Postimplantation Syndrome Research Articles

Stent-Induced Inflammation: A Comparative Cross-Sectional Study of Post-Implantation Syndrome in Venous and Arterial Procedures

Background: Postimplantation syndrome (PIS) is a known inflammatory response following endovascular stent placement, yet comparative data between venous and arterial stenting remains limited. This study seeks to evaluate the incidence, characteristics, and clinical implications of PIS across these two distinct vascular territories. Methods: We retrospectively analyzed 191 patients who underwent either venous (n = 36) or arterial (n = 155) stent placement. Data collection encompassed demographic profiles, perioperative laboratory findings, and clinical outcomes. The primary endpoint was the incidence of PIS, defined as the presence of fever (≥38 °C), leukocytosis, and elevated C-reactive protein (CRP) within 30 days postprocedure. Secondary outcomes included length of hospital and ICU stay, incidence of endoleaks, reintervention rates, and 30-day mortality. Comparative statistical analyses were conducted to assess differences between the venous and arterial stent groups. Results: PIS was observed more frequently in arterial stent patients, as evidenced by significantly elevated postoperative white blood cell counts at 24 and 48 h (p = 0.046 and p = 0.014, respectively), along with borderline CRP increases (p = 0.052). Fever occurrence peaked at 72 and 96 h postprocedure, predominantly in the arterial cohort. Furthermore, patients with arterial stents had significantly longer hospital stays (5.59 ± 0.46 days vs. 3.42 ± 0.36 days; p = 0.0018) and a higher rate of 30-day endoleaks (7.1% vs. 0%; p = 0.005). Despite similar mortality and major adverse cardiac event (MACE) rates between groups, arterial stent patients exhibited a greater need for reintervention. While PIS was less common among venous stent recipients, its potential impact on postoperative recovery warrants careful monitoring. Conclusions: Arterial stenting is associated with a higher incidence of PIS and a more pronounced systemic inflammatory response, contributing to longer hospitalization and increased postoperative complications. Although venous stent patients experience PIS less frequently, its occurrence should not be overlooked, as it may influence overall recovery and clinical outcomes. Recognition and management of PIS in both venous and arterial stent patients are critical to improving patient care and optimizing procedural success.

Risk prediction and prognostic analysis of post-implantation syndrome after thoracic endovascular aortic repair

This study aimed to establish a predictive model for the risk of post-thoracic endovascular aortic repair (TEVAR) post-implantation syndrome (PIS) in type B aortic dissection (TBAD) patients, assisting clinical physicians in early risk stratification and decision management for high-risk PIS patients. This study retrospectively analyzed the clinical data of 547 consecutive TBAD patients who underwent TEVAR treatment at our hospital. Feature variables were selected through LASSO regression and logistic regression analysis to construct a nomogram predictive model, and the model's performance was evaluated. The optimal cutoff value for the PIS risk nomogram score was calculated through receiver operating characteristic (ROC) curve analysis, further dividing patients into high-risk group (HRG) and low-risk group (LRG), and comparing the short to midterm postoperative outcomes between the two groups. In the end, a total of 158 cases (28.9%) experienced PIS. Through LASSO regression analysis and multivariable logistic regression analysis, variables including age, emergency surgery, operative time, contrast medium volume, and number of main prosthesis stents were selected to construct the nomogram predictive model. The model achieved an area under the curve (AUC) of 0.86 in the training set and 0.82 in the test set. Results from calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC) demonstrated that the predictive model exhibited good performance and clinical utility. Furthermore, after comparing the postoperative outcomes of HRG and LRG patients, we found that the incidence of postoperative PIS significantly increased in HRG patients. The duration of ICU stay and mechanical assistance time was prolonged, and the incidence of postoperative type II entry flow and acute kidney injury (AKI) was higher. The risk of aortic-related adverse events (ARAEs) and major adverse events (MAEs) at the first and twelfth months of follow-up also significantly increased. However, there was no significant difference in the mortality rate during hospitalization. This study established a nomogram model for predicting the risk of PIS in patients with TBAD undergoing TEVAR. It serves as a practical tool to assist clinicians in early risk stratification and decision-making management for patients.

