Diagnosis and predictors of post-implantation syndrome following endovascular repair of aortic aneurysms – a narrative review
DOI:
https://doi.org/10.48750/acv.569Palavras-chave:
Abdominal Aortic Aneurysms, Post-implantation syndromeResumo
INTRODUCTION: After endovascular aortic repair (EVAR), many patients develop a systemic inflammatory response called post-implantation syndrome (PIS). AAA and procedure-related characteristics have been linked with increased odds of developing this syndrome. Similarly, some short- and long-term consequences have been associated with PIS. This study aims to review the literature on the diagnosis and predictors of post-implantation after endovascular repair of aortic aneurysms.
RESULTS: A non-systematic review of the MEDLINE and Scopus databases was performed using the keywords "abdominal aortic aneurysm," "inflammation," and "endovascular techniques.” No time or language limitations were imposed. Manuscripts were considered irrespective of study design. Articles of interest were analyzed, and the relevant information was organized in tables.
RESULTS: PIS is defined as a combination of constitutional symptoms, including fatigue and fever, and elevated inflammatory markers. There are several proposed diagnostic criteria, most including a combination of fever with leukocytosis and/or elevated C-reactive protein (CRP). These result in discrepant rates, as low as 2% and up to 100%. The typical evolution of this syndrome is spontaneous resolution, although pharmacologic measures for symptom relief may be needed. These symptoms often resolve within two weeks; no significant permanent complications remain. Most PIS cases will present up to the first 72 postoperative hours. Endograft material, particularly polyester-based stent grafts, has been consistently linked to increased odds of PIS, up to five-fold, compared to polytetrafluoroethylene (PTFE) grafts. Aneurysm thrombus load (both pre-existing and new-onset) has also been related to an increased odds of PIS. Bacterial translocation, contrast media, and other patient or procedure-related characteristics have not been linked to an increased risk of PIS.
CONCLUSION: PIS is a common finding after EVAR. Universal diagnostic criteria for diagnosis are required. Polyester-based stent grafts present the highest risk of developing this syndrome. Aneurysm thrombus load may also relate to this increased risk. The impact of other clinical or anatomical factors remains undetermined.
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Arnaoutoglou E, Papas N, Milionis H, Kouvelos G, Koulouras V, Matsagkas MI. Post-implantation syndrome after endovascular repair of aortic aneurysms: Need for postdischarge surveillance. Interact Cardiovasc Thorac Surg. 2010; 11:449-54
Voûte MT, Bastos Gonçalves FM, Van De Luijtgaarden KM, Klein Nulent CGA, Hoeks SE, Stolker RJ et al. Stent graft composition plays a material role in the post-implantation syndrome. J Vasc Surg. 2012; 56:1503–9.
Nano G, Occhiuto MT, Stegher S, Malacrida G, Cova M, Righini P et al. Post-implantation syndrome after endovascular aortic repair using the anacondaTM endograft. Ann Vasc Surg. 2014; 28:1409–15.
Kwon H, Ko GY, Kim MJ, Han Y, Noh M, Kwon TW, et al. Effects of post-implantation systemic inflammatory response on long-term clinical outcomes after endovascular aneurysm repair of an abdominal aortic aneurysm. Medicine (Baltimore). 2016; 95:4532
Arnaoutoglou E, Kouvelos G, Papa N, Kallinteri A, Milionis H, Koulouras V, et al. Prospective Evaluation of Post-implantation Inflammatory Response After EVAR for AAA : Influence on Patients’ 30 Day Outcome. Eur J Vasc Endovasc Surg. 2015; 49:175-83
Arnaoutoglou E, Kouvelos G, Papa N, Gartzonika K, Milionis H, Koulouras V et al. Prospective evaluation of post-implantation syndrome evolution on patient outcomes after endovascular aneurysm repair for abdominal aortic aneurysm. J Vasc Surg. 2016; 63:1248–55
Soares Ferreira R, Bastos Gonçalves F, Abreu R, Camacho N, Catarino J, Correia R et al. Post-implantation syndrome after EVAR. Angiol Cir Vasc. 2018; 14:176-81
Schürmann K, Vorwerk D, Bücker A, Neuerburg J, Klosterhalfen BMG. Perigraft inflammation due to Dacron-covered stent grafts in sheep iliac arteries: Correlation of MR imaging and histopathologic findings. Radiology. 1997; 204:757-63.
Melissano G, Tshomba Y, Rinaldi E, Chiesa R. Initial clinical experience with a new low-profile thoracic endograft. Journal of Vascular Surgery. 2015; 62:336-42.
De La Motte L, Kehlet H, Vogt K, Nielsen CH, Groenvall JB, Nielsen HB, et al.
Preoperative methylprednisolone enhances recovery after endovascular aortic repair: A randomized, double-blind, placebo-controlled clinical trial. Annals of Surgery. 2014; 260:540-9.
