Post-implantation syndrome following endovascular abdominal aortic aneurysm repair: preliminary data

Abstract

PIS is a relatively common complication of EVAR used to treat AAAs and it is associated with features of a systemic inflammatory response and prolongation of hospitalization. Further studies are necessary towards understanding the underlying pathophysiology and evaluating effective preventive strategies.

Prospective Evaluation of Post-implantation Inflammatory Response After EVAR for AAA: Influence on Patients' 30 Day Outcome

“…23 A significant decrease in platelet count, an indirect index of platelet activation and consumption, has been observed postoperatively in a substantial proportion of EVAR patients. 3,9 The amount of mural thrombus has also been proposed to incur a role in the inflammatory response, as PIS initially was linked with the release of inflammatory mediators from the aneurysm thrombus. 15,16 Kakisis et al 24 recently evaluated nearly 85 patients after EVAR and reported an association between new onset thrombus and PIS.…”

“…The detailed process has been previously reported. 3 In brief, serum and standard samples were incubated into the micro wells of an enzyme linked immunosorbent assay (ELISA) plate, coated with a mouse monoclonal antibody against the corresponding human molecule. During the incubation a bound complex of antigeneantibody was formed.…”

“…In most cases, PIS is generally well tolerated, but even then it may result in a more demanding post-operative recovery leading to prolonged hospitalization, and thus it might be considered a moderate complication of the procedure. 2,3 Rarely, the inflammatory process has been reported to lead to the development of serious complications such as pulmonary dysfunction, cardiovascular events, renal insufficiency, even multisystem organ failure. 4e7 However, in several large EVAR papers the association of these clinical reactions with PIS has not been yet reported.…”

“…3 PIS was diagnosed in 35% of the patients. Patients with PIS showed significantly greater changes of inflammation marker levels, including high sensitivity C-reactive protein (hs-CRP) and interleukin 6 (IL-6), than the non-PIS group.…”

Inflammatory mediators after endovascular aortic aneurysm repair

“…EVAR may elicit a postoperative systemic inflammatory response, referred to as post-implantation syndrome (PIS) featuring pyrexia, negative blood culture results, leucocytosis, increased C-reactive protein and/or coagulation disturbances [28]. The reported incidence of PIS after EVAR varies widely between 14% and 60% [28], and both underestimation and lack of explicit criteria for this syndrome may account for this large variation [29]. Plasma levels of IL-6 have been shown to increase already on the first postoperative day, culminate at 24 h, and remain increased for at least 6 days [28][29][30][31].…”