Systemic inflammatory response after transcatheter aortic valve replacement: a case report

Introduction. The growing prevalence of transcatheter aortic valve implantation (TAVI) over the past few years has revealed a unique set of events and complications that require rapid identification and treatment to improve outcomes, often involving a multidisciplinary team.Brief description. We present the case of a 79-year-old woman with severe aortic stenosis who underwent a TAVI procedure that was complicated postoperatively by hectic fever without an identified source of infection. After excluding all possible causes of fever, a diagnosis of post-implantation syndrome was made, and glucocorticosteroid therapy led to the patient's recovery.Discussion. A systemic inflammatory response may occur after endovascular aortic aneurysm repair in some patients. This inflammatory response is called postimplantation syndrome and includes fatigue or other flu-like symptoms, fever, and laboratory signs of inflammation. Our case describes the difficulties in differential diagnosis of post-implantation syndrome as a possible complication of TAVI, and also demonstrates the importance of a multidisciplinary approach to such patients.

Postimplantation syndrome after endovascular aortic repair: Impact of endograft material and a review of the literature

Aim: Postimplantation syndrome (PIS) is a systemic inflammatory response occurring acutely after endovascular aneurysm repair (EVAR), with reported incidence ranging from 14% to 60%. This study aimed to evaluate the association of different endograft materials with the manifestation and severity of PIS and the role of thrombus formation with type II endoleak incidence. Material and Methods: A retrospective analysis was performed on data from patients who underwent elective EVAR between January 2021 and January 2024. After applying inclusion and exclusion criteria, 171 patients were included. The patients had a mean age of 70.3±8.6 years and 93% were male. Patients were divided into PIS and Non-PIS groups, with a subgroup analysis within the PIS group comparing polyester and expanded polytetrafluoroethylene (e-PTFE) materials. Patient outcomes post-discharge and within the first-year post-surgery were evaluated. Results: No early mortality was observed. PIS was diagnosed in 39.2% of the patients. There was no significant difference on longer intensive care unit (ICU) or hospital stays among the PIS and Non-PIS groups. The incidence of PIS was significantly higher in the polyester subgroup (60%) compared to the ePTFE subgroup (25%). Univariate logistic regression identified polyester material as the factor associated with PIS (P=0.03). First-year computed tomographic angiography (CTA) follow-ups showed a statistically significant lower incidence of type II endoleak (p=0.01) and higher new thrombus formation (p=0.04) in the polyester group. Conclusion: Following EVAR, the patients experience systemic inflammatory responses influenced by the choice of endograft material. Polyester endografts are associated with a higher incidence of PIS and thrombogenicity but a lower incidence of type II endoleak in our study.

Postimplantation Syndrome after Traumatic Internal Carotid Artery Pseudoaneurysm Repair with Stent

AbstractEndovascular repair of traumatic internal carotid artery pseudoaneurysm (TICAP) with covered stents represents a safe treatment with few complications. However, the presence of foreign material used to treat TICAP and blood clots in the excluded pseudoaneurysms can trigger an acute systemic inflammatory response syndrome called postimplantation syndrome (PIS). To the best of our knowledge, PIS is described only after abdominal aortic endovascular aneurysm repair. Here, we report the case of PIS in a young, healthy, polytraumatized female patient with TICAP treated with endovascular covered stent.

Outcomes of post-implantation syndrome after endovascular repair for Stanford type B aortic dissection

