysm rupture, lately, the endovascular repair (EVAR) is preferred over the open repair due to the inferior morbimortality rate. Endoleak is the presence of flow in the aneurysm sac outside the graft, it is seen in up to 25% of EVAR patients and it is the main cause of readmission and reintervention. Most of the endoleaks are benign and do not have to be repaired, but those associated with sac enlargement or inadequate sealing have to be treated to avoid ruptured.EVAR patients need an indefinite follow-up with the purpose to identify possible complications which may need surgical repair. Computed tomography angiography (CTA) is the gold-standard to detect those complications.The aim of this study is to define a predictive model of complications after EVAR in the short and medium-term analysing diverse cytokines implicated in the AAA physiopathology.A cohort prospective study was designed and 50 patients with asymptomatic AAA treated with EVAR between June 2015 and June 2016 in the Angiology and Vascular Surgery Department of the Hospital Clínico Universitario de Valladolid were included.Demographic and comorbility data were collected as well as baseline, 6 months and 12 months after EVAR AAA diameter was measured in the corresponding CTA. Analytic levels of interleukin (IL) 1β, IL-2, IL-6, IL-8, monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), apolipoproteins A-I (apo A-I) and B (apo B), homocysteine, D-dimer and fibrinogen, preoperatively, 7 days postoperatively and 6 and 12 months after were determined.A statistical analysis was assessed to study the evolution of the different biomarkers after EVAR, as well as its relationship to endoleaks, it was also determined the capacity of the postoperatory concentrations of the statistical significative biomarkers to identify those inidividuals with endoleak. A regression logistic analysis to evaluate the risk factors related to endoleaks was assessed.All of the patients were male, mean age was 72,2 years and their main comorbilities were arterial hypertension, dislypemia and smoking. Advanced aged and ischemic cardiopathy were significatively associated with the presence of endoleaks (OR 1,64 and 2,15 respectively), while smoking was a protective factor (OR 0,001). A statistically signficant correlation was established between the presence of endoleaks and elevated levels 12 months after EVAR of IL-1β, IL-8, MCP-1 and D-dimer and also between correct aneurysm exclusion and elevated plasmatic levels of apo B and fibrinogen 12 months after intervention.In conclusion, we consider that the plasmatic measure a year after EVAR of IL-1β, IL-8, MCP-1, D-dimer, apo B and fibrinogen is a useful tool in the prediction of an incomplete endovascular exclusion of AAA.
YR 2025
FD 2025
LK https://uvadoc.uva.es/handle/10324/76274
UL https://uvadoc.uva.es/handle/10324/76274
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 31-jul-2025