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

Abstract

The aim was to prospectively evaluate post-implantation syndrome (PIS) after elective endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) and to investigate its association with clinical and laboratory parameters and the clinical outcome of the patients. From January 2010 till June 2013, 214 consecutive patients treated electively by EVAR for AAA were prospectively included. PIS was defined according to systemic inflammatory response syndrome criteria. Adverse events included any major adverse cardiovascular events (MACE), acute renal failure, re-admission and death from any cause. PIS was diagnosed in 77 (34%) patients. Pre-operative white blood cell (WBC) count values (p<.001), endograft material (polyester) (p<.001), and heart failure (p=.03) were independent predictors of PIS. Mean post-operative temperature (p<.001), length of hospital (p<.001) and intensive care unit (p=.008) stay, as well as maximum post-operative WBC count (p<.001) and hs-CRP values (p<.001) were significantly higher in the PIS group. Post-operative hs-CRP (p=.001) and duration of fever (p=.02) independently predicted the occurrence of MACE. Post-operative hs-CRP (p=.004), maximum temperature (p=.03), and the presence of PIS (p=.01) were independent predictors of an adverse event during the first 30 days. A threshold of post-operative hs-CRP value of 125mg/L was highly associated with the occurrence of MACE, with a sensitivity of 82% and specificity of 75%. A systematic inflammatory response is observed in a significant number of patients after EVAR. The type of endograft material seems to play a significant role in this inflammatory process. The intensity of inflammation, as assessed mainly by the post-operative hs-CRP values, correlates with the presence of a cardiovascular or any other adverse event during the first 30 days after the procedure.