ObjectiveThe aim of this study was to investigate the correlation between post-implantation syndrome (PIS) and long-term prognosis in patients with Stanford type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR). MethodsThis retrospective study included 547 consecutive patients diagnosed with TBAD who underwent TEVAR at our institution between January 2014 and December 2019. Patients were categorized into two groups: the PIS group (patients with post-TEVAR PIS) and the non-PIS group (patients without post-TEVAR PIS). In-hospital and follow-up data were analyzed. ResultsThe incidence of PIS was 28.9% (158/547 patients). No baseline differences were observed between the PIS (n = 158) and the non-PIS (n = 389) groups. The proportion of emergency surgery in the PIS group was higher than that in the non-PIS group (44.9% vs 26.0%; P < .001), the operation time was longer (median, 65.0; interquartile range [IQR], 56.0-75.0 minutes vs 56.0; IQR, 45.0-66.0 minutes; P < .001), the volume of contrast medium used (median, 65.0; IQR, 56.0-75.0 mL vs 56.0; IQR, 45.0-66.0 mL; P < .001), and the average number of trunk stents (1.85 ± 0.4 vs 1.34 ± 0.5 pieces; P < .001) and branch stents (0.7 ± 0.7 vs 0.2 ± 0.5 pieces; P < .001) used were more in the PIS group than in the non-PIS group. The incidence of supra-aortic branch procedures was higher in the PIS group than in the non-PIS group. There was no significant difference in device-related complications (DRCs) or 30-day mortality between the two groups (2.5% vs 4.4%; P = .442 and 1.3% vs 1.3%; P = .688, respectively). Univariate and multivariable logistic regression analysis showed that emergency surgery, number of trunk stents >1, operation time >58.5 minutes, and contrast medium volume >75 mL were risk factors for PIS, and the odds ratios of emergency operation, number of trunk stents >1 piece, operation time >58.5 minutes, and contrast medium volume >75 mL were 2.526 (95% confidence interval [CI], 1.530-4.173), 4.651 (95% CI, 2.838-7.624), 3.577 (95% CI, 2.201-5.815), and 7.356 (95% CI, 4.111-13.160), respectively. Follow-up was completed in 98.5% (532/540) of the patients, with a median follow-up of 67 months (IQR, 50-86 months). There was no significant difference in survival between the PIS and non-PIS groups (12.4% vs 10.3%; P = .476) during follow-up. The incidences of DRCs (7.8% vs 11.6%; P = .200) and aortic false lumen thrombosis (75.8% vs 79.2%; P = .399) were comparable between the PIS and non-PIS groups. Univariate logistic regression analysis showed that PIS had no effect on long-term follow-up mortality, DRCs, entry flow, or aortic false lumen thrombosis rate. ConclusionsPIS is relatively common after TEVAR and emergency surgery; number of trunk stents >1, operation time >58.5 minutes, and contrast medium volume >75 mL are of high predictive value for the assessment of PIS after TEVAR. However, PIS had little effect on early and late postoperative mortality or DRCs.

Systematic review of risk factors and outcomes of post-implantation syndrome following endovascular aortic repair

ObjectivePost implantation syndrome (PIS) is an early systemic inflammatory response following endovascular aortic repair (EVAR). The response is variable in patients and the clinical significance of PIS upon outcomes is unknown. This study aims to evaluate the incidence, risk factors, and prognostic implication of PIS. MethodsSystematic literature review and analysis was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines of PubMed, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. Eligible English-language studies regarding PIS after infrarenal EVAR were included, after removing duplicates. ResultsAfter screening, 31 studies were included. A total of 2847 patients were reviewed, with mean age of 70.7 years, of which 2012 (90.4%) were male, with a pooled mean follow-up of 26.1 months. PIS was reported in 25.3% of cases, with mean aneurysm diameter of 56.4 cm. Polytetrafluoroethylene (PTFE) grafts were utilized in 794 patients (27.9%) with polyester in 1839 (64.6%). White blood cell count, C-reactive protein, interleukin (IL)-6, IL-8, and IL-10 levels were all significantly elevated postoperatively. Thirty-day outcomes included type I endoleak rate of 0.8%, type II endoleak rate of 1.7%, reintervention rate of 0.35%, and mortality rate of 0.25%. Subgroup pooled analysis of patients with PIS (n = 309) vs No-PIS (n = 691) revealed that polyester (n = 642), rather than PTFE (n = 234) grafts, were associated with a higher rate of PIS (94.8% vs 3.7%; P = .0001), White blood cell count was higher in the PIS group both preoperatively (7.61 vs 6.76 × 109/L; P = .04) and postoperatively (15.0 vs 9.8 × 109/L; P = .0007) and IL-6 levels were higher in the PIS group postoperatively (98.6 vs 25.2 pg/mL; P = .02). Aneurysm diameter and amount of chronic or new thrombus within the aneurysm sac was not identified as a risk factor for PIS. Pooled outcomes of patients with PIS vs No-PIS demonstrated a significantly higher rate of 30-day mortality (0.6% vs 0%; P = .03) and major adverse cardiac events (5.8% vs 0.43%; P < .0001) without any differences seen in reintervention or 30-day type I or type II endoleaks. ConclusionsThis systematic review suggests that polyester grafts are strongly associated with PIS compared with PTFE. Interestingly, this report is suggestive of an association between 30-day mortality and major adverse cardiac events and PIS. Given these clinical sequelae, consideration for use of PTFE over polyester grafts to reduce the incidence of PIS may be a simple step to improve overall outcome. Further, exploration of the relationship between inflammatory mediators associated with PIS and mortality and cardiac complications may engender deeper understanding of risks, leading to eventual mitigation of harm for patients experiencing PIS.

