Post-implantation Syndrome After Thoracic Endovascular Aortic Repair for Type B Aortic Dissection: A Single-center Experience with 646 Cases

Abstract

Introduction - A systemic inflammatory response called post-implantation syndrome (PIS) was frequently observed after thoracic endovascular aortic repair (TEVAR) of type B aortic dissection (TBAD). While a clear definition and explanation of PIS is yet to be clarified, PIS is considered as a prognostic factor of TBAD, and it has been reported to be an independent predictor of mortality. Methods - This retrospective study included 646 patients who underwent TEVAR between January 2010 and December 2015. PIS was defined by fever (>38 ◦C) and leukocytosis (>12,000μL−1), without evidence of infection. Patients were divided into PIS group and non-PIS group. The clinical data and follow-up results were collected for statistical analysis to determine the factors related to PIS and mid-term clinical outcomes of these patients. Results - A total of 692 patients (54.5±11.1 years, 86.4% males) were included in the study. PIS was diagnosed in 264 (28.1%) patients. Age less than 60 years was positively associated with PIS (odds ratio [OR]:1.994, 95% confidence interval [CI]: 1.368-2.907; P < 0.001). Hypertension (OR: 11.503, 95% CI: 4.066-32.544; P < 0.001), over 1 stent-graft placed (OR:2.029, 95% CI: 1.178-3.494; P =0.011) and arch vessel bypass (OR: 2.105, 95% CI:1.384-3.202; P =0.001) were identified that positively associated with PIS, whereas Statin (OR: 0.617, 95% CI: 0.424-0.898; P =0.012) was negatively associated with PIS in multiple logistic regression analysis based on the stepwise regression model. On Kaplan–Meier analysis, there is no significant trend towards survival for patients with or without PIS was evident. Conclusion - PIS was accorded with the concept of host immune response trigged by aortic endograft, and it was a benign course without worsening mid-term outcome.