Does a Postimplantation Syndrome Following Endovascular Treatment of Aortic Aneurysms Exist?

Abstract

The postimplantation syndrome (PIS) is a weakly defined condition that has been observed following endovascular treatment of aortic aneurysms; the postulated criteria include significant leukocytosis, fever, and/or coagulation disturbances. Among the factors that are supposed to contribute to this syndrome are contact activation by the stent covering with consecutive endothelial activation. Associated clinical parameters of a PIS were perioperatively monitored in the postoperative phase in a total of 69 patients with infrarenal aortic aneurysms treated with Y-stent grafts. C-reactive protein (CRP)-levels, leukocyte concentrations, and body temperature curves were directly compared to those of 50 patients undergoing conventional transperitoneal aneurysm resection. A subgroup of 10 patients of the endovascular group was compared with 13 operated-on patients with regard to an ischemia-reperfusion syndrome of the lower extremities. The mediator determinations were performed on venous (femoral vein) as well as in systemic (arterial) blood samples. The incidence of temperature values above 38 degrees C was higher in patients following endovascular treatment (72%) compared to conventionally operated-on patients (28%). CRP levels were not significantly different within the first 8 post-operative days. During open surgery, significantly higher values for lactate and lower pH levels were observed (p<0.01), as well as higher 6 keto prostaglandin F1alpha (PGF1alpha) levels. There was a short peak of PGF1alpha during eventeration of the intestine during the operative procedure that could not be detected during endovascular manipulations. The clinical and biochemical parameters do not prove the presence of a PIS following endovascular treatment of aortic aneurysms. In contrast, during open surgery the unspecific inflammatory reaction is higher, but not long-lasting. In the future, the suggested phenomenon of a decreased antiinflammatory cytokine response during endovascular surgery needs to be further examined.

Evaluation of the Endurant stent graft under instructions for use vs off-label conditions for endovascular aortic aneurysm repair

“…two groups. Incidence of postimplantation syndrome, defined as the presence in the postoperative period of fever, leukocytosis, or coagulation disturbances, 21 was similar between the two groups. Four reinterventions were performed in the IFU group (2 sutures of arteriotomy for false aneurysm in access site, 1 thrombectomy and 1 femorofemoral crossover prosthetic bypass graft for limb graft thrombosis).…”

Early pyrexia after endovascular aneurysm repair: are cultures needed?

“…2,4 Postoperative pyrexia has been shown to be more common (72%) in endovascular repair than in open repair (38%). 5 Inflammatory markers were not measured in this study as they have been well shown to be elevated after endovascular aneurysm repair. The white cell count (WCC) peaks at 24-72 h, the C-reactive protein (CRP) at 48-72 h and interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-1β (IL-1β) also rise.…”

“…The white cell count (WCC) peaks at 24-72 h, the C-reactive protein (CRP) at 48-72 h and interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-1β (IL-1β) also rise. 3,5,6 The combination of fever, elevated white cell count and CRP with or without a coagulation disturbance is known as the post implantation syndrome.…”

The Effect of Steroid Therapy on Postoperative Inflammatory Response after Endovascular Abdominal Aortic Aneurysm Repair

“…Furthermore, the incidence of PIS ranges from 3 to 94% due to differences in the definition of PIS. 2,8) A study compared EVAR with open surgery, and indicated that fever after open surgery was observed in 38% of the patients, whereas post-EVAR fever was noted in 72%, 9) suggesting that PIS is a phenomenon specific to EVAR. We consider that even EVAR, which is minimally invasive, may reduce appetite or ADL through fever, and that inhibition of postoperative inflammation leads to an improvement in the quality of life (QOL).…”