Impact of post-implantation syndrome on outcomes in acute type B aortic syndrome patients undergoing endovascular repair.

Background: The aim of this study was to explore the impact of post-implantation syndrome (PIS) on prognosis outcomes in individuals with type B acute aortic syndrome (AAS) undergoing thoracic endovascular aortic repair (TEVAR). Patients and methods: Data from type B AAS individuals who underwent TEVAR from January 2014 to April 2021 were retrospectively reviewed. Study subjects were divided into PIS and non-PIS (nPIS) groups and postoperative clinical outcomes were analyzed. Results: Our study cohort of 74 individuals with type B AAS included 40 aortic dissection (AD), 30 intramural hematoma (IMH), 4 penetrating aortic ulcer (PAU). The incidence of PIS was 14.9%. No statistically significant differences were found in baseline characteristics. The left subclavian artery (LSCA) reconstruction was performed more frequently among the PIS group (45.5% vs 9.5%, p=.008). Major adverse events (MAE) tended to be more frequent in the PIS group, but the difference was not significant (27.3% vs 22.2%, p=.707). At 2-year follow-up, results were comparable between the two groups. Kaplan-Meier analysis showed that PIS was not associated with a higher incidence of mortality, endoleak, new-onset AD, or stroke. A baseline neutrophil-to-lymphocyte ratio (NLR) >10.3 was associated with greater incidence of MAE. In individuals with IMH, better aortic remodeling evaluated by lower total aortic diameter/true lumen diameter (TAD/TLD) was achieved in the nPIS group (1.23±0.10 vs 1.43±0.07, p<.001), and a TAD/TLD ratio >1.32 was associated with significantly more MAE. Cox multivariate regression analysis also showed that a postoperative TAD/TLD ratio >1.32 was an independent risk factor for MAE (OR, 11.36; 95% CI, 1.53-84.26; p=.017). Conclusions: PIS was associated with a trend toward a higher incidence of MAE after TEVAR. In individuals with IMH, a TAD/TLD ratio >1.32 was an independent predictor of postoperative MAE.

Predictors of 30-Day Postoperative Outcome after Elective Endovascular Abdominal Aortic Aneurysm Repair: A Tertiary Referral Center Experience.

We evaluated the 30-day postoperative outcome after elective endovascular aneurysm repair (EVAR) and the possible predictors for the 30-day postoperative outcome. Demographics, medical history, laboratory values, intensive care unit (ICU) admission and 30-day complications classified as major (major adverse cardiovascular events (MACEs), acute kidney injury (AKI) and death of any cause) and minor (postimplantation syndrome (PIS), postoperative delirium (POD), urinary tract infection (UTI) and technical graft failure) were documented (March 2016 to February 2019). We included 322 patients. The majority were managed under general anesthesia (83%) with femoral cutdown (98.1%). Overall, 121 (37.5%) complications, mostly minor (n = 103, 31.9%), were recorded. In total, 11 patients (3.4%) developed MACEs, 5 (1.6%) experienced AKI and 2 (0.6%) died in the ICU. Moreover, 77 patients (23.9%) suffered from PIS, 11 from POD, 11 from UTI and 4 from technical graft failure. The multivariate logistic regression analysis revealed that aneurysm diameter (p = 0.01) and past smoking (p = 0.003) were predictors for complications. PAD was an independent predictor of MACEs (p = 0.003), preoperative neutrophil to lymphocyte ratio (NLR) of AKI (p = 0.003) and past smoking of PIS (p = 0.008), respectively. Our study showed that the 30-day morbidity after EVAR exceeded 35%. However, the majority of complications were minor, and the associated mortality was low. Aneurysm diameter and past smoking were independent predictors for postoperative outcome.

