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Thoraco-Abdominal Aorta pp 287–297Cite as

Hemostasis, Bleeding, Blood- sparing Strategies, and Allogeneic Transfusions in Thoraco-Abdominal Aortic Aneurysm Surgery

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Abstract

Surgery for thoraco-abdominal aortic aneurysm (TAAA) is frequently associated with excess bleeding, due to extensive surgical dissection areas and altered hemostasis resulting from complex perioperative coagulopathy. In this setting, requirement for allogeneic transfusion is also predicted by advanced age, low preoperative hematocrit, extent of surgical repair, prolonged operative times, prolonged extracorporeal circulation, long periods of organ ischemia, and hypothermia. For these reasons, patients undergoing TAAA surgery are given transfusions of large quantities of blood-derived products. In recent years, the need for treating an increasing number of patients refusing transfusion for religious reasons, the limited availability, and the unpredictable shortage of allogeneic blood products, the high costs, and the potential for severe complications, have all called for a profound revision of transfusion criteria in major surgery, particularly in terms of individualized assessment of anemia tolerance, and of an integrated approach to perioperative autologous blood conservation. In this chapter, the coagulation abnormalities, frequently reported in patients requiring surgery for TAAA, will be described, along with the potential complications associated with allogeneic transfusions and the most commonly used blood-sparing methods.

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References

  1. Cinà CS, Clase CM. Coagulation disorders and blood product use in patients undergoing thoracoabdominal aortic aneurysm repair. Transfus Med Rev 2005;19:143–154

    Article  PubMed  Google Scholar 

  2. Shore-Lesserson L, Bodian C, Vela-Cantos F et al. Antifibrinolytic use and bleeding during surgery on the descending thoracic aorta: a multivariate analysis. J Cardiothorac Vasc Anesth 2005;19:453–458

    Article  PubMed  CAS  Google Scholar 

  3. Shander A, Goodnough LT. Why an alternative to blood transfusion? Crit Care Clin 2009;25:261–277

    Article  PubMed  Google Scholar 

  4. Thompson RW, Adams DH, Cohen JR et al. Disseminated intravascular coagulation caused by abdominal aortic aneurysm. J Vasc Surg 1986;4:184–186

    Article  PubMed  CAS  Google Scholar 

  5. Utoh J, Kunitomo R, Hara M et al. Consumption coagulopathy associated with aneurysms of the abdominal aorta and the bilateral femoral arteries. Report of a case. J Cardiovasc Surg (Torino) 2001; 42:245–248

    CAS  Google Scholar 

  6. Yuan SM, Shinfeld A, Tager S, Raanani E. Aortic aneurysm-induced disseminated intravascular coagulopathy: successful surgical repair. Vascular 2009;17:55–59

    PubMed  Google Scholar 

  7. Kuo MC, Dunn P, Wang PN et al. Dissecting aortic aneurysm complicated with acute disseminated intravascular coagulation: case report. Changgeng Yi Xue Za Zhi 1999;22:138–142

    PubMed  CAS  Google Scholar 

  8. Getaz EP, Louw JH. The coagulopathy associated with aortic aneurysms. Postgrad Med J 1977;53:668–671

    Article  PubMed  CAS  Google Scholar 

  9. Davies MJ, Murphy WG, Murie JA et al. Preoperative coagulopathy in ruptured abdominal aortic aneurysm predicts poor outcome. Br J Surg 1993;80:974–976

    Article  PubMed  CAS  Google Scholar 

  10. Cate JW, Timmers H, Becker AE. Coagulopathy in ruptured or dissecting aortic aneurysms. Am J Med 1975;59:171–176

    Article  PubMed  Google Scholar 

  11. Mukaiyama H, Shionoya S, Ikezawa T et al. Abdominal aortic aneurysm complicated with chronic disseminated intravascular coagulopathy: a case of surgical treatment. J Vasc Surg 1987;6:600–604

    Article  PubMed  CAS  Google Scholar 

  12. Aramoto H, Shigematsu H, Muto T. Perioperative changes in coagulative and fibrinolytic function during surgical treatment of abdominal aortic aneurysm and arteriosclerosis obliterans. Int J Cardiol 1994;47(Suppl 1):S55–S63

    Article  PubMed  CAS  Google Scholar 

  13. Fisher DF Jr, Yawn DH, Crawford ES. Preoperative disseminated intravascular coagulation associated with aortic aneurysm: a prospective study on 76 cases. Arch Surg 1983;118:1252–1255

    PubMed  Google Scholar 

  14. Taylor FB Jr, Toh CH, Hoots WK et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. J Thromb Haemost 2001;86:1327–1330

