Endotoxemia after major vascular operations.

PURPOSE: Endotoxemia has been associated with syndromes such as adult respiratory distress syndrome and multiple organ failure. Translocation of endotoxins from the gut has been demonstrated to occur experimentally in animals after splanchnic ischemia.

METHODS

We investigated endotoxemia in 11 patients with hemorrhagic shock caused by a ruptured abdominal aortic aneurysm and in five patients after elective abdominal aortic aneurysm repair. Endotoxin was measured quantitatively with a limulus assay with a detection limit of 12.5 pg/ml.

RESULTS

In 7 of the 11 patients admitted to the hospital with an acute condition endotoxin was present on admission (range 15 to 25 pg/ml), even before resuscitation and operation were started. In patients treated electively endotoxin was noticed after cross-clamping of the aorta in four of five patients (mean +/- SEM: 18.9 +/- 4.6 pg/ml). After reperfusion endotoxemia increased and was present in all patients (22.8 +/- 2.8 pg/ml). All five patients treated electively had an uneventful recovery without specific organ failures or infectious complications.

CONCLUSIONS

It is concluded that systemic endotoxemia as monitored by the limulus assay is a common finding in patients after major vascular operation. Hemorrhagic shock resulting in splanchnic ischemia may lead to endotoxemia. Ischemia and especially reperfusion after aortic cross-clamping also result in endotoxin translocation. However, the low concentrations of systemic circulating endotoxin found were not related to subsequent adverse effects of either the patients treated for acute conditions or in the electively treated patients.