Blood trace elements in abdominal aortic aneurysm (AAA): a pilot study on pre and post variation after endovascular aortic repair (EVAR)

Objective: Some studies have shown that the oxidation of some elements (Fe, Cu, Cr, Co, and others) and the alteration of the homeostasis of the metal-ion may cause oxidation stress, resulting in lipid peroxidation, protein alteration, and other complications which are the basis for numerous diseases including the formation of abdominal aortic aneurysm (AAA). The study is focused on the concentrations of arsenic (As), calcium (Ca), cadmium (Cd), chromium (Cr), copper (Cu), lead (Pb), magnesium (Mg), manganese (Mn), selenium (Se), and zinc (Zn) in the blood of patients with AAA, compared with subjects affected by peripheral arterial disease (PAD). The same metals were also assayed in the blood of subjects with AAA before and after aneurysm correction with endovascular aortic repair (EVAR). Material and methods: 56 patients of either sex were divided in 2 groups: a) 26 patients with AAA (21 treated by EVAR); b) 30 patients with PAD syndrome. The metal concentration in the blood was quantified by dynamic reaction cell inductively coupled plasma mass spectrometry (DRC-ICP-MS). Results and discussion: the mean values of element concentrations in subjects with PAD were slightly lower than those found in patients suffering from AAA while the level of Se in AAA were higher than in PAD patients. In the comparison between the pre- and post-stent implantation of EVAR treatment the values of Mg, Cu, Zn, and Ca were stable after 6 months; after 12 months, there was a reduction of the blood concentration; after more than 12 months, the level of metals and, in particular, Mg, Cu, and Zn, was even lower. Cr and Se values increased in the first 6 months, then decreased between 7 and 12 months to end with a new rise after 12 months. Pb always showed a positive difference after 6 months and this was confirmed after 12 months. The level of Cd seemed to rise in the first 6 months to remain stable over time. The behavior of manganese was significant, showing a clear increase in concentration since the installation of the endovascular implantation. Conclusions: The results of the present work show that the elimination of the hemodynamic stress and the reduction of the aneurysm changed the quantity of metals in the blood. Possible change in the concentration of some metals after EVAR may be also used in future in planning pharmacological strategies to slow down or stop the progressive expansion of the aortic tissue.