    CAS  Google Scholar 

  15. Toh CH, Downey C. Performance and prognostic importance of a new clinical and laboratory scoring system for identifying non-overt disseminated intravascular coagulation. Blood Coagul Fibrinolysis 2005;16:69–74

    Article  PubMed  Google Scholar 

  16. Siebert WT, Natelson EA. Chronic consumption coagulopathy accompanying abdominal aortic aneurysm. Arch Surg 1976;111:539–541

    PubMed  CAS  Google Scholar 

  17. Balduini CL, Salvini M, Montani N et al. Activation of the hemostatic process in patients with unruptured aortic aneurysm before and in the first week after surgical repair. Haematologica 1997;82:581–583

    PubMed  CAS  Google Scholar 

  18. Hosaka A, Miyata T, Aramoto H et al. Clinical implication of plasma level of soluble fibrin monomer-fibrinogen complex in patients with abdominal aortic aneurysm. J Vasc Surg 2005;42:200–205

    Article  PubMed  Google Scholar 

  19. Oba J, Shiya N, Matsui Y et al. Alterations in coagulation and fibrinolysis after surgery for aortic aneurysm. Surg Today 1995;25:532–535

    Article  PubMed  CAS  Google Scholar 

  20. Cinà CS, Clase CM, Bruin G. A cohort study of coagulation parameters and the use of blood products in surgery of the thoracic and thoracoabdominal aorta. J Vasc Surg 2001;33:462–468

    Article  PubMed  Google Scholar 

  21. Mamiya S, Endo Y, Miura AB et al. Disseminated intravascular coagulation accompanying thoracic and abdominal aortic aneurysm; report of three cases. Jpn J Med 1988;27:91–95

    PubMed  CAS  Google Scholar 

  22. Godet G, Samama CM, Ankri A et al. Mechanisms and prediction of hemorrhagic complications during surgery of thoraco-abdominal aortic aneurysm. Ann Fr Anesth Reanim 1990;9:415–422

    PubMed  CAS  Google Scholar 

  23. Gertler JP, Cambria RP, Brewster DC et al. Coagulation changes during thoracoabdominal aneurysm repair. J Vasc Surg 1996;24:936–945

    Article  PubMed  CAS  Google Scholar 

  24. Mulcare RJ, Royster TS, Phillips LL. Intravascular coagulation in surgical procedures on the abdominal aorta. Surg Gynecol Obstet 1976;143:730–734

    PubMed  CAS  Google Scholar 

  25. Gibbs NM, Crawford GP, Michalopoulos N. Postoperative changes in coagulant and anticoagulant factors following abdominal aortic surgery. J Cardiothorac Vasc Anesth 1992;6:680–685

    Article  PubMed  CAS  Google Scholar 

  26. Bradbury A, Adam D, Garrioch M et al. Changes in platelet count, coagulation and fibrinogen associated with elective repair of asymptomatic abdominal aortic aneurysm and aortic reconstruction for occlusive disease. Eur J Vasc Endovasc Surg 1997;13:375–380

    Article  PubMed  CAS  Google Scholar 

  27. Gibbs NM, Crawford GP, Michalopoulos N. A comparison of postoperative thrombotic potential following abdominal aortic surgery, carotid endarterectomy, and femoro-popliteal bypass. Anaesth Intensive Care 1996;24:11–14

    PubMed  CAS  Google Scholar 

  28. Levy PJ, Tabares AH, Olin JW et al. Disseminated intravascular coagulation associated with acute ischemic hepatitis after elective aortic aneurysm repair: comparative analysis of 10 cases. J Cardiothorac Vasc Anesth 1997;11:141–148

    Article  PubMed  CAS  Google Scholar 

  29. Schmitz A, Hartmann M. Acute intracardiac thrombus formation during thoracoabdominal aortic surgery. Anesth Analg 2006;102:1658–1659

    Article  PubMed  Google Scholar 

  30. Cohen JR, Angus L, Asher A et al. Disseminated intravascular coagulation as a result of supraceliac clamping: implications for thoracoabdominal aneurysm repair. Ann Vasc Surg 1987;1:552–557

    Article  PubMed  CAS  Google Scholar 

  31. Cohen JR, Schroder W, Leal J, Wise L. Mesenteric shunting during thoracoabdominal aortic clamping to prevent disseminated intravascular coagulation in dogs. Ann Vasc Surg 1988;2:261–267

    Article  PubMed  CAS  Google Scholar 

  32. Illig KA, Green RM, Ouriel K et al. Primary fibrinolysis during supraceliac aortic clamping. J Vasc Surg 1997;25:244–251