Post-Implantation Syndrome Incidence is Higher After Complex Endovascular Aortic Procedures Than After Standard Infrarenal Repair

Post-implantation syndrome (PIS), characterised by malaise, fever, and increased inflammatory markers, is a common occurrence after endovascular aneurysm repair (EVAR), causing prolonged hospitalisation and increased cost. This study aimed to determine the incidence and short-term outcomes of PIS after fenestrated or branched procedures in aorto-iliac aneurysms compared with standard EVAR. A retrospective, comparative study from a tertiary academic institution was undertaken. All patients who underwent elective EVAR with polyester stent grafts from January 2015 to June 2021 were considered. Two groups were defined: standard EVAR (sEVAR) and complex EVAR (cEVAR). The latter included visceral fenestrated and branched or iliac branch and chimney stent grafts. The primary outcome was the incidence of PIS within three days of the index procedure. Secondary outcomes were short-term complications and risk factors for PIS. A multivariable model was constructed to correct for confounders. Overall, 253 patients were included: 165 (65.2%) sEVAR and 88 (34.8%) cEVAR. Complex EVAR patients were younger, with larger aneurysms, had longer procedures, and were more likely to have intra-operative complications. The PIS incidence was 23.7% (n= 60), significantly higher in cEVAR (34.1% vs. 18.2%; p= .005) and increased with the complexity of the procedure (EVAR: 18.2% vs. EVAR+iliac branch device: 25.0% vs. fenestrated and branched EVAR: 36.2%; p= .030). On multivariable analysis, cEVAR (OR 2.833, 95% CI 1.295 - 6.198; p= .009) was associated with a significantly increased risk of PIS. No differences in short term outcomes according to PIS status were noted. Group sub-analysis for cEVAR patients did not reveal any statistically significantly different outcomes according to PIS occurrence. In this cohort, cEVAR procedures were associated with a significantly increased risk of developing PIS compared with standard infrarenal repair. Post-implantation syndrome also appears to have a benign course with no major impact on peri-operative outcomes after cEVAR. Further research to confirm these findings is required.

Combined Endovascular Treatment of Complex Aortic Pathologies.

Multisegmented aortic pathologies present challenging issues independent of the treatment chosen. Whether open or endovascular, staged, or simultaneous, every treatment modality has its own pros and cons. We revealed our patients retrospectively with early and midterm results who had simultaneous endovascular thoracic and abdominal aortic repair for thoracic aortic pathologies and infrarenal abdominal aortic aneurysm (iAAA) as a single-center experience. Between January 2016 and January 2021, 16 patients were diagnosed with thoracic aortic pathology and iAAA was simultaneously repaired in an endovascular manner. All patients were operated on with the same cardiovascular surgeon team. The average age of the patients were 76.9 ± 6.2 (64-86) years. There was no early mortality. The technical success was 100%. In total, 18 thoracic endografts were deployed in 16 patients for thoracic aortic pathologies. Follow-up period was 21.85 ± 8.96 months, and in the follow-up period, two patients had a secondary intervention. One cardiac and one coronavirus disease 2019 mortality was detected in the follow-up period. There was no aneurysm-related mortality. The postoperative first-year survival was 84.6 ± 10.0. Simultaneous endovascular solution for complex multisegmented aortic pathologies provides a rapid, less-invasive approach with successful early and midterm morbidity, mortality with short intensive care unit period, and length of hospital stay. A combination of endovascular aortic aneurysm repair and thoracic endovascular aortic repair where anatomic suitability exists is a strong alternative over staged and hybrid therapies. Contrast-induced nephropathy, postimplantation syndrome, and spinal cord ischemia should be carefully monitored with this strategy.

Abstract Number ‐ 115: A Case of Post‐Pipeline Headache : New Post‐Flow Diversion Headaches for Intracranial Aneurysm

