POST-IMPLANTATION SYNDROME AFTER EVAR
DOI:
https://doi.org/10.48750/acv.97Keywords:
Inflammation, Aortic Aneurysm, Abdominal, Endovascular Procedures, Postimplantation syndromeAbstract
Introduction: Post-implantation syndrome (PIS) is characterized by fever, flu-like symptoms, leukocytosis and elevation of reactive C protein in the postoperative period of EVAR. The authors aim to estimate the incidence of PIS after EVAR in their institution, identify risk factors and determine the association with clinical events.
Materials and Methods: A retrospective study was designed at a tertiary center. All patients undergoing EVAR between July 2014 and December 2016 were included. Data were collected through electronic clinical records, as leukogram, reactive C protein and body temperature. The primary endpoint evaluated was the incidence of PIS, defined as fever> 38 ° and reactive C protein > 75mg / L. The association with demographic and procedural characteristics, length of hospitalization and perioperative clinical events (death or major complications) was assessed.
Results: 205 patients were identified in this period. After analysis of the clinical records, 25 patients were excluded due to the use of branched or fenestrated endografts; 11 patients were excluded due to EVAS; in 17 patients, the indication wasn’t a primary aneurysm or it was a mycotic aneurysm and; in 46 patients the time of surgery wasn’t elective. In the remaining 106 patients, the incidence of PIS was 19% (n = 20). A statistically significant association was found between PIS and smoking (p = 0.005), COPD (p = 0.005) and statin therapy (p = 0.031). The multivariate logistic regression analysis, correcting for smoking and statin therapy, revealed that smoking is an important risk factor (OR 7.26, p = 0.03) and statin therapy a protective factor (OR = 0.341, p = 0.049). Regarding for the characteristics of the procedure, percutaneous approach, amount of contrast, intraoperative complications and need for complementary procedures, no differences were observed. A significant difference was found between groups in hospitalization length, with a median of 5 days in the group without PIS and 7 days in the PIS group (p = 0.034). No significant differences were found in cardiovascular events, complications or death within 30 days postoperatively between the groups.
Conclusion: The incidence of PIS was 19%, which is concordant with literature. The results suggest that smoking is a risk factor. There was also an increase in hospitalization length in 2 days in PIS group. Statin therapy at the time of surgery is a modifiable factor that has been shown to be protective with respect to PIS, reinforcing the benefit of this therapy in the perioperative period of AAA patients.
Downloads
References
2. Nano G, Occhiuto M, Stegher S et al. Postimplantation Syndrome after Endovascular Aortic Repair Using the Anaconda Endograft. Ann Vasc Surg 2014; 28 (6): 1409–15.
3. Arnaoutoglou E, Kouvelos G, Papa N et al. Prospective evaluation of postimplantation syndrome evolution on patient outcomes after endovascular aneurysm repair for abdominal aortic aneurysm. J Vasc Surg. 2016 May;63(5):1248–55.
4. Sartipy F, Lindstrom D, Gillgren P et al. THe Role of Procalcitonin in Postimplantation Syndrome after EVAR: A Pilot Study. Ann Vasc Surg. 2014; 28(4):866–73.
5. Kakisis JD,Moulakakis KG, Antonopoulos CN et al. Volume of new-onset thrombus is associated with the development of postimplantation syndrome after endovascular aneurysm repair. J Vasc Surg 2014;60:1140–45.
6. Kwon H, Ko GY, Kim MJ et al. Effects of postimplantation systemic inflammatory response on long-term clinical outcomes after endovascular aneurysm repair of an abdominal aortic aneurysm. Medicine (Baltimore). 2016 Aug;95(32): 4532.
7. Sartipy F, Lindstrom D, Gillgren P et al. The Impact of Stent Graft Material on the Inflammatory Response After EVAR. Vasc Endovascular Surg. 2015 Apr-May;49(3-4):79–83.
8. Voûte M, Gonçalves FB, Luijtgaarden KM et al. Stent graft composition plays a material role in the postimplantation syndrome. J Vasc Surg. 2012; 56(6):1503–9.
9. Motte L, Kehlet H, Vogt K et al. Preoperative Methylprednisolone Enhances Recovery After Endovascular Aortic Repair — A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Ann Surg. 2014;260(3):540–8.
10. Arnaoutoglou E, Kouvelos G, koutsoumpelis A et al. An Update on the Inflammatory Response after Endovascular Repair for Abdominal Aortic Aneurysm. . Mediators of Inflammation. 2015.
11. Moulakasis K, Alepaki M, Sfyroeras G et al. The impact of endograft type on inflammatory response after endovascular treatment of abdominal aortic aneurysm. Journal of Vascular Surgery 2013; 57: 668–77.