    Article  PubMed  CAS  Google Scholar 

  33. Anagnostopoulos PV, Shepard AD, Pipinos II et al. Hemostatic alterations associated with supraceliac aortic cross-clamping. J Vasc Surg 2002;35:100–108

    PubMed  Google Scholar 

  34. Haithcock BE, Shepard AD, Raman SBK et al. Activation of fibrinolytic pathways is associated with duration of supraceliac aortic cross-clamping. J Vasc Surg 2004;40:325–333

    Article  PubMed  Google Scholar 

  35. Cambria RP, Davison JK, Giglia JS, Gertler JP. Mesenteric shunting decreases visceral ischemia during thoracoabdominal aneurysm repair. J Vasc Surg 1998;27:745–749

    Article  PubMed  CAS  Google Scholar 

  36. Chiesa R, Melissano G, Civilini E et al. Ten years experience of thoracic and thoracoabdominal aortic aneurysm surgical repair: lessons learned. Ann Vasc Surg 2004;18:514–520

    Article  PubMed  Google Scholar 

  37. Esmon CT. The protein C pathway. Chest 2003;124(Suppl 3):S26–S32

    Article  Google Scholar 

  38. Ihara A, Kawamoto T, Matsumoto K et al. Relationship between hemostatic markers and circulating biochemical markers of collagen metabolism in patients with aortic aneurysm. Pathophysiol Haemost Thromb 2004;33:221–224

    Article  Google Scholar 

  39. Coselli JS, LeMaire SA, Conklin LD et al. Morbidity and mortality after extent II thoracoabdominal aortic aneurysm repair. Ann Thorac Surg 2002;73:1107–1115

    Article  PubMed  Google Scholar 

  40. Madjdpour C, Heindl V, Spahn DR. Risks, benefits, alternatives and indications of allogeneic blood transfusions. Minerva Anestesiol 2006;72:283–298

    PubMed  CAS  Google Scholar 

  41. Stramer SL, Hollinger FB, Kalz LM et al. Emerging infectious disease agents and their potential threat to transfusion safety. Transfusion 2009;49(Suppl 2):S1–S29

    Article  Google Scholar 

  42. Inoue Y, Motohashi Y, Koizumi A. History of blood transfusion before 1990 is associated with increased risk of cancer mortality independently of liver disease: a prospective long-term follow-up study. Environ Prev Med 2009;17:55–59

    Google Scholar 

  43. Godet G, Fleron MH, Vicaut E et al. Risk factors for acute postoperative renal failure in thoracic and thoracoabdominal aortic surgery: a prospective study. Anesth Analg 1997;85:1227–1232

    Article  PubMed  CAS  Google Scholar 

  44. Koch C, Li L, Figueroa P et al. Transfusion and pulmonary morbidity after cardiac surgery. Ann Thorac Surg 2009;88:1410–1418

    Article  PubMed  Google Scholar 

  45. Bursi F, Barbieri A, Politi L et al. Perioperative red blood cell transfusion and outcome in stable péatients after elective major vascular surgery. Eur J Endovasc Surg 2009;37:311–318

    Article  CAS  Google Scholar 

  46. Kertai MD, Tiszai-Szucs T, Varga KS et al. Intraoperative use of packed red blood cell transfusion and mortality in patients undergoing abdominal or thoracoabdominal aortic aneurysm surgery. J Cardiovasc Surg 2009;50:501–508

    CAS  Google Scholar 

  47. Offner PJ. Age of blood: does it make a difference? Crit Care 2004;8(Suppl 2):S24–S26

    Article  PubMed  Google Scholar 

  48. Davies I, Brown TJ, Haynes S et al. Cost-effectiveness of cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion: a systematic review and economic model. Health Technol Assess 2006;10:1–210

    Google Scholar 

  49. Sarac TP, Clifford C, Waters J et al. Preoperative erythropoietin and blood conservation management for thoracoabdominal aneurysm repair in a Jehovah’s Witness. J Vasc Surg 2003;37:453–455

    Article  PubMed  Google Scholar 

  50. Casati V, Barbato L, D’Angelo A et al. Complex cardiac surgery in Jehovah’s Witnesses with chronic renal failure. J Cardiothorac Vasc Anesth 2008;22:453–454

    Article  PubMed  Google Scholar 

  51. Laupacis A, Fergusson D. Erythropoietin to minimize perioperative blood transfusion: a systematic review of randomized trials. Transfus Med 1998;8:309–317

    Article  PubMed  CAS  Google Scholar 

  52. Singbartl G, Schreiber J, Singbartl K. Preoperative autologous blood donation versus intraoperative blood salvage: intraindividual analysis and modeling of efficacy in 1103 patients. Transfusion 2009; 49:2374–2383