Introduction Flow diversion using devices such as the “pipeline” stent is now a common treatment for unruptured intracranial aneurysms. Though much is known about the efficacy of the device, less is reported regarding potential side effects. We aimed to describe a case of giant aneurysm with new onset and severe headache Post‐ Pipeline flow diversion stent application. Methods A 70‐year‐old female patient was admitted to the neurology outpatient clinic with complaints of diplopia and drooping of the left eyelid that started three months ago. Neurological examination revealed decreased visual acuity and total ophthalmoplegia in the left eye. In neuroimaging,semi‐thrombosed aneurysm, 20*25*20 mm in size, compressing the optic nerve and cavernous structures was observed in the left internal carotid artery cavernous segment. In digital subtraction angiography, a narrow neck, 20*25*22 mm giant aneurysm was observed in the left ICA C4 segment in three‐dimensional imaging. In premedication, were started seven days ago acetylsalicylic acid 100 mg 1*1 and 48 hours ago ticagrelol 2*90 mg and Pipeline 4.25*30 mm flow diverter was applied to cover the aneurysm neck under general anesthesia. One day after the procedure, the patient developed a new headache behind the left eye, throbbing, sensitive to sound and light, unresponsive to paracetamol and non‐steroidal anti‐inflammatory agents.In contrast‐enhanced cranial MRI, an aneurysm causing a central thrombosed hypointense mass effect was observed in the left cavernous structure neighbor with a peripheral enhanced, hyperintense T2 Flair sequence compatible with peripheral vasogenic edema. Pulse 1 gram/day steroid treatment was applied to the patient for three days.The patient’s headache completely regressed at the end of the third month, and perianeurysmal inflammation disappeared in the same contrast‐enhanced cranial MRI.In the 12th month post‐procedure imaging of the patient, it was observed that the aneurysm was completely occluded. Results In the case, we reporta patient with neurologic worsening after flow‐diverter treatment for unruptured cerebral aneurysms. We found MR imaging evidence of perianeurysmal brain inflammation after the therapeutic thrombosis of the sac to be the main cause explaining clinical aggravation. Consequently, we may consider a perianeurysmal brain inflammation when encountering the association of a postprocedure headache with an increase in previous compressive signs, possibly associated with MR imaging signs of inflammation1,2. We tried pulse steroid therapy, which is accepted as the first‐line treatment for postimplantation syndrome after endovascular repair of aortic aneurysms in the literature for a patient who did not respond dramatically to nonsteroidal anti‐inflammatory therapy3.We experienced a significant improvement in the patient’s clinical findings and contrast‐enhanced MRI findings after steroid treatment. Conclusions An inflammatory reaction may aggravate, transiently, clinical symptoms after aneurysm treatment with a flow‐diverter device. Further research is needed to better understand the underlying mechanisms as well as to achieve better prevention strategies.

Post-Implantation Syndrome Occurs More Often After f/bEVAR and IBD Procedures Than After Standard EVAR

Post-Implantation Syndrome Occurs More Often After f/bEVAR and IBD Procedures Than After Standard EVAR

Impact of Frozen and Conventional Elephant Trunk on Aortic New-Onset Thrombus and Inflammatory Response.

(1) Aim: The primary endpoint of this study was to evaluate the impact of frozen elephant trunk (FET) and conventional elephant trunk (CET) on aortic mural thrombus. The secondary endpoint was to investigate the incidence of persistent inflammatory response (IR) in the form of post-implantation syndrome (PIS) or persistent fever without infection focus after FET and CET, respectively, as well as the risk factors associated with its occurrence. (2) Methods: A single-center, retrospective, observational study of 57 consecutive patients treated with FET and CET between April 2015 and June 2020 was performed. Demographics, procedural data, perioperative laboratory exams as well as vital parameters were recorded. Pre- and postoperative computer tomography angiography (CTA) scans were analyzed with a dedicated software. IR was defined as the presence of continuous fever (>38°, lasting > 24 h) and leukocytosis (white blood cell count > 12 × 1000/µL) developing after surgery in the absence of an infection focus. (3) Results: Fifty-seven consecutive patients (mean age 58.4 ± 12.6 years, 36.8% females) treated with FET (66.6%) or CET (33.3%) for acute aortic dissection (56.1%), post-dissection-aneurysm (19.2%) or aortic aneurysm (24.5%) were included. The median thrombus volume on CTA preoperatively was 10.1 cm3 (range 2–408 cm3). After surgery, the median new-onset mural thrombus was 9.7 cm3 (range 0.2–376 cm3). Nineteen (33.3%) patients developed IR; patients with IR were significantly younger (p = 0.027), less frequently of female gender (p = 0.003) and more frequently affected from acute dissection (p = 0.002) and stayed in the intensive care unit (ICU) significantly longer (p = 0.033) than those without IR. Postoperatively, the volume of new-onset thrombus was significantly greater in the IR group (84.4 vs. 3.2 cm3, p < 0.001). (4) Conclusions: In the context of CET and FET, the persistent inflammatory response occurred in 33.3% of the patients with persistent fever without infection focus. IR was associated with a higher volume of new-onset thrombus and significantly prolonged ICU stay. Further studies to investigate these observations are needed.

Impact of the underlying aortic pathology on postimplantation syndrome after endovascular thoracic aortic repair.

