Impact of graft composition on the systemic inflammatory response after an elective repair of an abdominal aortic aneurysm

Abstract

PurposeThe present study aimed to evaluate the risk factors and the role of graft material in the development of an acute phase systemic inflammatory response, and the clinical outcome in patients who undergo endovascular aneurysm repair (EVAR) or open surgical repair (OSR) of an abdominal aortic aneurysm (AAA).MethodsWe retrospectively evaluated the risk factors and the role of graft material in an increased risk of developing systemic inflammatory response syndrome (SIRS), and the clinical outcome in patients who underwent EVAR or OSR of an AAA.ResultsA total of 308 consecutive patients who underwent AAA repair were included; 178 received EVAR and 130 received OSR. There was no significant difference in the incidence of SIRS between EVAR patients and OSR patients. Regardless of treatment modality, SIRS was observed more frequently in patients treated with woven polyester grafts. Postoperative hospitalization was significantly prolonged in patients that experienced SIRS. In multivariate analyses, the initial white blood cell count (P = 0.001) and the use of woven polyester grafts (P = 0.005) were significantly associated with an increased risk of developing SIRS in patients who underwent EVAR. By contrast, the use of woven polyester grafts was the only factor associated with an increased risk of developing SIRS in patients who underwent OSR, although this was not statistically significant (P = 0.052).ConclusionThe current study shows that the graft composition plays a primordial role in the development of SIRS, and it leads to prolonged hospitalization in both EVAR and OSR patients.

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

“…In the present study, there was a substantial incidence of PIS in patients undergoing elective EVAR of an AAA, similar to that reported in the literature by most authors, [ 6 7 8 9 10 11 12 ] and PIS did not affect all-cause mortality and other clinical outcomes. However, the incidence of type II endoleaks was significantly higher in the non-PIS group, and an unexpected beneficial effect of PIS in preventing type II endoleaks during the postoperative period was observed.…”

“…Graft type plays a primary role in PIS development, and woven polyester endografts reportedly result in a stronger systemic inflammatory response. [ 6 7 8 9 10 11 12 ] In this study, persistent or new type II endoleaks were statistically and significantly associated with female gender, preoperative embolization of the internal iliac artery, and PIS. There was a trend toward an increased incidence of type II endoleaks without any statistical significance in patients receiving ePTFE endografts.…”

“… [1] Although the pathophysiology underlying PIS is not well understood and the relation of this systemic inflammatory response with patient outcomes has not been well established, PIS is considered to be a well-tolerated, benign state in most studies, except that it may lead to prolonged hospitalization and a more complicated postoperative recovery. [ 6 7 8 9 10 11 ] However, recently, several studies have reported that a serious systemic inflammatory response might result in a cardiovascular or any other adverse event during the first year after EVAR or a lower quality of life during a mean follow-up of 4 years. [ 12 17 ] In this study, during the mean follow-up of 44 months, patients with and without PIS showed similar long-term overall survival rates and other clinical outcomes, except that a longer postoperative hospital stay was noted in the PIS group; we did not assess patient quality of life.…”

“…Postimplantation syndrome (PIS), defined as continuous pyrexia coinciding with a rise in inflammatory marker levels despite antibiotic therapy, has been used to describe a clinical entity characterized by an acute-phase systemic inflammatory response shortly after EVAR of an AAA. [ 6 7 8 9 10 11 12 ] Although PIS, observed in nearly one-third of EVAR patients, is believed to be transient and harmless in most cases, its effect on patient outcomes is a concern because it may lead to prolonged hospitalization and a more complicated postoperative recovery. [ 8 9 10 11 12 ] The exact pathophysiology of PIS remains debatable, and there is presently no consensus on its effect on clinical outcomes during long-term follow-up after elective EVAR.…”

A new risk-scoring model for predicting 30-day mortality after repair of abdominal aortic aneurysms in the era of endovascular procedures

“…For any repair procedure, whether open or endovascular, the process of informed consent requires a thorough explanation of the risks and benefits to the patient, and the risks presented by vascular surgeons to patients undergoing AAA repair are based on anecdotal experience or on currently available risk estimation tools. In the past two decades, many studies have attempted to identify factors capable of predicting death in patients undergoing open repair of AAAs, whether intact or ruptured, and various risk assessment tools are currently used to predict perioperative mortality; each model has its strengths and weaknesses [ 5 6 7 16 17 18 19 20 21 22 23 24 25 ]. The existing risk-scoring models vary greatly in the nature and quality of their results, and the methods used for reporting.…”