    Article  PubMed  Google Scholar 

  53. Jamnicki M, Kocian R, Van der Linder P et al. Acute normovolemic haemodilution: physiology, limitations, and clinical use. J Cardiothorac Vasc Anesth 2003;17:747–754

    Article  PubMed  Google Scholar 

  54. Loubser PG, Chan AC. Prediction of the effects of acute normovolemic haemodilution on the hematological constituents of sequestered autologous whole blood. Anesth Analg 2006;102:991–997

    Article  PubMed  Google Scholar 

  55. Casati V, Speziali G, D’Alessandro C et al. Intraoperative low-volume acute normovolemic hemodilution in adult open-heart surgery. Anesthesiology 2002;97:367–373

    Article  PubMed  Google Scholar 

  56. Cinà CS, Clase CM, Bruin G. Effects of acute normovolaemic haemodilution and the partial exchange transfusion on blood product utilization, haemostasis and haemodynamics in surgery of the thoracoabdominal aorta. A cohort study in consecutive patients. Panminerva Med 2000;42:211–215

    PubMed  Google Scholar 

  57. Fleischlag JA. Intraoperative blood salvage in vascular surgery-worth the effort? Crit Care 2004;8 (Suppl 2):S53–S56

    Article  Google Scholar 

  58. Society of Thoracic Surgeons Blood Conservation Guideline Task Force and Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion. Perioperative blood transfusion and blood conservation in cardiac surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 2007;83(Suppl 5):S27–S86

    Google Scholar 

  59. Fraser IS, Porte RJ, Kouide PA et al. A benefit-risk review of systemic haemostatic agents. Part 1: in major surgery. Drug Saf 2008;31:217–230

    Article  PubMed  CAS  Google Scholar 

  60. Fergusson DS, Hebert PC, Mazer CD et al. A comparison of aprotinin and lysine analogues in highrisk cardiac surgery. N Eng J Med 2008;358:2319–2331

    Article  CAS  Google Scholar 

  61. Casati V, Guzzon D, Oppizzi M et al. Hemostatic effects of aprotinin, tranexamic acid, and epsilon-aminocaproic acid in primary cardiac surgery. Ann Thorac Surg 1999;68:2252–2257

    Article  PubMed  CAS  Google Scholar 

  62. Casati V, Sandrelli L, Speziali G et al. Hemostatic effects of tranexamic acid in elective thoracic aortic surgery: a prospective, randomized, double-blind, placebo-controlled study. J Thorac Cardiovasc Surg 2002;123:1084–1091

    Article  PubMed  CAS  Google Scholar 

  63. Roberts HR, Monroe DM, White GC. The use of recombinant factor VII in the treatment of bleeding disorders. Blood 2004;104:3858–3864

    Article  PubMed  CAS  Google Scholar 

  64. Ghosh S, Pendurthi UR, Steinoe A et al. Endothelial cell protein C receptor acts as a cellular receptor for factor VIIa on endothelium. J Biol Chem 2007;282:11849–11857

    Article  PubMed  CAS  Google Scholar 

  65. Warren OJ, Alcock EM, Choong AM et al. Recombinant activated factor VII: a solution to refractory haemorrhage in vascular surgery? Eur J Vasc Endovasc Surg 2008;35:145–152

    Article  PubMed  CAS  Google Scholar 

  66. O’Connell KA, Wood JJ, Wise RP et al. Thromboembolic adverse events after use of recombinant human coagulation factor VIIa. JAMA 2006;295:293–298

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, S. Gaudenzio Clinic (Policlinico di Monza Group), Novara, Italy

    Valter Casati

  2. Coagulation Service and Thrombosis Research Unit, IRCCS H. San Raffaele, Milan, Italy

    Armando D’Angelo

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  1. Valter Casati
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  2. Armando D’Angelo
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Editors and Affiliations

  1. Department of Vascular Surgery, “Vita-Salute” University, IRCCS H., San Raffaele, Milan, Italy

    Roberto Chiesa , Germano Melissano  & Alberto Zangrillo ,  & 

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Casati, V., D’Angelo, A. (2011). Hemostasis, Bleeding, Blood- sparing Strategies, and Allogeneic Transfusions in Thoraco-Abdominal Aortic Aneurysm Surgery. In: Chiesa, R., Melissano, G., Zangrillo, A. (eds) Thoraco-Abdominal Aorta. Springer, Milano. https://doi.org/10.1007/978-88-470-1857-0_23

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  • DOI: https://doi.org/10.1007/978-88-470-1857-0_23

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