Velázquez OC, Carpenter JP, Baum RA, Barker CF, Golden M, Criado F et al. Perigraft air, fever, and leukocytosis after endovascular repair of abdominal aortic aneurysms. American Journal of Surgery. 1999; 178:185-9
Dosluoglu HH, Lall P, Blochle R, Harris LM, Dryjski ML. Ambulatory percutaneous endovascular abdominal aortic aneurysm repair. Journal of Vascular Surgery. 2014; 59:58-64
Sartipy F, Lindström D, Gillgren P, Ternhag A. The role of procalcitonin in post-implantation syndrome after EVAR: A pilot study. Annals of Vascular Surgery. 2014; 28:866-73;
Kakisis JD, Moulakakis KG, Antonopoulos CN, Mylonas SN, Giannakopoulos TG, Sfyroeras GS, et al. Volume of new-onset thrombus is associated with the development of post-implantation syndrome after endovascular aneurysm repair. Journal of Vascular Surgery. 2014; 60: 1140-5.
Ferreira V, Machado R, Martins J, Loureiro L, Loureiro T, Borges L et al. Post-implantation syndrome - retrospective analysis of 52 patients. Angiol Cir Vasc 2015; 11:204-8
Soares Ferreira R, Oliveira-Pinto J, Ultee K, Voûte MT, Oliveira NFG, Hoeks S et al. Long Term Outcomes of Post-Implantation Syndrome After Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg. 2021; 62:561-8
Gorla R, Erbel R, Kahlert P, Tsagakis K, Jakob H, Mahabadi AA, et al. Clinical features and prognostic value of stent graft-induced post-implantation syndrome after thoracic endovascular aortic repair in patients with type B acute aortic syndromes. Eur J Cardiothorac Surg. 2016; 49:1239-12
Ribeiro TF, Soares Ferreira R, Amaral C, Ferreira ME, Bastos Gonçalves F. Post-Implantation Syndrome Incidence is Higher After Complex Endovascular Aortic Procedures Than After Standard Infrarenal Repair. Eur J Vasc Endovasc Surg 2023; 66:804-12
Blum U, Voshage G, Lammer J, Beyersdorf F, Töllner D, Kretschmer G et al. Endoluminal stent–grafts for Infrarenal abdominal aortic aneurysms. New Eng J Med. 1997;336:13-20
Chang CK, Chuter TAM, Niemann CU, Shlipak MG, Cohen MJ, Reilly LM et al. Systemic inflammation, coagulopathy, and acute renal insufficiency following endovascular thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2009;49:1140-6
Georgiadis GS, Trellopoulos G, Antoniou GA, Gallis K, Nikolopoulos ES, Kapoulas KC, et al. Early results of the Endurant endograft system in patients with friendly and hostile infrarenal abdominal aortic aneurysm anatomy. J Vasc Surg 2011; 54:616-27
Mazzaccaro D, Occhiuto MT, Stegher S, Righini P, Malacrida G, Nano G. Tips about the Cordis INCRAFT Endograft. Ann Vasc Surg. 2016; 30:205-10
Chatzelas DA, Pitoulias AG, Telakis ZC, Kalogirou TE, Tachtsi MD, Christopoulos DC et al. Incidence and risk factors of post-implantation syndrome after elective endovascular aortic aneurysm repair. Int Angiol 2022; 41:196-204.
Kwon H, Ko G-Y, Kim M-J, Han Y, Noh M, Kwon T-W, et al. Effects of post-implantation systemic inflammatory response on long-term clinical outcomes after endovascular aneurysm repair of an abdominal aortic aneurysm. Medicine (Baltimore). 2016; 95:4532
Sousa J, Vilares AT. Post-implantation Syndrome Is Not Associated with Myocardial Injury after Noncardiac Surgery after Endovascular Aneurysm Repair. Ann Vasc Surg 2020. 68:275-82
Soares Ferreira R, Bastos Gonçalves F. Post-implantation syndrome after endovascular aneurysm repair. In: Koncar I, editor. Abdominal Aortic Aneurysm – From Basic Research to Clinical Practice. IntechOpen; 2018.
Swartbol P, Truedsson LNL. Adverse reactions during endovascular treatment of aortic aneurysms may be triggered by interleukin 6 release from the thrombotic content. J Vasc Surg. 1998; 28:664-8
Perini P, Bianchini Massoni C, Azzarone M, Ucci A, Rossi G, Gallitto E et al. Significance and Risk Factors for Intraprosthetic Mural Thrombus in Abdominal Aortic Endografts: A Systematic Review and Meta-analysis. Ann Vasc Surg 2018. 53:234-42
Moulakakis KG, Sfyroeras GS, Papapetrou A, Antonopoulos CN, Mantas G, Kakisis J, et al. Inflammatory response and renal function following endovascular repair of the descending thoracic aorta. Journal of Endovascular Therapy. 2015;22:201-6
Videm V, Ødegård AMH. Iohexol-induced neutrophil myeloperoxidase release and activation upon contact with vascular stent graft material: A mechanism contributing to the post-implantation syndrome. Journal of Endovascular Therapy. 2003; 10:958-67