Thoracic endovascular aortic repair (TEVAR) is the treatment option of choice for almost all pathologies of the descending thoracic aorta. The aim of the present study was to determine the impact of aortic pathology on the occurrence of postimplantation syndrome (PIS) after TEVAR. Seventy-four patients undergoing TEVAR for aortic dissection (TAD, 25), aortic aneurysm (TAA, 26), and aortic rupture or perforated ulcer (TAR/PAU, 23) were included in this retrospective study. The clinical outcome measures were persistent inflammation at hospital discharge and in-hospital mortality. PIS was assessed in 22.97% of all patients, predominantly in the TAD group (P=0.03). CRP increased after TEVAR (156.6±94.5, P<0.001; 108.1±57.7, P<0.01 and 117.8±70.4, P<0.05) vs. baseline (58.1±77.5, 31.94±52.1 and 31.9±52.1 mg/L, in TAD, TAA and TAR/PAU, respectively) and this increase was more accentuated in TAD group (P<0.05). Stent-length was similar in all groups (P=0.226) but correlated with postoperative CRP only in TAD (R=0.576, P=0.013). Fresh parietal thrombus correlated with CRP (R=0.4507, P=0.0005) and is (OR=1.0883, P=0.0001), together with the pathology of aortic dissection (OR=6.2268, P=0.0288), a predictor of PIS after TEVAR. Whereas mortality (5.4%) did not correlate with PIS (P=0.38) either with aortic pathology (P=0.225), hospital stay after TEVAR was significantly prolonged by PIS (P=0.03). Aortic dissection is associated with more inflammation after TEVAR than aortic aneurysm, rupture or perforated ulcer, with the amount of fresh parietal thrombus playing the most significant role in the occurrence of PIS. Importantly, PIS prolongs hospital stay but not mortality after TEVAR.

Fever Management after TEVAR in Patients with Aortic Dissection.

Post-implantation syndrome (PIS) is characterised as a noninfectious continuous fever and a concomitant rise in inflammatory markers shortly after thoracic endovascular aortic repair (TEVAR). This current study aims to analyse the risk factors of PIS, postoperative major adverse cardiac events (MACE), and overall survival as well as the correlation between new-onset mural thrombus and the risk of developing PIS after TEVAR in patients with type B aortic dissection (TBAD). Patients were included who had a B dissection, both acute and chronic forms. In the acute form, both acutely complicated and uncomplicated patients were included in the study. A main point of our investigation is the postoperative fever management of PIS patients. A total of 90 patients with type B dissection underwent TEVAR in the University Hospital of Muenster between 2016 and 2020. The occurrence of PIS was defined as the presence of fever (>38°C lasting longer than 24 hours in hospital) and leucocytosis (white blood cell count >12000/µL). Patients with other possible reasons for fever and/or leucocytosis, such as a urinary tract infection (UTI), pneumonia, or sepsis, were excluded beforehand. Besides demographic and operation-related data, inflammatory markers and therapeutic measures were evaluated before and 5 days postoperatively. Computed tomography scans were examined to calculate the volume of preexistent and new-onset mural thrombus after TEVAR. Of 90 patients, 40 patients were excluded because of recent infection or bypass surgery. Of the 50 patients included in the study, 10 patients developed post-implantation syndrome. Younger patients significantly more often developed PIS after TEVAR (52.2±11.6 vs. 61.5±13.6, p=0.045). New-onset thrombus after TEVAR was significantly higher in PIS patients (61cm³ vs. 12cm³, p<0.001) and PIS patients often received more medical examinations (investigation of X-ray, U status, and blood cultures). There was no significant difference in overall survival for 40 months and in the incidence of MACE. PIS may be related to an increased rate of new-onset thrombus. A more robust conclusion is not justified according to our study. There is no difference in overall survival.

Systemic Inflammatory Response and Delayed Thrombocytopenia Following Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

Postimplantation syndrome following endovascular aneurysm repair (EVAR) is a known entity which presents within the 1st week of EVAR. The symptoms include fever, leukocytosis, and elevated C-reactive protein. Although the pathogenesis is unknown, it resolves within a 5 days. This case report involves elaborating on delayed onset inflammatory response in the 3rd week following EVAR when the patient developed thrombocytopenia which went as low as 55,000/μL. It resolved gradually with supportive measures and systemic steroids.

Incidence and risk factors of postimplantation syndrome after elective endovascular aortic aneurysm repair.

