Effects of postimplantation systemic inflammatory response on long-term clinical outcomes after endovascular aneurysm repair of an abdominal aortic aneurysm

Abstract

The aim of this study was to determine the association between postimplantation syndrome (PIS) and long-term clinical outcomes after elective endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm.In this single-center, observational cohort study, a total of 204 consecutive patients undergoing EVAR were included. Primary outcome was long-term mortality from any cause; secondary outcomes included long-term mortality, systemic or implant-related complications, and secondary therapeutic procedures.The diagnosis of PIS was established in 64 patients (31.4%). PIS patients were more likely to receive woven polyester endografts and have a longer postoperative hospital stay and lower incidence of type II endoleaks. In multivariate analysis, PIS was significantly associated with a decreased risk of developing type II endoleaks (P = 0.044). During follow-up period of 44 months, clinical outcomes showed no significant differences in mortality (P = 0.876), systemic (P = 0.668), or implant-related complications (P = 0.847), although rates of secondary therapeutic procedure were significantly higher in non-PIS patients (P = 0.037). The groups had similar rates of overall survival (P = 0.761) and other clinical outcomes (P = 0.562).Patients with and without PIS had similar long-term overall survival rates and other clinical outcomes. PIS was beneficial in preventing type II endoleaks during postoperative period.

Postimplantation Syndrome after Endovascular Aneurysm Repair

“…The global incidence of PIS was 28%. A single-center, observational cohort study of 204 consecutive EVARs revealed an incidence of PIS of 31.4%, with the same definition [20]. In a similar way, Arnaoutoglou et al [21] in a more recent prospective study with 182 consecutive EVARs, diagnosed PIS in 65 patients (35.7%).…”

“…In another study that evaluated inflammatory response to Anaconda® endografts, the patients who developed this syndrome had a longer hospital-stay [8]. Other studies showed a significant prolongation of postoperative hospitalization in the PIS group compared to non-PIS group [4,10,20].…”

“…Conversely, Kwon et al [20] stated that patients with and without PIS had similar longterm overall survival rates and other clinical outcomes, such as systemic or implant-related complications.…”

“…The majority of the studies pointed to a higher incidence of PIS or a greater increase of inflammatory markers in polyester-based endografts [4,5,8,18,20]. Voûte et al [5] constructed a multivariable risk model for PIS, and woven polyester constitution of the endograft was the only significant factor associated with an increased risk of developing PIS (HR 5.58; p = 0.007).…”

Causes and consequences of mesenteric embolization after endovascular aorto-iliac intervention — a nested case control study

“…In a recent report, shaggy aorta was defined as a nominal variable [13] and it appeared to be a prominent risk factor for multiple arterial thromboembolism, and for increased short-and long-term mortality after both open and endovascular AAA repair. However, a shaggy aorta was not found to be associated with mesenteric embolization in EVAR patients in the present study.…”