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International Angiology 2022 Feb 09

DOI: 10.23736/S0392-9590.22.04759-9


language: English

Incidence and risk factors of post implantation syndrome after elective endovascular aortic aneurysm repair

Dimitrios A. CHATZELAS , Apostolos G. PITOULIAS, Zisis C. TELAKIS, Thomas E. KALOGIROU, Maria D. TACHTSI, Dimitrios C. CHRISTOPOULOS, Georgios A. PITOULIAS

Division of Vascular Surgery, G. Gennimatas, Second Department of Surgery, School of Health Sciences, Faculty of Medicine, Thessaloniki General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece


BACKGROUND: Post implantation 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.
MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected data covering the period 2016 - 2020. 191 patients were included. 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 semiautomated 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.
RESULTS: The incidence of PIS was 21.5%. No significant differences were observed regarding demographics, risk factors, aneurysm anatomy or operative data. The amount of preexisting 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).
CONCLUSIONS: 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.

KEY WORDS: Endovascular aortic aneurysm repair; Post implantation syndrome; Systematic inflammatory response; Stent-graft

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