Postimplantation syndrome (PIS) represents an acute phase systemic inflammatory response following endovascular aortic aneurysm repair (EVAR). Our objective was to investigate the risk factors associated with the manifestation and severity of PIS with various available stent-grafts. We performed a retrospective analysis of prospectively collected data covering the period 2016-2020. The study included 191 patients. Body temperature was recorded regularly and blood sample was obtained daily. The imaging protocol included computed tomography aortoiliac angiography before surgery and one month after. The volumes of pre-existing and new-onset mural thrombus were calculated in a semi-automated fashion. Five abdominal aortic stent-graft devices were used: Endurant™ ΙΙ, Anaconda™, Treo®, E-tegra® and AFX® 2. Subgroup analysis was performed between woven polyester and ePTFE lined devices. The incidence of PIS was 21.5%. No significant differences were observed regarding demographics, risk factors, aneurysm anatomy or operative data. The amount of pre-existing and new-onset mural thrombus were not related with PIS (P=0.117 and P=0.096). PIS incidence in the polyester subgroup was 24.2%, significantly higher compared to 8.3% in the ePTFE subgroup. In-subgroup analysis revealed that the use of Anaconda™ was associated with the higher frequency (61.1%, P=0.021). Multivariate logistic regression showed that polyester was the single factor significantly associated with PIS (hazard ratio=2.6, P=0.043), as opposed to the new onset thrombus (hazard ratio=1.29, P=0.101). PIS is not uncommon and should be taken into consideration in patients presenting with fever after EVAR. The endograft's liner material seems to play the primordial role, with woven polyester to be attributed with significantly higher incidence.

COMPONENTS OF BODY QUALITY: THE ROLE OF RADIOLOGY

The aim of the work is to refine the concept of body quality and identify the components of body quality based on medical imaging information technologies. Variant anatomy. Transposition of internal organs. Circle of Willia. Body composition: fat, muscle and bone components of the body. Brown adipose tissue and positron emission tomography. Sarcopenia and musculoskeletal index at the level of the body of the third lumbar vertebra. Pathophysiological mineralization of the body. Heterotopic osification. Prostatoliths, ophthalmoliths, pulmoliths, sialoliths, dentoliths, rhinoliths, calcifications of the coronary arteries, atherosclerotic plaques, calcifications of the diaphragm of the Turkish saddle, basal ganglia, walls of the internal carotid artery and basilar. Endoecology of the human body. Consideration of the negative (perioperative, long-term) consequences of procedures for improving the quality of the body by endoprosthetics of organs. Maxillary post-implantation syndrome. Bone metallosis and bone cement implantation syndrome. Augmentation mammoplasty. Deposition of nano- and macroplastics. Aging is an integral result of changes in the quality of the body and its functioning. Biohacking is practically an activity to improve the quality of the body and its functions. Possible monetization of the concept of body quality is shown on the example of the dentoalveolar system within the framework of voluntary health insurance.

Stroke, spinal cord ischemia and upper limb ischemia in patients undergoing TEVAR with coverage of the left subclavian artery: a case series study

BackgroundWe performed routine spinal fluid drainage for patients who underwent TEVAR for thoracic aortic pathology together with left subclavian artery coverage, which was needed for achievement of a safe proximal sealing zone. We assessed the occurrence of spinal cord ischemia as well the rate of occurrence of other complications such as stroke, and upper limb ischemia.ResultsThis was a case series study done between July 2014 and April 2020, in them all the left subclavian artery was covered to ensure a proximal safe seal zone. Routine spinal fluid drainage was done, keeping the spinal fluid pressure < 10–15 mmHg with catheter in place for 48 h. Data was obtained from twenty-three patients who underwent TEVAR for thoracic aortic dissection (73.91%), thoracic aortic aneurysm (21.74%), or ulcer (4.35%). Planning was based upon multi-slice computed tomographic angiography and covering the left subclavian was mandatory to achieve a proximal sealing zone. Technical success was achieved in 100% of cases. 4.35% of patients had three endograft, 56.52% had two endografts, 39.13% had one endograft. All patients lost their radial pulsations immediately after implantation, 8.70% developed post implantation syndrome(fever) that was managed conservatively, 4.35% developed stroke related to the anterior circulation, 4.35% developed signs of spinal cord ischemia. During the follow up, one patient died within 6 h after the procedure due to extensive myocardial infarction (patient was scheduled for CABG after our procedure). 17.40% developed upper limb symptoms that were tolerable and were managed conservatively.ConclusionBy adopting routine spinal cord drainage and pressure monitoring, we can consider not to revascularize the left subclavian artery prior to TEVAR if it will be covered.