Prospective evaluation of postimplantation syndrome evolution on patient outcomes after endovascular aneurysm repair for abdominal aortic aneurysm

Abstract

This study prospectively investigated the association of postimplantation syndrome (PIS) with the clinical outcome during the first year after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm and assessed the evolution of the inflammatory response as outlined from specific inflammatory markers. The study prospectively included 182 consecutive patients treated electively by EVAR for abdominal aortic aneurysm from January 2010 to January 2013. PIS was defined according to systemic inflammatory response syndrome criteria. Patients were monitored for 1year. Adverse events included any major adverse cardiovascular events (MACE), acute renal failure, readmission, and death from any cause. PIS was diagnosed in 65 patients (35.7%). White blood cell count, high-sensitivity C-reactive protein, and interleukin 6 were significantly higher in the PIS group during the postoperative period (P< .001). At the 1-year follow-up, high-sensitivity C-reactive protein (P= .99) and interleukin 6 (P= .17) were attenuated toward the values of the non-PIS group. The white blood cell count (P= .02) remained higher in the PIS group, although within the normal reference range. During the follow-up period, MACE and adverse events occurred, respectively, in 17.2% and in 18.8% of patients in the PIS group and in 4.3% and 5.1% of the non-PIS group. The occurrence of PIS was the only independent predictor of a MACE (P= .007) or an adverse event (P= .005) during the follow-up period. The inflammatory response after EVAR is attenuated after the first postoperative month, as shown by the kinetics of several inflammatory biomarkers. However, PIS seems to correlate with the presence of a cardiovascular or any other adverse event during the first year after EVAR. Further studies should focus on whether a change in care is needed to ameliorate the higher cardiovascular risk of PIS patients.